钠-葡萄糖共转运体2型抑制剂治疗慢性心力衰竭:新证据

V. N. Larina, M. V. Leonova
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引用次数: 0

摘要

由于慢性心力衰竭(HF)预后不良,合理的药物治疗仍然是一个相关问题。多项重要研究证实,现代疾病调节疗法(包括钠-葡萄糖共转运体 2 型抑制剂(SGLT-2 抑制剂或格列奈类))对降低住院率和死亡率有积极作用,无论心力衰竭患者的左心室射血分数(LVEF)和糖尿病情况如何,均被视为一线疗法。综述介绍了这类药物在心房颤动中的作用机制研究,包括代谢、血流动力学和其他多效应,SGLT-2 抑制剂可通过这些效应阻止不同 LVEF 的心房颤动的发生和发展。此外,还讨论了 SGLT-2 抑制剂对 HF 患者临床症状和生活质量影响的可能性,以及 N 端前 B 型钠尿肽水平的变化作为临床合理用药靶点的合理性。由于预后不良,慢性心力衰竭(HF)的合理药物治疗仍是一个相关问题。多项重要研究证实,现代疾病修饰疗法(包括钠-葡萄糖共转运体 2 型抑制剂(SGLT-2 抑制剂或格列奈类))对降低住院率和死亡率有积极作用,无论心力衰竭患者的左心室射血分数(LVEF)和糖尿病情况如何,均被视为一线疗法。综述介绍了这类药物在心房颤动中的作用机制研究,包括代谢、血流动力学和其他多效应,SGLT-2 抑制剂可通过这些效应阻止不同 LVEF 的心房颤动的发生和发展。此外,还讨论了 SGLT-2 抑制剂对 HF 患者临床症状和生活质量影响的可能性,以及 N 端前 B 型钠尿肽水平的变化作为临床合理用药靶点的合理性。根据临床情况提出了四联疗法的概念,其基础是快速、同时启动主要救命药物组(血管紧张素转换酶抑制剂/沙库比特利+缬沙坦、SGLT-2 抑制剂、β-受体阻滞剂和矿物质皮质激素受体拮抗剂)的组合,旨在改善临床状况和预后。因此,治疗心房颤动和不同 LVEF 患者的现代有效方法必然包括使用 SGLT-2 抑制剂,因为有足够的证据表明它们适用于这类患者。
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Sodium-glucose cotransporter type 2 inhibitors in the treatment of chronic heart failure: new evidence
Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combina-Rational pharmacotherapy for chronic heart failure (HF) remains a relevant issue due to the unfavorable prognosis. Several major studies have confirmed the beneficial effect on reducing hospitalization rates and mortality of modern disease-modifying therapy, including sodium-glucose cotransporter type 2 inhibitors (SGLT-2 inhibitors or gliflozins), considered first-line therapy regardless of the left ventricular ejection fraction (LVEF) and diabetes mellitus in HF patients. The review presents the studied mechanisms of action of this group of drugs in HF, including metabolic, hemodynamic, and other pleiotropic effects, through which SGLT-2 inhibitors prevent the development and progression of HF with different LVEF. The possibilities of the influence of SGLT-2 inhibitors on clinical symptoms and quality of life of HF patients are discussed, as well as the change in the level of N-terminal pro-B-type natriuretic peptide as a target for rational clinical use justification. The concept of quadruple therapy, depending on the clinical situation, is presented, the basis of which is the rapid and simultaneous initiation of a combination of major life-saving drug groups (angiotensin-converting enzyme inhibitors / sacubitril + valsartan, SGLT-2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists), aimed at improving the clinical condition and prognosis. Thus, a modern, effective approach to managing patients with HF and different LVEF necessarily includes the use of SGLT-2 inhibitors, which have sufficient evidence for their use in this category of patients.
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