沙库巴曲/缬沙坦在甲亢性心脏病的防治作用

Effect of sacubitril/valsartan on the prevention and treatment of hyperthyroid heart disease

甲亢性心脏病心室重构是由于血液循环中超生理量的三碘甲状腺原氨酸(T3)长期作用于心脏及血管,导致心脏基因改变、血流动力学改变、心肌炎症反应、肾素-血管紧张素-醛固酮(RAAS)及交感神经系统(SNS)的过度激活,最终引起心肌病理性肥厚、心室重构,继而发生心力衰竭,是甲亢死亡的主要原因。近年来,沙库巴曲/缬沙坦(ARNI)在治疗各种类型的心力衰竭、预防心室重构等领域取得重要突破;但在甲亢性心室重构及心衰的治疗中,尚无明确证据表明早期应用ARNI可以获益,本文对相关研究进行综述。

Hyperthyroid heart failure is caused by the long-term attack of an excessive physiological quantity of triiodothyronine(T3)in the blood circulation on the blood vessels and heart,leading to cardiac gene alterations,hemodynamic modifications,myocardial inflammatory reactions,exorbitant activation of the renin-angiotensin-aldosterone system(RAAS)and sympathetic nervous system(SNS).It will at length bring about pathological hypertrophy of myocardium,ventricular remodeling,and then heart failure;It is the main indue of death in hyperthyroidism patients.In recent years,significant breakthroughs have been made by sacubitril/valsartan(ARNI)in the fields of stopping ventricular remodeling and treating various types of heart failure.However,there is no clear and definite testimony that early-stage use of ARNI in the treatment of hyperthyroid heart failure can get a profit.This paper will review the etiopathogenesis of hyperthyroid heart failure and ARNI’s feasibility in treating this disease.