刘浩林, 汪钦, 何鸣镝, 王智, 陈根锐, 王汝涛, 谢华宁, 廉坤, 何争. 作用于肾素-血管紧张素-醛固酮系统的心力衰竭治疗新策略[J]. 心脏杂志, 2018, 30(6): 720-727. DOI: 10.13191/j.chj.2018.0171
    引用本文: 刘浩林, 汪钦, 何鸣镝, 王智, 陈根锐, 王汝涛, 谢华宁, 廉坤, 何争. 作用于肾素-血管紧张素-醛固酮系统的心力衰竭治疗新策略[J]. 心脏杂志, 2018, 30(6): 720-727. DOI: 10.13191/j.chj.2018.0171
    LIU Hao-lin, WANG Qin, HE Ming-di, WANG Zhi, CHEN Gen-rui, WANG Ru-tao, XIE Hua-ning, LIAN Kun, HE Zheng. New strategies acting on renin-angiotensin-aldosterone system for treatment of heart failure[J]. Chinese Heart Journal, 2018, 30(6): 720-727. DOI: 10.13191/j.chj.2018.0171
    Citation: LIU Hao-lin, WANG Qin, HE Ming-di, WANG Zhi, CHEN Gen-rui, WANG Ru-tao, XIE Hua-ning, LIAN Kun, HE Zheng. New strategies acting on renin-angiotensin-aldosterone system for treatment of heart failure[J]. Chinese Heart Journal, 2018, 30(6): 720-727. DOI: 10.13191/j.chj.2018.0171

    作用于肾素-血管紧张素-醛固酮系统的心力衰竭治疗新策略

    New strategies acting on renin-angiotensin-aldosterone system for treatment of heart failure

    • 摘要: 心力衰竭(HF)是各种心血管病的严重和终末阶段,其患病率高、死亡率高、再住院率高,给公众带来了沉重的疾病负担。神经内分泌系统尤其是肾素-血管紧张素-醛固酮系统(renin-angiotensin-aldosterone system,RAAS)的过度激活在HF病理发展过程中起着关键作用,RAAS抑制剂(ACEIs/ARBs、醛固酮受体拮抗剂)已是HF治疗的基石。近年HF治疗取得令人瞩目的成就。PARDIGM-HF试验显示沙库巴曲缬沙坦(LCZ696)治疗HF有极好的疗效,是过去20年内HF治疗领域的一个突破。本课题组已发表的研究显示,超大剂量ACEIS/ARBS治疗HF效果优于常规剂量。除此,随着对RAAS认识的不断深入,还发现了许多新的药物作用靶点,为临床治疗HF提供了新策略。本文旨在对以上内容做一综述。

       

      Abstract: Heart failure (HF), a serious and end stage of numerous types of cardiovascular diseases, has brought a heavy burden to the public related to its high morbidity, mortality, and hospitalization rate. Excessive activation of neuroendocrine, especially the renin-angiotensin-aldosterone system (RAAS), is pivotal in the pathological process of HF. RAAS inhibitors (ACEIs/ARBs, aldosterone receptor antagonists) have been the cornerstone in HF treatment. In recent years, remarkable advances in HF treatment have been made. Sacubitril/valsartan (LCZ696) presents superiority to enalapril in PARDIGM-HF and this is a significant breakthrough in HF therapy over the past two decades. Our research, published in ESC Heart Fail, has demonstrated that supramaximal-dose of ACEIs/ARBs is superior to normal-dose in HF treatment. Many new therapeutic targets have emerged as novel strategies for HF treatment as the exploration into RAAS continues into the future and key findings are elaborated on in this review.

       

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