脂肪因子与慢性心力衰竭研究进展

慢性心力衰竭的发病率和病死率高。肥胖、高血压和糖尿病等为慢性心力衰竭的传统危险因素,但近期研究表明发现肥胖的慢性心力衰竭患者预后较好,这一现象被人称为“肥胖悖论”。脂肪组织目前被认为是一种内分泌组织,分泌的多种脂肪因子可调控多种心血管功能。现综述可影响心血管功能的脂肪因子。     

抑郁对慢性心力衰竭患者的影响

慢性心力衰竭患者常伴有抑郁,而抑郁又对慢性心力衰竭的发生和发展产生影响,现就抑郁对慢性心力衰竭患者的临床影响、发生机制及相关治疗做一综述。     

宣导泻肺饮治疗慢性心力衰竭的临床研究

目的观察中药宣导泻肺饮治疗慢性心力衰竭的疗效及对心功能的影响.方法将心功能Ⅲ级～Ⅳ级,辨证属三焦壅塞、痰瘀水停证病人96例随机分为治疗组（48例）和对照组（48例）,对照组采用西药常规治疗,治疗组在此基础上加用宣导泻肺饮,两组疗程均为8周.结果两组治疗后在中医证候、Lee氏心力衰竭记分以及心功能NYHA分级、左室射血分数（LVEF）、短轴缩短率（FS）、左室收缩末容积（LVESV）均比治疗前有明显改善（P〈0.01）,但治疗组疗效优于对照组（P＜0.05）;治疗组治疗后左室舒张末容积（LVEDV）较治疗前也有明显改善（P〈0.01）;治疗组利尿剂和地高辛用量以及住院天数明显少于对照组（P〈0.05或P〈0.01）.结论宣导泻肺饮结合常规西药治疗心力衰竭,可减少住院天数,减少利尿剂和地高辛的用量,改善心功能和提高临床疗效.     

Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure: An Analysis From GISSI-HF

Background

Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.

肌钙蛋白T与慢性心力衰竭的关系

心力衰竭（心衰）是各种心脏疾病发展至最后的临床综合征,心室重塑是心衰进展的重要机制。心肌细胞的丢失和室壁纤维化促进心室重塑。肌钙蛋白T是心肌细胞损伤的特异性标志物。大部分心衰患者血浆中可检测到肌钙蛋白T,提示心衰进展中持续存在慢性心肌损伤。研究表明心衰患者肌钙蛋白T浓度与心衰严重程度及发生不良事件的危险性密切相关,可较准确地提供患者预后信息。肌钙蛋白T可作为预后的一项重要生化标志物。现就肌钙蛋白T对心衰的预后研究做一综述。     

慢性心力衰竭的免疫学研究进展

慢性心力衰竭是一种常见的综合征,它的发病机制很多,最近的研究表明免疫激活影响慢性心力衰竭的发生与发展。现就慢性心力衰竭与免疫学的关系作一综述。     

Effects of Trimetazidine in Nonischemic Heart Failure: A Randomized Study

ObjectivesHeart failure (HF) is associated with changes in myocardial metabolism that lead to impairment of contractile function. Trimetazidine (TMZ) modulates cardiac energetic efficiency and improves outcomes in ischemic heart disease. We evaluated the effects of TMZ on left ventricular ejection fraction (LVEF), cardiac metabolism, exercise capacity, O₂ uptake, and quality of life in patients with nonischemic HF.Methods and ResultsSixty patients with stable nonischemic HF under optimal medical therapy were included in this randomized double-blind study. Patients were randomized to TMZ (35 mg orally twice a day) or placebo for 6 months. LVEF, 6-minute walk test (6MWT), maximum O₂ uptake in cardiopulmonary exercise test, different markers of metabolism, oxidative stress, and endothelial function, and quality of life were assessed at baseline and after TMZ treatment. Left ventricular peak glucose uptake was evaluated with the use of the maximum standardized uptake value (SUV) by 18-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET). Etiology was idiopathic in 85% and hypertensive in 15%. Both groups were similar in age, functional class, LVEF, and levels of N-terminal pro–B-type natriuretic peptide at baseline. After 6 months of TMZ treatment, no changes were observed in LVEF (31 ± 10% vs 34 ± 8%; P = .8), 6MWT (443 ± 25 m vs 506 ± 79 m; P = .03), maximum O₂ uptake (19.1 ± 5.0 mL kg⁻¹ min⁻¹ vs 23.0 ± 7.2 mL kg⁻¹ min⁻¹; P = .11), functional class (percentages of patients in functional classes I/II/III/IV 10/3753/0 vs 7/40/50/3; P = .14), or quality of life (32 ± 26 points vs 24 ± 18 points; P = .25) in TMZ versus placebo, respectively. In the subgroup of patients evaluated with ¹⁸FDG-PET, no significant differences were observed in SUV between both groups (7.0 ± 3.6 vs 8.2 ± 3.4 respectively; P = .47).ConclusionsIn patients with nonischemic HF, the addition of TMZ to optimal medical treatment does not result in significant changes of LVEF, exercise capacity, O₂ uptake, or quality of life.     

HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure

Background

The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive value.

他汀类药物治疗慢性心力衰竭的研究进展

临床研究已证实他汀在冠心病治疗中的价值,至少已在无心力衰竭的冠心病患者中得以明确.因此他汀可能对慢性心力衰竭具有很大的潜在价值,尤其对冠心病性心力衰竭.现综述他汀治疗慢性心力衰竭的研究进展.     

