心肾间交互作用与急性心力衰竭时肾功能恶化的关系

Relationship between Heart-kidney Interaction and Renal Function Deterioration in Patients with Acute Heart Failure

在生理过程中,心脏和肾脏协同工作、相互补充和代偿另一个器官的功能,是维持循环系统稳定性最重要的两个器官。此时,两个器官中任何一个功能改变,势必影响另一个器官。这种稳定性的维持十分复杂,涉及对心肾功能间的精细调节和神经内分泌活性的控制,包括利钠肽家族、肾素-血管紧张素-醛固酮系统和交感神经系统。一个器官的功能损害或疾病可以引发、加重或直接参与另一个器官的功能损害和疾病进程,并形成恶性循环(互害)。另外,心肾间的相互作用还受到一些疾病或危险因素的共同作用,包括老化、高血压、糖尿病、动脉粥样硬化等(共病)。仅以动脉硬化为例,老化的机械应力引起的大动脉硬化本身就可以独立参与两个器官功能损害和疾病发生。然而,在进展期肾病中,血流动力学和神经内分泌的稳定性遭到破坏,容量负荷和压力负荷明显增加,心肾损伤的风险增大。与此同时,一些药物的清除和代谢也受到影响。所有这些因素对心肾疾病的共存埋下隐患,老年人尤为明显。当两类疾病共存时,病理损害效应显著放大,预示着不良预后,药物治疗需谨慎。因此,心肾疾病预防及诊疗一体化的理念,需要广泛地推广和普及。

In the physiological process,the heart and kidney work together,complement and compensate for the function of the other organ,and they are the two most important organs in maintaining the stability of the circulatory system. At this point,the other organ is bound to be affected if the function of any of the two organs changes. The maintenance of this stability is very complex and involves the fine regulation between cardiac and renal functions and the control of neuroendocrine activity,including the natriuretic peptide family,rennin angiotensin aldosterone system and sympathetic nervous system. The dysfunction or diseases of an organ can cause,aggravate,or directly participate in the functional damage and disease progression of another organ and form a vicious circle（ mutual damage）. In addition,the interaction between the heart and kidney is also affected simultaneously by some diseases or risk factors, including aging, hypertension, diabetes, atherosclerosis, etc.（ co-morbidity）. Only taking arteriosclerosis as an example, the large arteriosclerosis itself caused by the changes of the aging mechanical stress can independently involved in the occurrence of dysfunction and disease of the two organs. However,in the progressive stage of nephropathy,the stability of hemodynamics and neuroendocrine is damaged,the capacity load and pressure load increases significantly,and the risk of heart and kidney injury increases. At the same time,some of the drug clearance and metabolism are also affected. All these factors contribute to the risk of the coexistence of heart and kidney diseases,especially in the elderly. When the two kinds of disease coexist,the effect of pathological damage will significantly enlarge,which indicates a poor prognosis, and medication should be cautious. Therefore, the concept of prevention of heart and kidney disease and integration of diagnosis and treatment needs to be extensively promoted and popularized.