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射血分数保留的心力衰竭常见合并症的病理机制及治疗策略

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射血分数保留的心力衰竭(HFpEF)的病理生理机制尚未明确,目前认为与肾素-血管紧张素-醛固酮系统、晚期糖基化终末产物及其受体、冠状动脉微血管炎症等介导的细胞自噬、氧化应激、炎症反应及心脏能量代谢障碍等相关。高血压、糖尿病、冠心病、心房颤动等均可通过各种信号途径导致左心室心肌僵硬度增加、舒张期充盈受损等病理改变,最终导致HFpEF的发生。目前研究显示能够改善HFpEF预后的药物主要为钠-葡萄糖共转运蛋白2抑制剂,而射血分数降低的心力衰竭的治疗手段也并不适用于HFpEF,故通过对HFpEF合并症进行早期预防及治疗,以控制HFpEF的发生发展显得尤为重要。现从HFpEF常见合并症的病理机制及治疗等方面进行归纳,以期为HFpEF的临床治疗提供借鉴和指导。
Pathophysiology and Treatment Strategies of Comorbidities in Heart Failure with Preserved Ejection Fraction
The pathophysiological mechanisms of heart failure with preserved ejection fraction(HFpEF)are not yet fully understood.It is currently believed to be associated with cellular autophagy mediated by the renin-angiotensin-aldosterone system,advanced glycation end products-receptor for advanced glycation end products,coronary microvascular inflammation,oxidative stress,inflammatory response,and cardiac energy metabolism disorder.Hypertension,diabetes,coronary artery disease,and atrial fibrillation can lead to increased left ventricular myocardial stiffness and impaired diastolic filling through various pathways,promoting HFpEF.Current studies have shown that the drugs which can improve the prognosis of HFpEF are mainly sodium-glucose cotransporter 2 inhibitor,and the treatment of heart failure with reduced ejection fraction is not applicable to HFpEF,so it is important to control the development of HFpEF by early prevention and treatment of its comorbidities.This paper reviews the pathological mechanisms and treatment of the common comorbidities of HFpEF to help the clinical management of HFpEF.

Heart failure with preserved ejection fractionHypertensionDiabetes mellitusPathological mechanismTreatment guidelines

张啸、刘剑刚

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中国中医科学院西苑医院国家中医临床心血管病医学研究中心,北京 100091

中国中医科学院研究生院,北京 100700

射血分数保留的心力衰竭 高血压 糖尿病 病理机制 治疗方针

中央本级重大增减支项目

2060302

2024

心血管病学进展
成都市心血管病研究所,成都市第三人民医院

心血管病学进展

CSTPCD
影响因子:0.932
ISSN:1004-3934
年,卷(期):2024.45(2)
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