透析中的心脏和血管系统
Christoph Wanner1, Kerstin Amann2, Tetsuo Shoji3
1Comprehensive Heart Failure Center and Renal Division, University Hospital of Würzburg, Würzburg, Germany.
Lancet (London, England)
|May 27, 2016
概括
病加速心脏和血管衰老,导致显著的心脏功能障碍和透析患者的死亡率增加. 需要进行新的大规模试验,以在置换治疗期间有效的心脏保护策略.
科学领域:
- 肝脏病学
- 心脏病学
- 血管生物学
背景情况:
- 功能下降和置换疗法 (RRT) 导致主要的心血管变化.
- 接受RRT的患者表现出加快的心血管衰老,包括左心室缩,功能障碍,纤维化和血管疾病 (动脉样硬化,动脉样硬化).
- 流体过载和高血压是心脏问题的主要驱动因素,而内透析应激会加剧心脏骤停的风险.
研究的目的:
- 总结需要RRT的功能下降的患者的心血管结构和功能变化.
- 突出加快衰老的表型和心血管死亡率的增加.
- 强调当前药物干预的局限性以及大规模心脏保护试验的必要性.
主要方法:
- 对与脏疾病和RRT相关的心血管变化的审查.
- 分析风险因素,包括液体过载,高血压和内透析压力.
- 关于药物干预的现有试验限制的评估.
主要成果:
- 显著的左心室缩,扩张,静心/腹功能障碍和心肌纤维化是普遍存在的.
- 受动脉样硬化和动脉样硬化影响的血管树,介质化.
- 与一般人群相比,心脏和血管死亡率显著上升,特别是在年轻患者中.
结论:
- 在RRT患者中,心血管疾病模仿加速衰老和潜在心力衰竭.
- 目前的药物干预措施 (如他类药物) 存在局限性.
- 专注于心脏活性干预的大型实用试验对于在RRT中有效的心脏保护至关重要.
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