心力衰竭药物研究进展

心力衰竭是各种心血管疾病发展的最后阶段,是大多数器质性心脏疾病进展的最终结局,也是最主要的死亡原因。为了更有效地治疗心力衰竭,逆转心脏重塑,提高患者的生存率,近几年在心力衰竭的治疗方面已有多种新药问世,如重组B型利钠肽、钙增敏剂、血管加压素受体拮抗剂、内皮素受体拮抗剂、他汀类药物等。这些新药中,重组B型利钠肽对治疗高龄急性失代偿性心力衰竭患者具有很好的疗效及安全性;左西孟旦适用于传统治疗(利尿剂、血管紧张素转换酶抑制剂和洋地黄)疗效不佳,并且需要增加心肌收缩力的急性失代偿心力衰竭的短期治疗;血管加压素(arginine vasopressin,AVP)受体拮抗剂能够阻滞AVP对肾集合管V2受体的作用,增强游离水排泄,而没有明显的钠钾丢失,从而使血钠浓度升高,为充血性心力衰竭(congestive heart failure,CCF)水肿和低钠血症的治疗提供了一种新方法。这些新药为医生及患者带来新的希望,但关于新问世的药物对心力衰竭患者预后的影响,还需遵循循证医学的原则,进行大规模临床试验来证实。

New progress in the drug treatment of heart failure

Heart failure is a variety of cardiovascular diseases in the final stages of development, is the most organic heart disease progression in the final outcome and is the most important cause of death. In order to treat heart failure more effectively, reversal of cardiac remodeling, improve the survival rate of patients, there were variety of new drugs available for the treatment of heart failure, such as recombinant B type natriuretic peptide, calcium sensitizer, vasopressin receptor antagonists, endothelin receptor antagonist and statins in the last few years. Among these new drugs, recombinant B type natriuretic peptide in the treating of eider patients with acute decompensated heart failure had very good efficacy and safety. Levosimendan applicable to conventional therapy （diuretics, angiotensin-converting enzyme inhibitors and digitalis） but with poor effect, and need to increase of myocardial contractility in acute decompensated heart failure cases for short term treatment, vasopressin receptor antagonists may block AVP on renal collecting duct V2 receptor function, enhanced free water excretion, without significant loss of sodium and potassium, increase the concentration of blood sodium and provides a new method for eongesttive heart failure（CCF） edema and hyponatremia threatment. These new drugs offer a new hope to physicians and patients, but with regard to the prognosis for heart failure patients, large-scale clinical trials and evidence- based medicine trials should be conducted.