目标剂量与目标剂量以下的ACE抑制剂和美国退伍军人患有HFrEF的功能衰竭风险较低
Amiya A Ahmed1,2, Frederick Lu1,3, Sijian Zhang3
1Veterans Affairs Medical Center, Washington, DC, USA.
European journal of heart failure
|March 9, 2026
概括
酶转化酶抑制剂 (ACEI) 降低了心力衰竭患者的功能衰竭风险,特别是那些患有晚期慢性病 (CKD) 患者. 生存益处是适度的,在没有晚期CKD的患者中观察到.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種神經病學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 减少喷射率 (HFrEF) 的心力衰竭患者往往同时患有慢性病 (CKD).
- 血管激素转化酶抑制剂 (ACEI) 和血管激素受体抑制剂 (ARB) 是HFrEF的标准治疗方法,改善结果,但可能影响功能.
- 目标剂量的ACEI和ARB对HFrEF患者,特别是晚期CKD患者的功能衰竭 (KF) 的影响需要进一步调查.
研究的目的:
- 评估目标剂量ACEI和ARB与HFrEF患者功能衰竭 (KF) 风险和全因死亡率的相关性.
- 专门研究晚期慢性病 (CKD) 患者的这些关联.
主要方法:
- 对154,945名具有HFrEF (EF≤40%) 和没有基线KF的退伍军人进行了回顾性队列研究.
- 为了比较目标剂量与低于目标剂量的启动,组建了两个倾向性得分匹配的队列 (ACEI和ARB).
- 用危险比率估计了5年KF和全因死亡率的结果.
主要成果:
- 在ACEI队列中,目标剂量与KF风险降低18%,死亡风险降低6%.
- 在基线eGFR<35毫升/分钟/1.73米2 (晚期CKD) 的患者中,目标剂量ACEI的KF风险降低显著.
- 目标剂量ACEI对EGFR≥35毫升/分钟/1.73m2的患者的死亡益处显著,但目标剂量ARB与结果没有显著关联.
结论:
- 目标剂量的ACEI,但不是ARB,与HFrEF患者的功能衰竭 (KF) 风险降低有关,特别是那些晚期CKD患者.
- 目标剂量的ACEI观察到适度的生存益处,仅限于没有晚期CKD的患者.
- 这些发现表明,优化ACEI剂量对晚期CKD的HFrEF患者的脏保护有潜在的益处.
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