心力衰竭的治疗进展

Progress in Treatment of Heart Failure

心力衰竭是各种心血管疾病终末阶段的临床综合征,患病率高,预后不佳,是危害人类健康的第一杀手。心力衰竭传统治疗药物至今仍是心力衰竭治疗的基石,主要包括利尿剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂和盐皮质激素受体拮抗剂。目前,新型抗心力衰竭药物主要有伊伐布雷定、沙库比曲/缬沙坦以及托伐普坦等,另有部分药物仍在研发阶段,且临床获益已日趋明显。干细胞疗法作为新的心力衰竭治疗策略,其需求量大,可见心力衰竭再生疗法具有巨大潜能。迄今为止,心力衰竭基因靶点检测仍未有重大突破,基因靶向治疗尚未实现;器械治疗作为心力衰竭尤其是难治性心力衰竭的重要治疗手段,在临床中的应用亦日趋成熟,但远期安全性仍有待证实。

Heart failure is a clinical syndrome in the terminal stages of various cardiovascular diseases.It has a high prevalence and poor prognosis and is the first killer of human health.Traditional medicines for heart failure mainly include diuretics,angiotensin converting enzyme inhibitors/angiotensinⅡ receptor blockers,β blockers and mineralocorticoid receptor antagonists,which are still the cornerstones of heart failure treatment.Nowadays,new medicines for heart failure on the market mainly include ivabradine,sakubitril/valsartan and tolvaptan,and some new medicines are still in the research and development stage,and their clinical benefits have become increasingly obvious.Stem cell therapy,as a new treatment strategy for heart failure,is in great demand and has great potential in the development of heart failure regenerative therapy.There has been no major breakthrough in the detection of heart failure gene targets,so the path of gene targeting therapy is still very long;device therapy has become an important treatment for heart failure,especially for refractory heart failure,and its clinical application is becoming more mature,but the long-term safety remains to be validated.