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神经内分泌失调与慢性心力衰竭(CHF)的不良预后相关,是临床CHF治疗的一个重要靶点。心力衰竭患者虽已接受血管紧张素转化酶抑制剂(ACEI)或血管紧张素受体阻断剂(ARB)以及β受体阻断剂等治疗,但心血管事件发生率仍然很高。选择性醛固酮受体拮抗剂依普利酮与神经内分泌抑制剂联合应用,可降低轻度收缩性心力衰竭患者的死亡率和住院率,且与螺内酯相比,可更进一步减少长期治疗所致的内分泌紊乱。本文综述醛固酮拮抗剂治疗心衰的意义,重点介绍依普利酮在慢性收缩性心力衰竭治疗中的循证依据与优势。
Neuroendocrine disorders are associated with poor prognosis of chronic heart failure (CHF) and are an important target for the clinical treatment of CHF. Although patients with heart failure have been treated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and beta-blockers, the incidence of cardiovascular events is still high. The combination of the selective aldosterone receptor antagonist eplerenone with a neuroendocrine inhibitor reduces mortality and hospitalization in patients with mild systolic heart failure and further reduces the risk of long-term treatment compared with spironolactone hormone imbalance. This article reviews the significance of aldosterone antagonists in the treatment of heart failure and highlights the evidence base and advantages of eplerenone in the treatment of chronic systolic heart failure.