Empagliflozin

扩张型心肌病是一种异质性心肌病，以心室扩大和心肌收缩功能降低为特征。近年来，随着基因组学、分子生物学及临床研究的进展，扩张型心肌病的病因和病理生理机制逐渐得到更深刻的理解，尤其是在遗传因素、信号通路以及早期病理变化的研究上取得了显著突破。这些进展不仅为该疾病的早期诊断提供了新的思路，也为新型治疗方法的研发奠定了基础。 近日，第35届长城心脏病大会在北京国际会议中心隆重召开。作为心血管领域的重要学术盛会，长城心脏病大会汇聚了来自全球的顶尖专家学者，共同探讨心血管疾病的最新研究成果和治疗进展。在本次大会中，梅斯医学特邀来自四川大学华西医院的陈玉成教授分享了关于扩张型心肌病的最新研究进展及未来的治疗方向。 梅斯医学：近年来，扩张型心肌病在病因学、病理生理学方面有哪些最新的研究进展？ 陈玉成教授：扩张型心肌病是一类病因复杂、表现多样的心脏疾病。尽管其症状表现为心脏扩张和收缩功能下降，但其具体病因仍然十分复杂。过去，我们就已认识到遗传因素可能在扩张型心肌病中起到关键作用。随着二代基因测序技术的发展，我们对不同基因引发的扩张型心肌病的临床表型和临床表现有了更深刻的理解。例如，FLNC、DSP等特定基因与扩张型心肌病的发生有着密切关联，且这些突变所引起的疾病往往更容易导致猝死，对药物治疗反应较差。因此，近年来我们对扩张型心肌病的遗传特征有了更加深入的认识。 在病理生理学方面，扩张型心肌病具有多个亚型，这些亚型反映了疾病的早期和晚期病理改变。例如一些患者在早期阶段表现为心脏功能减退，但尚未出现明显的左心室扩张。另一部分患者在早期阶段出现心脏扩张，但心脏功能尚未明显受损，甚至有些患者在早期阶段，尽管心脏功能相对正常，但已经存在明显的心肌纤维化改变。此外，近年来，扩张型心肌病研究取得了重要进展，发现了多种新的信号通路，这些发现为新药研发和治疗方法的创新提供了理论基础。未来，随着这些研究的深入，有望为扩张型心肌病患者带来更多有效的治疗选择，改善患者预后和生活质量。 梅斯医学：目前有哪些新型治疗方法和药物被应用于扩张型心肌病的治疗？这些新方法和药物的疗效和安全性如何？ 陈玉成教授：扩张型心肌病所导致的心力衰竭，通常伴随射血分数（EF）下降，这也是EF下降性心衰治疗中的一个典型亚类。因此，近年来在EF下降性心衰的药物治疗中，从传统的“金三角”到如今的“四联疗法”，我们见证了许多重要药物的创新发展。例如，SGLT-2抑制剂（如恩格列净、达格列净）已经在EF下降性心衰以及冠心病伴随收缩功能受损的患者中，展示了显著的心脏重构改善和心肌愈合效果。另外，可溶性鸟苷酸环化酶激动剂（如利奥西呱、维利西呱）近年来也显示出对EF下降性心衰，尤其是在扩张型心肌病患者中的良好疗效，能够有效改善心肌愈合。尽管临床上已有充足的研究支持这些药物的有效性，但针对扩心病的特定基因突变和生理特征，目前仍有许多新的进展。例如，针对特定信号通路的小分子药物目前正在进行二期和三期临床试验，这些药物显示出对改善扩张型心肌病患者射血分数下降的显著逆转作用。 针对一些特定致病基因（如DSP基因、FLNC基因突变）导致的心脏功能损害，目前国内外正在积极探索基因水平的修复和干预技术。基因治疗和基因编辑技术，尤其是在国家重点研发计划的支持下，正在取得突破性进展。在最新发布的心肌病治疗指南中，针对扩心病的治疗方法也不断推陈出新，包括细胞治疗和免疫吸附治疗。随着这些新技术和新药物的快速发展，我们有理由相信，未来扩张型心肌病的治疗将朝着更加精准和个体化的方向发展。 梅斯医学：未来，扩张型心肌病可能会朝哪个方向发展？ 陈玉成教授：扩张型心肌病的诊疗依然面临巨大的发展空间。尽管近年来药物治疗和治疗技术取得了显著进展，但患者的远期生存率仍不容乐观。根据我们团队的最新队列研究，扩张型心肌病的高发年龄大多集中在30至40岁之间，目前的治疗方法使得患者在10年内的生存率仍然不到70%。这意味着，约30%的患者将在10年内因病情加重而死亡。因此，探索新的治疗技术依然是当务之急。未来的治疗技术研发，将依赖于我们对扩心病病因和病理生理机制的进一步理解，尤其是通过深入探究扩张型心肌病发生发展机制，才能找到更多新的治疗靶点。 从未来发展趋势来看，扩张型心肌病的研究将朝着更加精准和高效的方向发展，尤其是对遗传因素和环境因素的交互作用进行深入探讨。其次，更精准的诊断和风险评估。目前影像学技术已经在扩张型心肌病的诊断和风险评估中展现出显著优势。MRI能够更精确地评估心脏结构和功能，实现对患者风险的分层评估。这一技术的应用将帮助医生对高风险患者进行早期干预，从而改善预后。在治疗方面，新兴的免疫治疗、细胞治疗、基因治疗以及终末期扩心病的器械治疗技术，预计将在未来几年取得更快的发展。这些新的治疗方案有望为扩张型心肌病患者带来更高效的治疗效果，从而显著提高患者的远期生存率。 总之，扩张型心肌病的治疗正在朝着个体化和精准化方向发展。从SGLT-2抑制剂到可溶性鸟苷酸环化酶激动剂等创新药物，再到基因治疗和细胞治疗的应用，新的治疗方法为患者带来了新的希望。然而，尽管取得了巨大的进展，但扩张型心肌病的远期生存率仍面临挑战，特别是高危患者的管理仍需加强。未来，随着对扩张型心肌病病因及病理生理机制的深入研究和新技术的不断进步，对扩张型心肌病的诊断、治疗和风险评估将变得更加精准，未来将显著改善患者的生存率和生活质量。 撰文 | 阿拉斯加宝 编辑 | 阿拉斯加宝 ●猪牛羊肉吃太多，患癌风险大增！每天多吃70g红肉，结直肠癌发生率高32%，背后机制首次明确！ ●重磅！一堆硕博医生缝合结扎都不熟练，现学现卖！科主任愤怒要求：每月给年轻医生搞一次外科基本功培训！新一代医生技能普遍偏弱令人担忧 ●震撼！患者抱怨“科室有9个医生，咋还让我等2个小时！”医生：9个医生很少，活干不完，等不来8小时工作制… 版权说明：梅斯医学（MedSci）是国内领先的医学科研与学术服务平台，致力于医疗质量的改进，为临床实践提供智慧、精准的决策支持，让医生与患者受益。欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。 点击下方「阅读原文」 立刻下载梅斯医学APP！

MONDAY, Nov. 11, 2024 -- The weight-loss drug Ozempic can help reduce stroke patients’ risk of a heart attack or death, a new study says. GLP-1 weight-loss drugs like Ozempic or SGLT2 diabetes medications like Jardiance or Farxiga both helped protect the health of people following a stroke, researchers found. Patients taking either a GLP-1 or SGLT2 drug had a 74% lower risk of death and an 84% lower risk of a heart attack within an average three years after their stroke, results show. SGLT2 drugs also were associated with a 67% lower risk of a second stroke, researchers report. “Unfortunately, a quarter of people who survive a stroke will have another stroke, and they are also at risk for other cardiovascular events such as a heart attack since many of the risk factors of a stroke are also associated with other forms of heart