心肾间交互作用与急性心力衰竭时肾功能恶化的关系

发布时间：2018-03-14 07:43

本文选题：心肾综合征　切入点：心力衰竭　出处：《中国全科医学》2017年09期 　论文类型：期刊论文

【摘要】：在生理过程中,心脏和肾脏协同工作、相互补充和代偿另一个器官的功能,是维持循环系统稳定性最重要的两个器官。此时,两个器官中任何一个功能改变,势必影响另一个器官。这种稳定性的维持十分复杂,涉及对心肾功能间的精细调节和神经内分泌活性的控制,包括利钠肽家族、肾素-血管紧张素-醛固酮系统和交感神经系统。一个器官的功能损害或疾病可以引发、加重或直接参与另一个器官的功能损害和疾病进程,并形成恶性循环(互害)。另外,心肾间的相互作用还受到一些疾病或危险因素的共同作用,包括老化、高血压、糖尿病、动脉粥样硬化等(共病)。仅以动脉硬化为例,老化的机械应力引起的大动脉硬化本身就可以独立参与两个器官功能损害和疾病发生。然而,在进展期肾病中,血流动力学和神经内分泌的稳定性遭到破坏,容量负荷和压力负荷明显增加,心肾损伤的风险增大。与此同时,一些药物的清除和代谢也受到影响。所有这些因素对心肾疾病的共存埋下隐患,老年人尤为明显。当两类疾病共存时,病理损害效应显著放大,预示着不良预后,药物治疗需谨慎。因此,心肾疾病预防及诊疗一体化的理念,需要广泛地推广和普及。
[Abstract]:In physiological processes, the heart and kidney work together to complement and compensate for the function of the other organ, which is the most important organ to maintain the stability of the circulatory system. The maintenance of this stability is complex, involving the fine regulation of heart and kidney functions and the control of neuroendocrine activity, including the natriuretic peptide family. Renin-angiotensin-aldosterone system and sympathetic nervous system. Dysfunction or disease of one organ can cause, aggravate or directly participate in the functional damage and disease process of another organ, and form a vicious circle. Cardiorenal interactions are also affected by a combination of diseases or risk factors, including aging, hypertension, diabetes, atherosclerosis, etc. Atherosclerosis, caused by aging mechanical stress, itself can be independently involved in two organ dysfunction and disease. However, in advanced nephropathy, hemodynamics and neuroendocrine stability are destroyed. A significant increase in volume and pressure loads increases the risk of heart and kidney damage. At the same time, the clearance and metabolism of some drugs are also affected. All these factors pose a hidden danger to the coexistence of cardiorenal diseases. When the two kinds of diseases coexist, the pathological damage effect is magnified significantly, which indicates bad prognosis, and the drug treatment should be careful. Therefore, the idea of integrative prevention and diagnosis and treatment of heart and kidney diseases needs to be widely popularized and popularized.
【作者单位】：中国人民解放军总医院心血管内科;
【分类号】：R541.6

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