射血分数保留性心力衰竭合并糖尿病的研究进展

心力衰竭是一种心脏结构或功能异常所致的临床综合征,据推测目前中国心血管病患者人数为2.9亿,其中心力衰竭占据450万。依据左心室射血分数,心力衰竭又分为射血分数降低性心力衰竭(HFrEF)和射血分数保留性心力衰竭(HFpEF)。近年来,HFpEF的发病率明显较HFrEF增加且已成为研究的热点。高血压、糖尿病和冠心病是常见能导致心力衰竭的基础疾病,其中糖尿病是最常见合并症之一。在美国,糖尿病在HFpEF中的患病率约为45%,但人们对这一人群的特征和结果了解甚少,在中国更是这样。现总结几项HFpEF治疗临床试验的数据,这些数据都表明糖尿病与HFpEF的发病率和长期死亡率增加有关,并讨论了HFpEF和糖尿病中的几种常见病理机制,包括钠潴留、代谢紊乱、骨骼肌功能受损和潜在的治疗靶点。随着对合并HFpEF和糖尿病的理解的增加,希望能为临床医生更好地提供有效的治疗方法。

Heart Failure with Preserved Ejection Fraction and Diabetes Mellitus

Heart failure is a clinical syndrome caused by abnormal heart structure or function.It is estimated that there are 290 million patients with cardiovascular disease in China,and the number of patients with central failure is 4. 5 million. Based on the left ventricular ejection fraction,heart failure is divided into heart failure with reduced ejection fraction( HFr EF) and heart failure with preserved ejection fraction( HFp EF).In recent years,the incidence of HFp EF has increased significantly compared with HFr EF and has become a research hotspot.The most common underlying diseases that cause heart failure are high blood pressure,diabetes mellitus( DM),and coronary heart disease,of which DM is one of the most common comorbidities. In the United States,the prevalence of DM in HFp EF is about 45%,but little is known about the characteristics and outcomes of this population,especially in our country.In this review,several data from clinical trials of HFp EF therapy are summarized. These data suggest that DM is associated with increased morbidity and long-term mortality of HFp EF,and several common pathological mechanisms in HFp EF and DM are discussed,including sodium retention,metabolic disorders,impaired skeletal muscle function and potential therapeutic targets. With the increased understanding of HFp EF and DM,it is hoped to provide effective treatment methods for clinicians.