射血分数保留的心力衰竭心脏外机制研究进展  

Advances in extracardiac mechanisms for heart failure with preserved ejection fraction

作　　者：王思羽 肖宜超[1] WANG Siyu;XIAO Yichao(Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011;Xiangya School of Medicine,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅二医院心血管内科,长沙410011 [2]中南大学湘雅医学院,长沙410008

出　　处：《中南大学学报（医学版）》2022年第12期1733-1739,共7页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81700309)。

摘　　要：射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)是一种临床表现具有高度异质性的综合征,近年来发病率持续上升。相比于射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFrEF),HFpEF预后更差。针对HFpEF心脏内机制的传统治疗方案对HFpEF疗效有限或无效,因此着眼于针对HFpEF心脏外机制的治疗方案有望找到治疗HFpEF的新靶点。近年研究表明,心肺的病理生理相互作用,加剧HFpEF进展;高血压、全身性血管损伤和炎症反应引发冠状动脉微血管功能障碍,导致心肌肥大和冠状动脉微血管的重构;急性肾损伤通过影响心肌能量产生、诱发氧化应激等方式导致心肌功能障碍,并诱导心肌蛋白质分解代谢;肝纤维化主要通过异常蛋白质的沉积和炎症因子作用介导心肌病变;骨骼肌代谢信号与交感神经系统相互作用,并产生肌因子,共同影响心脏功能。代谢综合征、肠道微生物群紊乱、免疫系统疾病及缺铁等通过代谢改变、氧化应激、炎症反应等途径促进HFpEF的发生和发展。因此针对HFpEF心脏外机制的研究对HFpEF的模型构建、机制研究及治疗策略制订有一定启发作用。Heart failure with preserved ejection fraction(HFpEF)is a syndrome with highly heterogeneous clinical symptoms,and its incidence has been increasing in recent years.Compared with heart failure with reduced ejection fraction(HFrEF),HFpEF has a worse prognosis.Traditional therapies targeting the internal mechanisms of the heart show limited or inefficacy on HFpEF,and new therapeutic targets for HFpEF are expected to be found by focusing on the extracardiac mechanisms.Recent studies have shown that cardiopulmonary pathophysiological interaction exacerbates the progression of HFpEF.Hypertension,systemic vascular injury,and inflammatory response lead to coronary microvascular dysfunction,myocardial hypertrophy,and coronary microvascular remodeling.Acute kidney injury affects myocardial energy production,induces oxidative stress and catabolism of myocardial protein,which leads to myocardial dysfunction.Liver fibrosis mediates heart injury by abnormal protein deposition and inflammatory factors production.Skeletal muscle interacts with the sympathetic nervous system by metabolic signals.It also produces muscle factors,jointly affecting cardiac function.Metabolic syndrome,gut microbiota dysbiosis,immune system diseases,and iron deficiency promote the occurrence and development of HFpEF through metabolic changes,oxidative stress,and inflammatory responses.Therefore,the research on the extracardiac mechanisms of HFpEF has certain implications for model construction,mechanism research,and treatment strategy formulation.

关 键 词：射血分数保留的心力衰竭 舒张功能障碍 发病机制 炎症 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]