Palmieri Emiliano A, Biondi Bernadette, Fazio Serafino
Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italia.
Heart Fail Rev. 2002 Apr;7(2):205-19. doi: 10.1023/a:1015336831407.
Mounting evidence suggests that increased circulating aldosterone levels, despite angiotensin-converting-enzyme inhibitors therapy, may exert deleterious cardiovascular effects in heart failure, leading to clinical deterioration and poor prognosis. In the past decades, a number of experimental investigations have provided major insight into the mechanism(s) of action and the biological effects of aldosterone on the cardiovascular system, indicating that aldosterone participates in the structural and functional remodeling of cardiac and vascular tissue. In particular, it has emerged that aldosterone plays a key role in the regulation of myocardial extracellular matrix composition and endothelial function with important pathophysiological implications. Such evidence, coupled with the recent beneficial effects of spironolactone, a competitive aldosterone receptor antagonist, in reducing cardiac mortality and morbidity in patients with severe chronic heart failure treated with angiotensin-converting-enzyme inhibitors and loop diuretics, highlights the importance of aldosterone in the pathophysiology of human heart failure. The purpose of this review is to provide an overview of the regulation of aldosterone production and metabolism in heart failure, the basic mechanism of aldosterone action, and the pathophysiological implications of aldosterone in heart failure, and to discuss recent evidence supporting the efficacy of aldosterone receptor blockade in the treatment of chronic heart failure in humans.
越来越多的证据表明，尽管使用了血管紧张素转换酶抑制剂治疗，但循环中醛固酮水平升高可能会对心力衰竭患者产生有害的心血管影响，导致临床病情恶化和预后不良。在过去几十年中，大量实验研究对醛固酮在心血管系统中的作用机制和生物学效应提供了重要见解，表明醛固酮参与心脏和血管组织的结构和功能重塑。特别是，已发现醛固酮在调节心肌细胞外基质组成和内皮功能方面起关键作用，具有重要的病理生理学意义。这些证据，再加上最近一种竞争性醛固酮受体拮抗剂螺内酯在降低接受血管紧张素转换酶抑制剂和襻利尿剂治疗的重度慢性心力衰竭患者的心脏死亡率和发病率方面的有益作用，凸显了醛固酮在人类心力衰竭病理生理学中的重要性。本综述的目的是概述心力衰竭中醛固酮产生和代谢的调节、醛固酮作用的基本机制、醛固酮在心力衰竭中的病理生理学意义，并讨论支持醛固酮受体阻滞剂治疗人类慢性心力衰竭疗效的最新证据。
