Lei Lei, Mao Yuanjie
1 Department of Endocrinology, Aerospace Center Hospital, Peking University Affiliate, Beijing, China.
2 Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Int Med Res. 2018 Jun;46(6):2063-2081. doi: 10.1177/0300060518761262. Epub 2018 Feb 22.
The common ultimate pathological feature for all cardiovascular diseases, congestive heart failure (CHF), is now considered as one of the main public health burdens that is associated with grave implications. Neurohormonal systems play a critical role in cardiovascular homeostasis, pathophysiology, and cardiovascular diseases. Hormone treatments such as the newly invented dual-acting drug valsartan/sacubitril are promising candidates for CHF, in addition to the conventional medications encompassing beta receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists. Clinical trials also indicate that in CHF patients with low insulin-like growth factor-1 or low thyroid hormone levels, supplemental treatment with growth hormone or thyroid hormone seems to be cardioprotective; and in CHF patients with volume overload the vasopressin antagonists can relieve the symptoms superior to loop diuretics. Furthermore, a combination of selective glucocorticoid receptor agonist and mineralocorticoid receptor antagonist may be used in patients with diuretic resistance. Finally, the potential cardiovascular efficacy and safety of incretin-based therapies, testosterone or estrogen supplementation needs to be prudently evaluated in large-scale clinical studies. In this review, we briefly discuss the therapeutic effects of several key hormones in CHF.
所有心血管疾病的共同最终病理特征——充血性心力衰竭（CHF），如今被视为主要的公共卫生负担之一，且具有严重影响。神经激素系统在心血管稳态、病理生理学以及心血管疾病中起着关键作用。除了包括β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和盐皮质激素受体拮抗剂在内的传统药物外，新发明的双效药物缬沙坦/沙库巴曲等激素治疗方法是治疗CHF的有前景的候选方案。临床试验还表明，在胰岛素样生长因子-1水平低或甲状腺激素水平低的CHF患者中，补充生长激素或甲状腺激素似乎具有心脏保护作用；在容量超负荷的CHF患者中，血管加压素拮抗剂缓解症状的效果优于袢利尿剂。此外，选择性糖皮质激素受体激动剂和盐皮质激素受体拮抗剂的联合应用可用于利尿剂抵抗的患者。最后，基于肠促胰岛素的疗法、睾酮或雌激素补充剂的潜在心血管疗效和安全性需要在大规模临床研究中进行审慎评估。在本综述中，我们简要讨论了几种关键激素在CHF中的治疗作用。
