Kalp yetersizliğinin farmakolojik tedavisinde güncel yaklaşımlar: nöroendokrin ve immün yanıtın baskılanması
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Date
2003-02-04
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Uludağ Üniversitesi
Abstract
Kalp yetersizliği (KY) kalp kasının fonksiyonlarının ve nörohormonal düzenin bozulmasına bağlı olarak dokuların metabolik ihtiyaçlarını karşılamakta yetersiz kaldığı bir klinik sendromdur. Bugün tedavide esas amaç, fizyopatolojiye dayanarak kalp yetersizliğine neden olan ve kötüleştiren olaylar zincirini durdurmaktır. Birinci basamak tedavide kullanılmakta olan anjiyotensin dönüştürücü enzim inhibitörleri, beta blokerlerin bu amaca hizmet ederek mortalite ve morbiditeyi ciddi anlamda azalttığı çok sayıda büyük çalışma ile gösterilmiş olup, anjiyotensin II tip 1 reseptör blokerleri, endotelin blokajı, nötral endopeptidazların inhibisyonu, natriüretik peptidler ve immün yanıtı baskılayan ajanların kullanımı henüz netlik kazanmamasına rağmen pilot çalışmalarla faydalı etkileri gösterilmiştir. Bu derlemede KY’nin kanıta dayalı tedavisi ile birlikte nöroendokrin ve immün yanıtın baskılanmasına yönelik yeni yaklaşımlar gözden geçirilmiştir.
Heart failure is a clinical syndrome in which the heart muscle is insufficient to supply the metabolic demands of the tissues due to its impaired neurohormonal state as well as functions. Today, by taking the physiopathology into consideration, the main aim of the therapy is to terminate chain reaction causing and exacerbating the heart failure. In working towards the aim stated above, it was shown in many large-scaled trails that the angiotensin-converting enzyme inhibitors and beta blockers, which are utilized as the first step in therapy, reduce mortality and morbidity rates. Angiotensin receptor blockers, endothelin receptor antagonists, neutral endopeptidase inhibitors, natriuretic peptides and immune suppressing agents showed beneficial effects in pilot trials, however their necessity is not clear. In this review, evidence based treatment of congestive heart failure and new approaches for the inhibition of neuroendocrine and immune responses were evaluated.
Heart failure is a clinical syndrome in which the heart muscle is insufficient to supply the metabolic demands of the tissues due to its impaired neurohormonal state as well as functions. Today, by taking the physiopathology into consideration, the main aim of the therapy is to terminate chain reaction causing and exacerbating the heart failure. In working towards the aim stated above, it was shown in many large-scaled trails that the angiotensin-converting enzyme inhibitors and beta blockers, which are utilized as the first step in therapy, reduce mortality and morbidity rates. Angiotensin receptor blockers, endothelin receptor antagonists, neutral endopeptidase inhibitors, natriuretic peptides and immune suppressing agents showed beneficial effects in pilot trials, however their necessity is not clear. In this review, evidence based treatment of congestive heart failure and new approaches for the inhibition of neuroendocrine and immune responses were evaluated.
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Keywords
Konjestif kalp yetersizliği, Congestive heart failure, Yeni tedaviler, Novel therapy, Anjiyotensin reseptör blokerleri, Angiotensin receptor blockers, Endotelin reseptör antagonistleri, Endothelin receptor antagonists, Natriüretik peptitler, Nötral endopeptidaz inhibitörleri, Neutral endopeptidase inhibitors, Natriuretic peptides
Citation
Aydın, A. vd. (2002). "Kalp yetersizliğinin farmakolojik tedavisinde güncel yaklaşımlar: nöroendokrin ve immün yanıtın baskılanması" Uludağ Üniversitesi Tıp Fakültesi Dergisi, 28(3),115-120.