disease,” said lead researcher Dr. Ali Sheffeh , an internal medicine physician and research scholar at the Mayo Clinic in Rochester, Minn. “Managing these risks, as well as looking at novel approaches to help lower the chances of another stroke, heart attack or death among this population are all critical steps in increasing stroke survival and improving the quality of life for people who have had a stroke,” Sheffeh added in a news release. For the study, researchers reviewed medical records for more than 7,000 adults treated for strokes caused by blood clots between January 2000 and June 2022 in Minnesota or Wisconsin. The team looked specifically at the potential benefits that might come from taking either a GLP-1 or SGLT2 drug after a stroke. GLP-1 drugs help manage diabetes and promote weight loss by mimicking the GLP-1 hormone, which works to control insulin and blood sugar levels, decrease appetite and slow digestion. SGLT2 drugs lower blood sugar levels by causing the kidneys to filter excess sugar from the body and excrete it in urine, researchers said in background notes. The death rate among stroke survivors who took either a GLP-1 or SGLT2 drug was under 12%, compared with 54% among patients who didn’t take either drug, researchers found. The rate of heart attacks among patients taking either medication was 1.5%, compared to 6% among patients taking neither, results show. “The results of the study are consistent with other research about the preventive role of these medications against cardiovascular disease in people with obesity or heart failure,” Sheffeh said. American Heart Association stroke expert Dr. Cheryl Bushnell said the findings jibe with what is known about the benefits of the two types of medication. “For several years now, we have seen from randomized controlled trials that SGLT2 inhibitors and GLP-1 receptor agonists have the ability to reduce the risk of cardiovascular disease, which includes stroke, heart attack and death,” Bushnell, vice chair of neurology research at Wake Forest University School of Medicine in Winston-Salem, N.C., said in a news release. “These new findings are in line with what we would expect, and we have seen that these outcomes are evident in patients with Type 2 diabetes and obesity and in patients with obesity without Type 2 diabetes,” Bushnell added. GLP-1 drugs not only promote weight loss, they’ve also been shown to help lower blood pressure and decrease the formation of plaques that clog arteries, Bushnell said. Both are risk factors for heart attack and stroke. “Another mechanism that could be very important for this current study is that GLP-1 receptor agonists can actually decrease clumping of blood platelets, and that, in itself, could decrease the risk of clotting and lead to a lower risk of stroke,” Bushnell said. “We need a clinical trial to know whether these SGLT2 inhibitors and GLP-1 receptor agonists could actually change practice, how we can help patients to prevent a second or recurrent stroke,” Bushnell added. “These medications could be really important, however, we just don't have that data yet.” Researchers presented the findings Monday at the American Heart Association’s annual meeting in Chicago. Because theses findings were presented at a medical meeting, they should be considered preliminary until published in a peer-reviewed journal. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.