射血分数保留型心力衰竭的病理生理及治疗药物进展

Advances in pathophysiology and therapeutic drugs of heart failure with preserved ejection fraction

射血分数保留型心力衰竭在心力衰竭中占40%~71%,是一种涉及心、肾、肺、血管系统和脂肪组织等的多系统疾病,严重影响患者的生活水平。近年来,随着医疗研究水平不断提升,射血分数保留型心力衰竭临床治疗取得一定的效果,但患者仍然存在预后不良情况,复发率升高而生活质量下降。文章通过对射血分数保留型心力衰竭近年国内外相关研究报道进行综述,发现其病理生理机制主要与高血压、冠脉疾病和冠脉微血管功能障碍、左心功能不全、右心室功能障碍和肺动脉疾病、激素系统异常、肥胖、系统性炎症和代谢异常相关,通常使用利尿剂、RAAS抑制剂、SGLT2is、MRA和他汀类药物进行治疗,不同分型的动物模型的构建也为射血分数保留型心力衰竭临床诊治提供一些有价值参考。

Heart failure with preserved ejection fraction accounts for 40%-71%of heart failure,is amultisystem disease involving the heart,kidneys,lungs,vascular system and adipose tissue,and seriously affects patients’quality of life.Recently,with the continuous improvement of medical research,its clinical treatment has achieved certain effects,but the prognosis of patients is still poor,the recurrence rate is increased and the quality of life is decreased.This article reviews the recent domestic and foreign research reports on heart failure with preserved ejection fraction,and finds that its pathological and physiological mechanisms are mainly related to hypertension,coronary artery disease and coronary microvascular dysfunction,left ventricular insufficiency,right ventricular dysfunction and pulmonary artery disease,abnormal hormone system,obesity,systemic inflammation and metabolic abnormality.Diuretics,renin-angiotensin-aldosterone system(RAAS)inhibitors,sodium-glucose cotransporter-2 inhibitor(SGLT2i),mineralocorticoid receptor antagonist and statins are usually used for treatment.The construction of animal models of different types is expected to provide some valuable references for the clinical diagnosis and treatment of heart failure with preserved ejection fraction.