Wong Aaron K F, AlZadjali Matlooba A, Choy Anna-Maria J, Lang Chim C
Division of Medicine and Therapeutics, University of Dundee and Medical School, Dundee, UK.
Cardiovasc Ther. 2008 Fall;26(3):203-13. doi: 10.1111/j.1755-5922.2008.00053.x.
There is increasing evidence to suggest that chronic heart failure (CHF) is an insulin resistant (IR) state and that the degree of IR correlates with the severity and mortality of CHF. The pathophysiology of IR in CHF has yet to be fully defined. Additionally, it remains to be determined if IR is merely a marker reflecting the severity of CHF or whether it contributes to the disease in CHF. If IR is truly a culprit that worsens CHF, it will potentially be a new target for therapy as strategies that can reverse IR in CHF may potentially result in an improvement in symptoms and even mortality in these patients. However, there are concerns regarding the use of certain insulin sensitizers, most notably, the thiazolidinediones (TZDs) which have been associated with increased risk of hospitalizations for CHF. Despite previous concerns of lactic acidosis (LA), there is now evidence that metformin may not only be safe but could potentially be useful in the setting of CHF. There are now ongoing prospective studies, including the TAYSIDE study, to determine if reversing IR with metformin will have beneficial effects in patients with CHF.
越来越多的证据表明，慢性心力衰竭（CHF）是一种胰岛素抵抗（IR）状态，且IR的程度与CHF的严重程度和死亡率相关。CHF中IR的病理生理学尚未完全明确。此外，IR仅仅是反映CHF严重程度的一个标志物，还是对CHF疾病有影响，仍有待确定。如果IR确实是使CHF恶化的罪魁祸首，那么它可能成为一个新的治疗靶点，因为能够逆转CHF中IR的策略可能会改善这些患者的症状甚至降低死亡率。然而，对于某些胰岛素增敏剂的使用存在担忧，最显著的是噻唑烷二酮类药物（TZDs），它们与CHF住院风险增加有关。尽管之前担心乳酸酸中毒（LA），但现在有证据表明二甲双胍不仅可能是安全的，而且在CHF情况下可能有用。目前正在进行前瞻性研究，包括泰赛德研究，以确定用二甲双胍逆转IR是否会对CHF患者产生有益影响。
