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醛固酮受体拮抗剂在收缩性心力衰竭中的应用

Author
Wilson S Colucci, MD
Section Editors
Stephen S Gottlieb, MD
Richard H Sterns, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC
Translators
孟照辉, 主任医师，教授

引言

醛固酮受体拮抗剂是收缩性心力衰竭(heart failure, HF)患者的治疗方法之一[1]。临床试验的数据表明，醛固酮受体拮抗剂治疗可降低某些心衰患者的死亡率。

醛固酮受体拮抗剂治疗用于收缩性心衰的有效性、风险及获益机制将总结在此。心衰的评估和整体治疗方法将单独讨论。 (参见“疑似心力衰竭患者的评估”和“急性失代偿性心力衰竭的评估”和“收缩功能障碍所致心力衰竭的治疗概述”和“射血分数保留型心力衰竭的治疗和预后”和“急性失代偿性心力衰竭治疗：总则”)

有效性

多项随机试验支持对某些心衰患者使用醛固酮受体拮抗剂(螺内酯或依普利酮)，这些试验表明该治疗能降低死亡率(表 1)。

RALES试验中螺内酯的有效性 — RALES试验中评估了螺内酯的有效性和安全性[2,3]。该研究纳入1663例当前心功能分级为纽约心脏协会(New York Heart Association, NYHA)Ⅳ级或Ⅲ级心衰、且入组前6个月内曾有过Ⅳ级心衰(表 2)且左室射血分数(left ventricular ejection fraction, LVEF)不超过35%(平均25%)的患者。患者既往接受的治疗包括一种血管紧张素转换酶(angiotensin converting enzyme, ACE)抑制剂和一种袢利尿剂，加或不加地高辛。将这些患者随机分配到安慰剂组或者每日单剂螺内酯组(25-50mg/d)。血清肌酐浓度高于2.5mg/dL(221µmol/L)或血清钾浓度高于5.0meq/L的候选患者被排除。

观察发现，使用螺内酯治疗的患者出现了以下血流动力学和电解质的变化[2]：

                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-28.
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