JACC:抑制心肌重构,盐皮质激素受体拮抗剂对2型糖尿病患者做到了!

2021-08-18 MedSci原创 MedSci原创

在高危T2DM患者中加入大剂量依普利酮可能在预防心力衰竭方面有临床益处。

目前心力衰竭已成为威胁全球人类健康的主要重大疾病之一,其全球发病率居高不下。据不完全统计,全球目前有超过2600万心力衰竭患者,每年花费1080亿美元治疗费用。我国大约有450万心衰患者。

随着我国社会人口老龄化进程、高血压、糖尿病以及缺血再灌注后心肌损伤等危险因素的流行,心衰发病率将持续增加。病人一旦发展到心力衰竭阶段,其五年生存率堪比恶性肿瘤。目前还缺乏有效的心衰治疗与干预策略,因此专家总是在呼吁大家重视干预心肌重构来防治心力患竭。

心肌重构是指在内源性或外源性因素作用下,心脏结构、代谢和功能不断调整,主要表现为左心室和(或)右心室心室空间构象和生物学效应的不断改变。研究已证实,心肌重构是几乎所有心脏疾病共同的病理通路,包括高血压血心脏病,代谢相关心脏病,缺血性心肌病、瓣膜性心脏病等。

国内外研究均证实抑制甚至逆转心肌重构有可能从根本上阻断心力衰竭的发生发展,进而改善心衰患者预后。循证医学表明,延缓心肌重构的药物主要包括血管紧张素转换酶抑制剂(ACEI)、血管紧张素II受体阻断剂(ARB)、β受体阻滞剂、醛固酮拮抗剂。

依普利酮是一种新型的盐皮质受体拮抗剂(MRA)。近日,来自丹麦哥本哈根大学的专家评估了依普利酮对心血管疾病(CVD)高风险的2型糖尿病(T2DM)患者的左心室质量(LVM)的影响。结果发表在JACC杂志上。

在该项随机、双盲临床试验中,对140名T2DM高危或已确定的CVD患者的次要终点进行了预先指定的分析。作为标准护理的补充,患者随机接受大剂量依普利酮(100mg-200mg)或安慰剂治疗,为期26周。使用心脏磁共振(CMR)成像测量指数化的LVM(LVMi)和T1时间。生物标志物包括NT-proBNP、I型胶原蛋白N-末端前肽(P1NP)和III型N-末端前肽(P3NP)。

两组患者LVM与LVMi的治疗情况比较

在MIRAD试验的140名患者中,104名患者接受了CMR成像(依普利酮:54名患者;安慰剂:50名患者)。基线时平均LVMi为74.2±16g/m2。治疗效果(即组间差异)是在依普利酮治疗后减少3.7g/m2(95%CI:-6.7至-0.7;P = 0.017),绝对LVM也相应减少。与安慰剂相比,使用依普利酮的血浆NT-proBNP浓度下降了22%,P1NP下降了3.3 ng/mL。组间没有观察到T1时间或P3NP浓度的差异。

可见,在高危T2DM患者中加入大剂量依普利酮与LVMi以及NT-proBNP和P1NP水平的明显降低有关,这可能表明在预防心力衰竭方面有临床益处。

参考文献:

Mineralocorticoid Receptor Antagonist Improves Cardiac Structure in Type 2 Diabetes: Data From the MIRAD Trial. J Am Coll Cardiol HF. 2021 Aug, 9 (8) 550–558

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    2022-01-30 hbwxf
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    2021-08-19 misszhang

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