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中国临床药理学与治疗学 ›› 2022, Vol. 27 ›› Issue (4): 373-381.doi: 10.12092/j.issn.1009-2501.2022.04.004

• 心血管疾病药物治疗最新研究进展 • 上一篇    下一篇

心力衰竭药物治疗的研究进展

彭娟1,范琳琳2,李然宜2,李晓宇2,吕迁洲2,邹云增1   

  1. 1上海心血管病研究所,复旦大学附属中山医院心内科,上海 200032;2复旦大学附属中山医院药剂科,上海 200032
  • 出版日期:2022-04-26 发布日期:2022-05-17
  • 通讯作者: 邹云增,男,博士,教授,主任医师,高血压,研究方向:心力衰竭与心肌重构。 E-mail: zou.yunzeng@zs-hospital.sn.cn
  • 作者简介:彭娟,女,博士,主治医师,研究方向:心脏心理学。 E-mail: peng.juan@zs-hospital.sh

Progress of pharmacotherapy for heart failure

PENG Juan1, FAN Linlin2, LI Ranyi2, LI Xiaoyu2, LV Qianzhou2, ZOU Yunzeng1   

  1. 1 Shanghai Institute of Cardiovascular Disease, Department of Cardiology Zhongshan Hospital, Fudan University, Shanghai 200032, China; 2 Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Online:2022-04-26 Published:2022-05-17

摘要: 心力衰竭是各种心脏疾病的终末阶段,尽管使用各种传统的药物标准治疗,但预后仍然不够理想,急需新的药物以及治疗方式的更新与提高。近年来,陆续出现了血管紧张素受体-脑啡肽酶抑制剂(沙库巴曲缬沙坦)类及钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)、可溶性鸟苷酸环化酶(sGC)激动剂(维利西呱)、心肌肌球蛋白激活剂(omecamtiv mecarbil)等新型治疗药物。钠-葡萄糖协同转运体2(SGLT2)抑制剂具有改善心室负荷,减少纤维化及影响心肌代谢等多种作用。sGC激动剂通过增强L-ARG-NO-sGC-cGMP信号通路,改善心肌和血管功能,逆转心室肥厚和纤维化,减缓心室重构,并通过全身和肺血管舒张减少心室后负荷发挥抗心衰作用。除此之外,新型盐皮质激素受体拮抗剂-非奈利酮也在心衰领域有良好的临床研究报道。因此,针对不同类型的心力衰竭患者,选择合适的药物,根据心衰的优化流程进行个体化治疗是未来心衰发展的方向与希望。

关键词: 心力衰竭, 血管紧张素受体-脑啡肽酶抑制剂, 钠-葡萄糖共转运蛋白2抑制剂, 可溶性鸟苷酸环化酶激动剂, 心肌肌球蛋白激活剂(omecamtiv mecarbil), 非奈利酮

Abstract: Heart failure is the terminal stage of all kinds of heart diseases. Despite the use of a variety of traditional drug standard treatment, the prognosis is still not ideal, and there is an urgent need for the update and improvement of new drugs and treatment methods. In recent years, angiotensin receptor-enkephalase inhibitors (Sacubitril/Valsartan), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), soluble guanoside cyclase agonists (Vericiguat) and myocardial myosin activators omecamtiv mecarbil have been developed successively. SGLT2 inhibitors can improve ventricular load, reduce fibrosis and affect myocardial metabolism. sGC agonists play an anti-heart failure role by enhancing l-ARg-No-SGC-CGMP signaling pathway, improving myocardial and vascular function, reversing ventricular hypertrophy and fibrosis, slowing ventricular remodeling, and reducing ventricular afterload through systemic and pulmonary vasodilation. In addition, fineridone, a novel salt corticosteroid receptor antagonist, has also been reported in clinical studies in the field of heart failure. Therefore, it is the direction and hope for the development of heart failure in the future to select appropriate drugs for different types of patients with heart failure and carry out individualized treatment according to the optimized process of heart failure.

Key words: heart failure, angiotensin receptor-enkephalase inhibitors, sodium-glucose cotransporter 2 inhibitors, soluble guanoside cyclase agonists, myocardial myosin activators, finerenone

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