糖尿病是最常见的代谢性疾病之一.糖尿病不仅会损害心血管结构与功能,还会显著增高罹患心力衰竭的风险,且独立于冠心病、高血压和心脏瓣膜疾病等传统危险因素,其导致心力衰竭的风险提高2.5～3.0倍.在糖尿病患者中,心力衰竭的发生率极高,并会显著影响患者的预后.根据左心室射血分数(left ventricular ejection fraction,LVEF)的具体数值表现,心力衰竭可分为射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)、射血分数受损的心力衰竭(heart failure with reduced ejection fraction,HFrEF)和射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF),其中HFpEF约占心力衰竭病例的50%.目前,糖尿病合并HFpEF患者的诊治仍面临许多挑战,其病理生理机制复杂,而有效的针对性药物也尚在开发中.系统总结糖尿病合并HFpEF的病理生理学特征、生物标志物的意义及治疗方法的进展,可为临床实践提供理论支持.
Clinical research progress in diabetes mellitus combined with heart failure with preserved ejection fraction
Diabetes mellitus(DM)is one of the most common metabolic diseases.It not only damages cardiovascular structure and function but also significantly increases the risk of heart failure(HF),independently of traditional risk factors such as coronary heart disease,hypertension,and valvular heart disease,raising the risk by 2.5-3.0 times.Among patients with diabetes,the incidence of HF is notably high and has a significant impact on prognosis.Based on left ventricular ejection fraction(LVEF),HF can be classified into heart failure with preserved ejection fraction(HFpEF),heart failure with reduced ejection fraction(HFrEF),and heart failure with mid-range ejection fraction(HFmrEF),with HFpEF accounting for approximately 50%of HF cases.Currently,the diagnosis and treatment of HFpEF in diabetic patients face numerous challenges due to its complex pathophysiological mechanisms,and effective targeted drugs are still under development.This review systematically summarizes the pathophysiological characteristics,significance of biomarkers,and treatment progress of diabetes combined with HFpEF through a review of multiple clinical studies and the latest clinical trial results,providing theoretical support for clinical practice.
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