Eur J Heart Fail:心衰伴射血分数降低患者盐皮质激素受体拮抗剂的使用情况如何?

2017-11-02 吴星 环球医学

2017年10月,发表在《Eur J Heart Fail》上的一项多中心、前瞻性研究(BIOSTAT-CHF)调查了临床实践中心衰伴射血分数降低(HFrEF)患者盐皮质激素受体拮抗剂(MRA)使用情况。研究结果证实:MRA在很大程度上使用不足,并经常停用。

2017年10月,发表在《Eur J Heart Fail》上的一项多中心、前瞻性研究(BIOSTAT-CHF)调查了临床实践中心衰伴射血分数降低(HFrEF)患者盐皮质激素受体拮抗剂(MRA)使用情况。研究结果证实:MRA在很大程度上使用不足,并经常停用。

目的:除非禁忌,否则MRA推荐用于所有心衰伴射血分数降低(HFrEF)患者的治疗。然而,常规临床实践中,MRA在很大程度上仍然使用不足。本研究旨在描述HFrEF患者中,MRA使用模式及其决定因素。

方法和结果:BIOSTAT-CHF是一项欧洲多中心前瞻性研究,入组的患者均为血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)和/或β-受体阻滞剂治疗效果不佳,研究的目的是为了优化指南指导下这些药物的使用。该回顾性事后分析从原始的2516例患者中纳入了1325例具有MRA治疗指征的患者,即左心室射血分数≤35%,估计肾小球滤过率≥30mL/分/1.73m2,K+≤5.0mmol/L。患者平均年龄为66.1±12.2岁。基线时,741例(56%)患者处方了MRA。基线处方MRA的患者更年轻,更多为男性,具有较高的体重指数,较低的钠水平,高血压史和较高比例的ACEI/ARB处方(所有的P都<0.05)。1049例完成基线和9个月就诊的患者中,585例(56%)基线开具MRA处方,662例(63%)9个月时开具MRA处方。585例基线开具MRA处方的患者中,91例(16%)停止治疗;在461例(44%)基线无MRA处方的患者中,168例(36%)随后初始开始MRA治疗。较高左心室射血分数和NYHA3/4级患者更可能停用MRA(P都<0.05)。基线和9个月时的MRA处方与死亡或心衰住院结局不相关(调整风险比,1.02;95% CI,0.66~1.58;P=0.93)。

结论:在这项欧洲前瞻性观察性研究中,MRA在很大程度上使用不足,并经常停用。由于这些动态改变,结局的推论不确定。

原始出处:

Ferreira JP, Rossignol P, Machu JL,et al. Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF. Eur J Heart Fail. 2017 Oct;19(10):1284-1293. doi: 10.1002/ejhf.900. Epub 2017 Jun 5.

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    2017-11-04 zhaojie88
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encryptionId=90d75628960, topicName=拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=474c10379153, createdName=ms5236388012055669, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562732, encodeId=fb931562e32bc, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600292, encodeId=06fe160029297, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706481, encodeId=38191e0648164, content=<a href='/topic/show?id=0510e227652' target=_blank style='color:#2F92EE;'>#盐皮质激素受体拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72276, encryptionId=0510e227652, topicName=盐皮质激素受体拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=274b31274626, createdName=1194695146_61857357, createdTime=Tue Jan 30 06:53:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258111, encodeId=e4de258111a1, content=学习了受益匪浅., beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Nov 02 19:24:34 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258094, encodeId=dec325809452, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1660817, encodeId=392a166081ef3, content=<a href='/topic/show?id=17b8268041b' target=_blank style='color:#2F92EE;'>#使用情况#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26804, encryptionId=17b8268041b, topicName=使用情况)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=169625169742, createdName=dzx0922897, createdTime=Tue May 08 17:53:00 CST 2018, time=2018-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356559, encodeId=da521356559e8, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, 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objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706481, encodeId=38191e0648164, content=<a href='/topic/show?id=0510e227652' target=_blank style='color:#2F92EE;'>#盐皮质激素受体拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72276, encryptionId=0510e227652, topicName=盐皮质激素受体拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=274b31274626, createdName=1194695146_61857357, createdTime=Tue Jan 30 06:53:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258111, encodeId=e4de258111a1, content=学习了受益匪浅., beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Nov 02 19:24:34 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258094, encodeId=dec325809452, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-04 slcumt
  6. 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createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
  7. 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createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
  8. 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createdName=zhaojie88, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449236, encodeId=1dfe1449236f1, content=<a href='/topic/show?id=2ff746814f0' target=_blank style='color:#2F92EE;'>#射血分数降低#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46814, encryptionId=2ff746814f0, topicName=射血分数降低)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=50105466425, createdName=lmm399, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1511684, encodeId=0e101511684af, content=<a href='/topic/show?id=90d75628960' target=_blank style='color:#2F92EE;'>#拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56289, encryptionId=90d75628960, topicName=拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=474c10379153, createdName=ms5236388012055669, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562732, encodeId=fb931562e32bc, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600292, encodeId=06fe160029297, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706481, encodeId=38191e0648164, content=<a href='/topic/show?id=0510e227652' target=_blank style='color:#2F92EE;'>#盐皮质激素受体拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72276, encryptionId=0510e227652, topicName=盐皮质激素受体拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=274b31274626, createdName=1194695146_61857357, createdTime=Tue Jan 30 06:53:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258111, encodeId=e4de258111a1, content=学习了受益匪浅., beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Nov 02 19:24:34 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258094, encodeId=dec325809452, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-02 131****1460

    学习了受益匪浅.

    0

  9. 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objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb1a18781011, createdName=bbwznl, createdTime=Sat Nov 04 07:53:00 CST 2017, time=2017-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1706481, encodeId=38191e0648164, content=<a href='/topic/show?id=0510e227652' target=_blank style='color:#2F92EE;'>#盐皮质激素受体拮抗剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72276, encryptionId=0510e227652, topicName=盐皮质激素受体拮抗剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=274b31274626, createdName=1194695146_61857357, createdTime=Tue Jan 30 06:53:00 CST 2018, time=2018-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258111, encodeId=e4de258111a1, content=学习了受益匪浅., beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Nov 02 19:24:34 CST 2017, time=2017-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=258094, encodeId=dec325809452, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Nov 02 17:52:30 CST 2017, time=2017-11-02, status=1, ipAttribution=)]
    2017-11-02 惠映实验室

    学习了.谢谢.

    0

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