Effects of Captopril on Cardiorenal Hemodynamics in Patients with Severe Chronic Congestive Heart Failure

The effects of captopril on cardiorenal function were studied in patients with chronic congestive heart failure. A single oral dose of captopril in 16 patients significantly increased cardiac indices and decreased total systemic vascular resistance. These changes were greater in subjects with higher baseline plasma renin activity (PRA). The increase in PRA and decrease in plasma aldosterone were also greater in this group. During 7 days of captopril therapy, renal plasma flow distinctly increased in 10 patients in whom renal function was followed. The increase in renal blood flow was greater in subjects with higher PRA. Simultaneous infusion of aprotinin in eight of these subjects did not affect the captopril-induced increase in renal plasma flow: these responses were the same in both PRA subgroups. The results suggest that captopril reduces total systemic vascular resistance in patients with chronic congestive heart failure through the inhibition of the renin-angiotensin system and the preferential renal vasodilating effect of captopril seems exclusively to be the sole result of this inhibition, with the kallikrein-kinin system or kinin-mediated prostaglandins not playing a major role.     

New Pharmacological Strategies in Chronic Heart Failure

Summary Diuretics, ACE inhibitors and betablockers form the cornerstone of pharmacological treatment of chronic heart failure (CHF), while angiotensin receptor blockers are gaining ground. However, despite optimal treatment CHF remains a syndrome with poor prognosis. For this reason, a large number of new agents have been developed as add-on treatment over the last few years. Vasopeptidase inhibitors, moxonidine, endothelin antagonists, vasopressin antagonists, and selective aldosterone antagonists, are some of the new agents that were designed to interfere with different neurohormonal pathways. Immunomodulating agents, growth hormone, caspase inhibitors, adrenomedullin, and erythropoietin have different modes of action, which in general are less understood. Although most of the agents exhibited efficacy in preclinical trials, the clinical results have not always been similarly positive. The results of trials involving vasopeptidase inhibitors, endothelin antagonists, immunomodulating agents, and growth hormone have been disappointing. Other compounds like caspase inhibitors, adrenomedullin, and vasopressin antagonists are still at the early stages of development. Currently, the two most promising agents seem to be erythropoietin and the selective aldosterone receptor blocker eplerenone. In the present article an overview of new pharmacological developments for CHF is given, and the clinical value of these developments is discussed.     

Effect of Losartan on the Cardiac and Renal Function in Patients With Chronic Heart Failure

Objectives To explore the effect of losartan on cardiac and renal function in patients with chronic heart failure (CHF). Methods Sixty-five patients with CHF were divided into two groups using a randomized, control and single blind method: losartan group (n=30) and convention group (n=35), with a treatment course of 8 weeks for both groups. The concentrations of cystatin C (cys C) in serum, microamount albumin (MA) in urine were measured by immunoturbidimetry. The concentration of aquaporin-2(AQP-2)was determined by enzyme-linked-immunosorbent assay (ELISA) and the heart contractile function was measured by echocardiography before and after treatment respectively. Results Comparing with routine treatment group, left ventricular end-diastolic dimension (LVEDd) decreased significantly, while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening (LVFS) increased significantly in losartan group. The levels of cys C in serum and MA, AQP-2 in urine were significantly lower in losartan group than in routine treatment group. Conclusion Losartan can improve cardiac and renal function in patients with CHF.     

西拉普利对充血型心力衰竭的疗效观察

目的：ACE抑制剂已经广泛地用于治疗严重充血性心力衰竭,但是用于治疗轻、中度心力衰竭少见报道。本组观察西拉普利对轻、中度心力衰竭的疗效。方法：68例心力衰竭病人,NYHAⅡ-Ⅲ级,观察治疗前后试验组病人症状、体征和运动试验耐受情况,并同安慰剂组进行对照。结果：试验组运动耐受程度改善27％,而安慰剂组仅为5％（P＜0．001）;试验组心力衰竭和NYHA分级也明显提高,两组血清钾、肌酐和尿酸无显著差异。结论：西拉普利明显改善轻、中度心力衰竭的症状、提高运动耐量,而且耐受良好。     

慢性心力衰竭与细胞凋亡的研究进展

细胞凋亡可能是慢性心力衰竭(CHF)的重要分子细胞学基础,细胞凋亡与神经内分泌细胞因子和凋亡的途径有关,还与凋亡相关的基因和蛋白的表达有关.     

慢性充血性心力衰竭大鼠模型的建立

目的：探讨建立慢性充血性心力衰竭大鼠模型的方法。方法：通过结扎大鼠左冠状动脉造成大面积心肌梗死。术后8周,进行血流动力学、心室质量指数检测及心肌标本留取。结果：术后大鼠出现明显的心肌梗死改变。血流动力学提示大鼠MBP下降,LVSP,±dp／dt显著下降,LVEDP明显升高。大鼠心室质量指数增加。光镜下大鼠心肌梗死区心肌纤维明显,心肌梗死边缘心肌排列紊乱、心肌细胞肥大,核增大,部分细胞可有核固缩。结论：结扎左冠状动脉可成功制造慢性心力衰竭大鼠模型,对心力衰竭的实验研究有益。     

抗神经内分泌治疗慢性心力衰竭进展

根据循证医学对近年来血管紧张素转换酶抑制剂、β受体阻滞剂、血管紧张素Ⅱ受体拮抗剂、醛固酮拮抗剂和利钠肽等神经内分泌拮抗剂的临床应用作一综述。