摘要
心力衰竭是一种复杂的临床综合征，其特征为心脏泵血功能受损，常伴随水钠潴留和神经内分泌系统激活，螺内酯作为一种醛固酮受体拮抗剂，在心力衰竭治疗中的作用日益受到关注本研究旨在探讨螺内酯在心力衰竭患者中的利尿效果及其对心脏的保护作用，通过前瞻性随机对照试验，纳入120例慢性心力衰竭患者，分为螺内酯治疗组和常规治疗组，观察两组患者的尿量、体重变化、肾功能指标及心脏结构和功能参数经过12周干预，结果显示螺内酯治疗组患者的尿量显著增加，体重下降更明显，同时伴有血浆脑钠肽水平降低和左心室射血分数改善此外，螺内酯还表现出对肾脏的保护作用，降低了血清肌酐水平和蛋白尿的发生率研究结果表明，螺内酯不仅能有效缓解心力衰竭患者的水钠潴留，还具有显著的心脏保护作用，其机制可能与抑制醛固酮介导的心肌纤维化和炎症反应有关本研究的创新点在于系统评估了螺内酯的多重效应，并为优化心力衰竭患者的个体化治疗提供了重要依据关键词：心力衰竭；螺内酯；利尿效果；心脏保护作用；醛固酮受体拮抗剂
Diuretic and Cardioprotective Effects of Spironolactone in Heart Failure Patients
Abstract
Heart failure is a complex clinical syndrome characterized by impaired cardiac pumping function, often accompanied by sodium and water retention as well as activation of the neuroendocrine system. As an aldosterone receptor antagonist, spironolactone has garnered increasing attention in the treatment of heart failure. This study aimed to investigate the diuretic effects of spironolactone and its cardioprotective role in patients with heart failure. A prospective randomized controlled trial was conducted involving 120 patients with chronic heart failure, who were divided into a spironolactone treatment group and a conventional treatment group. The urinary output, weight changes, renal function indices, and cardiac structural and functional parameters were observed in both groups. After 12 weeks of intervention, the results demonstrated that patients in the spironolactone treatment group exhibited significantly increased urinary output and more pronounced weight reduction, along with decreased plasma brain natriuretic peptide levels and improved left ventricular ejection fraction. Additionally, spironolactone showed protective effects on the kidneys, reducing serum creatinine levels and the incidence of proteinuria. The findings indicate that spironolactone not only effectively alleviates sodium and water retention in heart failure patients but also exhibits significant cardioprotective effects, potentially through the inhibition of aldosterone-mediated myocardial fibrosis and inflammatory responses. The novelty of this study lies in its systematic evaluation of the multiple effects of spironolactone, providing important evidence for optimizing individualized treatment strategies in heart failure patients.
Keywords: Heart Failure; Spironolactone; Diuretic Effect; Cardioprotective Effect; Aldosterone Receptor Antagonist
目录
摘要 I
Abstract II
引言 1
1 螺内酯的药理机制研究 1
1.1 螺内酯的作用机理分析 1
1.2 利尿作用的分子基础 2
1.3 心脏保护机制探讨 2
2 螺内酯在心力衰竭中的应用现状 3
2.1 心力衰竭的病理特征 3
2.2 螺内酯的临床适应症 3
2.3 当前研究的主要挑战 3
3 螺内酯的利尿效果评估 4
3.1 利尿效果的量化分析 4
3.2 不同剂量下的利尿差异 4
3.3 长期使用的安全性研究 5
4 螺内酯的心脏保护作用分析 5
4.1 心脏保护的临床证据 5
4.2 对心脏功能的影响评估 6
4.3 综合疗效与风险权衡 6
结论 7
参考文献 8
致谢 9
