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射血分数保留的心力衰竭合并抑郁的临床治疗进展

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刘先玲 ，洪牮 ，王凯 ，钱丽君 ，孙燕 ，马文杰 ，李钟鸣 ，许迪 1* 扫描二维码
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【摘要】 射血分数保留的心力衰竭（HFpEF）是心力衰竭（HF）的一种常见类型，由于其病理生理机制不同，
以往将针对射血分数减低的心力衰竭（HFrEF） 的治疗方法应用于 HFpEF 患者的疗效并不理想，以致患者预后差、
病死率高。抑郁是由各种原因引起的、以明显而持久的情绪低落为主要临床特征的一类常见的精神心理疾病。抑郁患
者常伴有不同程度的认知和行为改变，病情严重者甚至会出现自伤、自杀行为。随着对 HFpEF 的深入研究，人们发
现抑郁已成为 HFpEF 常见的合并症之一，且两者的相互作用可导致患者预后不良。目前有关 HFpEF 合并抑郁的研究
表明，部分药物可改善此类患者短期症状及临床预后。本文通过总结、归纳 HFpEF 合并抑郁的共病机制、研究现况
及相关治疗的最新进展，发现钠 - 葡萄糖协同转运蛋白 2（SGLT2）抑制剂、血管紧张素受体脑啡肽酶抑制剂（ARNI）、
他汀类药物在治疗 HF 及精神心理领域方面扮演着重要角色，不仅能改善 HFpEF 患者心功能及其预后，还具有抗抑郁
的效果，能为临床研究及治疗提供参考。
【关键词】 心力衰竭；抑郁；共病现象；射血分数保留的心力衰竭；临床治疗；综述
【中图分类号】 R 541.62 【文献标识码】 A DOI：10.12114/j.issn.1007-9572.2022.0315
刘先玲，洪牮，王凯，等 . 射血分数保留的心力衰竭合并抑郁的临床治疗进展［J］. 中国全科医学，2022，25（33）：
4196-4202. ［www.chinagp.net］
LIU X L，HONG J，WANG K，et al. Progress in clinical treatment of heart failure with preserved ejection fraction
combined with depression［J］. Chinese General Practice，2022，25（33）：4196-4202.

Progress in Clinical Treatment of Heart Failure with Preserved Ejection Fraction Combined with Depression LIU
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Xianling ，HONG Jian ，WANG Kai ，QIAN Lijun ，SUN Yan ，MA Wenjie ，LI Zhongming ，XU Di 1*
1.Department of Geriatrics，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
2.Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
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Corresponding author：XU Di，Professor，Chief Physician，Doctoral Supervisor；E-mail：xudi@jsph.org.cn
【Abstract】 Heart failure with preserved ejection fraction（HFpEF） is a common type of heart failure（HF），
and previous treatments that primarily target heart failure with reduced ejection fraction（HFrEF）do not benefit the patients
with HFpEF because of the differences in their pathophysiological mechanisms，resulting in high mortality and poor prognosis.
Whereas depression is one of the most common mental and psychological problems，caused by various reasons and characterized
by a pronounced and long-lasting low spirits，with various degrees of cognitive and behavioral changes. Those who are severely ill
even present self-injurious and suicidal behavior. With intensive research into HFpEF，it has emerged that depression has become
one of the most common comorbidities in HFpEF and that the two interact to contribute to poor prognosis for patients. Currently，
relevant studies in HFpEF with depression suggested that some drugs could improve short term symptoms and clinical prognosis in
such patients. This paper aimed to review the comorbid mechanism，research status and the latest progress of related treatment of
HFpEF complicated with depression. It is found that sodium glucose cotransporter 2（SGLT2） inhibitors，angiotensin receptor
enkephalinase inhibitors（ARNI） and statin drugs play important roles in the field of HF and psychophysiology. They can not
only improve the cardiac function and prognosis of HFpEF patients，but also have the effect of anti-depression，thus to provide
references for clinical study and treatment.
【Key words】 Heart failure；Depression；Comorbidity；Heart failure with preserved ejection fraction；Clinical
treatment；Review

基金项目：国家自然科学基金资助项目（81871359）
1.210029 江苏省南京市，南京医科大学第一附属医院老年医学科
2.210029 江苏省南京市，南京医科大学第一附属医院心血管内科
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通信作者：许迪，教授，主任医师，博士生导师；E-mail：xudi@jsph.org.cn
本文数字出版日期：2022-06-20