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炎症在射血分数保留型心力衰竭中的作用研究进展

张琦¹, 陈芸儿¹, 祝欣欣¹, 王霞^1,2, 曲爱娟^1,3,4,*

¹首都医科大学基础医学院生理学与病理生理学系，北京 100069；²首都医科大学附属北京佑安医院感染科，北京 100069；³重塑相关心血管疾病教育部重点实验室，北京 100069；⁴代谢紊乱相关疾病北京市重点实验室，北京 100069

摘要

射血分数保留型心力衰竭(heart failure with preserved ejection fraction, HFpEF)是指以左心室舒张功能障碍为主要特征且射血分数保留的一种心力衰竭。随着人口老龄化的到来和高血压、肥胖、糖尿病等代谢性疾病的增多，HFpEF患病率持续升高。与射血分数降低型心力衰竭(heart failure with reduced ejection fraction, HFrEF)相比，传统抗心力衰竭药物未能明显降低HFpEF的死亡率，这与HFpEF的病理生理学机制复杂且合并症多相关。已知HFpEF的心脏结构改变主要表现为心肌细胞肥大、心肌纤维化和左心室肥厚，且通常合并肥胖、糖尿病、高血压、肾功能不全等疾病，但这些合并症如何诱发心脏结构和功能损害尚不完全明确。近期研究表明免疫炎症反应在HFpEF进展中发挥重要作用，本文着重综述了炎症在HFpEF发生和发展中的病理作用研究进展及抗炎疗法在HFpEF中的应用进展，以期为HFpEF的深入研究和防治提供参考。

关键词： 射血分数保留型心力衰竭; 炎症; 左心室舒张功能障碍; 内皮功能障碍

The role of inflammation in heart failure with preserved ejection fraction

ZHANG Qi¹, CHEN Yun-Er¹, ZHU Xin-Xin¹, WANG Xia^1,2, QU Ai-Juan^1,3,4,*

¹Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China；²Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China；³Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing 100069, China；⁴Beijing Key Laboratory of Metabolic Disorder-Related Cardiovascular Diseases, Beijing 100069, China

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure characterized by left ventricular diastolic dysfunction with preserved ejection fraction. With the aging of the population and the increasing prevalence of metabolic diseases, such as hypertension, obesity and diabetes, the prevalence of HFpEF is increasing. Compared with heart failure with reduced ejection fraction (HFrEF), conventional anti-heart failure drugs failed to reduce the mortality in HFpEF due to the complex pathophysiological mechanism and multiple comorbidities of HFpEF. It is known that the main changes of cardiac structure of in HFpEF are cardiac hypertrophy, myocardial fibrosis and left ventricular hypertrophy, and HFpEF is commonly associated with obesity, diabetes, hypertension, renal dysfunction and other diseases, but how these comorbidities cause structural and functional damage to the heart is not completely clear. Recent studies have shown that immune inflammatory response plays a vital role in the progression of HFpEF. This review focuses on the latest research progress in the role of inflammation in the process of HFpEF and the potential application of anti-inflammatory therapy in HFpEF, hoping to provide new research ideas and theoretical basis for the clinical prevention and treatment in HFpEF.

Key words: heart failure with preserved ejection fraction; inflammation; left ventricular diastolic dysfunction; endothelial dysfunction

收稿日期：　　录用日期：

通讯作者：曲爱娟　　E-mail: aijuanqu@ccmu.edu.cn

引用本文：

张琦, 陈芸儿, 祝欣欣, 王霞, 曲爱娟. 炎症在射血分数保留型心力衰竭中的作用研究进展[J]. 生理学报 2023; 75 (3): 390-402.

ZHANG Qi, CHEN Yun-Er, ZHU Xin-Xin, WANG Xia, QU Ai-Juan. The role of inflammation in heart failure with preserved ejection fraction. Acta Physiol Sin 2023; 75 (3): 390-402 (in Chinese with English abstract).