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[心力衰竭治疗的新进展]

[Novelties in the treatment of heart failure].

作者信息

Souček Filip, Novak Jan

出版信息

Vnitr Lek. 2017 Spring;63(4):255-264.

Abstract

Heart failure (HF) is a complex clinical syndrome which is manifested by characteristic symptoms and objective signs of cardiac insufficiency. The incidence of HF, particularly its chronic form, is estimated 0.4-2 % in the central and western Europe, with an increase in higher age groups, affecting 10-20 % of the population aged over 80. With respect to its growing incidence and prevalence, novel modalities of pharmacological and non-pharmacological treatment are being developed in order to improve quality of life and survival of the affected patients. This review based on up-to-date guidelines focuses in the first part on brief description of the possibilities of diagnosing heart failure, including the novelties arising out from the latest clinical and preclinical studies (such as soluble ST2, FSTL1, etc), further it concentrates on innovations in pharmacological treatment of chronic (ivabradine, ARNI, gliflozins) and acute (ularitide, serelaxin, nesiritide) HF. The last part provides an overview of available non-pharmacological HF therapeutics options (modulation of cardiac contraction, influencing the activity of sympathetic and parasympathetic nervous systems and permanent and temporary device support).Key words: ARNI - ECMO - gliflozins - heart failure - modulation of sympathetic and parasympathetic nervous systems - sacubitril-valsartan - therapy.

摘要

心力衰竭(HF)是一种复杂的临床综合征,表现为心脏功能不全的特征性症状和客观体征。在中欧和西欧,HF的发病率,尤其是其慢性形式的发病率估计为0.4%-2%,且在较高年龄组中有所增加,80岁以上人群中10%-20%受其影响。鉴于其发病率和患病率不断上升,正在开发新的药物和非药物治疗方式,以提高受影响患者的生活质量和生存率。本综述基于最新指南,第一部分重点简要描述心力衰竭的诊断可能性,包括最新临床和临床前研究(如可溶性ST2、FSTL1等)产生的新进展,进一步集中阐述慢性心力衰竭(伊伐布雷定、ARNI、格列净类药物)和急性心力衰竭(乌拉立肽、松弛素、奈西立肽)药物治疗的创新。最后一部分概述了现有的非药物心力衰竭治疗选择(心脏收缩调节、影响交感和副交感神经系统活性以及永久性和临时性器械支持)。关键词:ARNI - 体外膜肺氧合 - 格列净类药物 - 心力衰竭 - 交感和副交感神经系统调节 - 沙库巴曲缬沙坦 - 治疗

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