射血分数保留的心力衰竭合并抑郁的临床治疗进展

Progress in Clinical Treatment of Heart Failure with Preserved Ejection Fraction Combined with Depression

射血分数保留的心力衰竭(HFpEF)是心力衰竭(HF)的一种常见类型,由于其病理生理机制不同,以往将针对射血分数减低的心力衰竭(HFrEF)的治疗方法应用于HFpEF患者的疗效并不理想,以致患者预后差、病死率高。抑郁是由各种原因引起的、以明显而持久的情绪低落为主要临床特征的一类常见的精神心理疾病。抑郁患者常伴有不同程度的认知和行为改变,病情严重者甚至会出现自伤、自杀行为。随着对HFpEF的深入研究,人们发现抑郁已成为HFpEF常见的合并症之一,且两者的相互作用可导致患者预后不良。目前有关HFpEF合并抑郁的研究表明,部分药物可改善此类患者短期症状及临床预后。本文通过总结、归纳HFpEF合并抑郁的共病机制、研究现况及相关治疗的最新进展,发现钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂、血管紧张素受体脑啡肽酶抑制剂(ARNI)、他汀类药物在治疗HF及精神心理领域方面扮演着重要角色,不仅能改善HFpEF患者心功能及其预后,还具有抗抑郁的效果,能为临床研究及治疗提供参考。

Heart failure with preserved ejection fraction(HFpEF)is a common type of heart failure(HF),and previous treatments that primarily target heart failure with reduced ejection fraction(HFrEF)do not benefit the patients with HFpEF because of the differences in their pathophysiological mechanisms,resulting in high mortality and poor prognosis.Whereas depression is one of the most common mental and psychological problems,caused by various reasons and characterized by a pronounced and long-lasting low spirits,with various degrees of cognitive and behavioral changes.Those who are severely ill even present self-injurious and suicidal behavior.With intensive research into HFpEF,it has emerged that depression has become one of the most common comorbidities in HFpEF and that the two interact to contribute to poor prognosis for patients.Currently,relevant studies in HFpEF with depression suggested that some drugs could improve short term symptoms and clinical prognosis in such patients.This paper aimed to review the comorbid mechanism,research status and the latest progress of related treatment of HFpEF complicated with depression.It is found that sodium glucose cotransporter 2(SGLT2)inhibitors,angiotensin receptor enkephalinase inhibitors(ARNI)and statin drugs play important roles in the field of HF and psychophysiology.They can not only improve the cardiac function and prognosis of HFpEF patients,but also have the effect of anti-depression,thus to provide references for clinical study and treatment.