弥漫性心肌纤维化诊治进展

Progress in Diagnosis and Treatment of Diffuse Myocardial Fibrosis

在许多慢性心脏病中,由于胶原纤维在整个心肌过度沉积而导致弥漫性心肌纤维化。这种损伤是由于成纤维细胞对原纤维胶原周转调节的改变,促进心肌间质和心肌内血管周围I型和III型胶原纤维的过度沉积。现有证据表明,除了纤维沉积的程度外,胶原成分和纤维的物理化学性质也与弥漫性心肌纤维化对心力衰竭患者心脏功能和临床结果的有害影响有关。研究结果表明,心力衰竭患者存在弥漫性心肌纤维化的各种临床病理表型。本篇综述中,主要总结了目前关于心力衰竭中弥漫性心肌纤维化的机制、目前可用的和潜在的未来治疗策略,旨在个性化地预防和逆转心力衰竭患者弥漫性心肌纤维化。

In many chronic heart diseases, diffuse myocardial fibrosis is caused by excessive deposition of col-lagen fibers throughout the heart muscle. This injury is due to the altered regulation of collagen turnover by fibroblasts, which promotes excessive deposition of type I and III collagen fibers in the myocardial interstitium and perivascular myocardium. The available evidence suggests that in ad-dition to the extent of fiber deposition, collagen composition and the physicochemical properties of fibers are also associated with the detrimental effects of diffuse myocardial fibrosis on cardiac func-tion and clinical outcomes in patients with heart failure. The results show that patients with heart failure have various clinicopathological phenotypes of diffuse myocardial fibrosis. In many chronic heart diseases, diffuse myocardial fibrosis is caused by excessive deposition of collagen fibers throughout the heart muscle. In this review, we summarize the current mechanisms of diffuse my-ocardial fibrosis in heart failure, current available and potential future treatment strategies, and aim to personalize the prevention and reversal of diffuse myocardial fibrosis in patients with heart failure.