在急性心力衰竭中以尿为导向的利尿疗法:一个务实的随机试验
Jozine M Ter Maaten1, Iris E Beldhuis2, Peter van der Meer2
1Department of Cardiology, University Medical Center Groningen, University of Gronigen, Groningen, the Netherlands. j.m.ter.maaten@umcg.nl.
Nature medicine
|August 28, 2023
概括
在急性心力衰竭患者中, natriuresis 指导治疗改善了24小时的尿路分泌. 然而,与标准护理相比,这种方法并没有显著降低死亡率或心力衰竭再入院.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床试验 临床试验
背景情况:
- 尿测量是评估急性心力衰竭 (AHF) 中尿液治疗反应的潜在生物标志物.
- 个性化利尿疗法可能会改善AHF患者的治疗结果.
研究的目的:
- 为了评估是否 natriuresis引导的利尿剂治疗改善 natriuresis 和 AHF 患者的临床结果.
- 为了在AHF管理中比较 natriuresis引导治疗与标准护理 (SOC).
主要方法:
- 一项务实,开放的试验,涉及310名AHF患者,接受静脉循环利尿剂治疗.
- 患者被随机分配到自然导疗法或SOC.
- 尿导向治疗涉及基于尿液位水平 (<70 mmol/L) 的治疗强化.
主要成果:
- 与SOC手臂 (345 ± 202 mmol;P=0.0061) 相比,尿导向手臂的24小时尿路分泌量 (409 ± 178 mmol) 显著增加 (345 ± 202 mmol;P=0.0061).
- 在两组之间 (180天后) 在所有原因死亡率或心力衰竭再住院时间的综合终点上没有显著差异 (31%在两组中).
结论:
- 在AHF患者中,以纳瑞斯为导向的治疗成功增强了纳瑞斯.
- 目前的证据不支持 natriuresis-guided治疗对SOC的死亡率或再住院的显著临床益处.
- 需要进一步的研究,以建立自然导疗法作为AHF的个性化治疗策略.
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