李新立--心力衰竭治疗的新策略.pptx(芪苈基础与临床证据2015、5、30络病会)PPT.ppt

基础研究证据 Part I: Traditional Chinese Medication Qiliqiangxin attenuates cardiac remodeling after acute myocardial infarction in mice Tao L, Shen S, Fu S, et al. Sci Rep 2015;5:8374 (IF:5.578) QLQX improves cardiac function and preserves cardiomyocyte architecture QLQX decreases cardiac fibrosis QLQX attenuates cardiac apoptosis QLQX improves cardiac function and survival rate AMI via increasing PPARγ QLQX attenuates cardiac fibrosis and apoptosis via PPARγ QLQX provides beneficial effects in remodeling phase 临床意义 作为预防心肌梗死后心室重构导致心衰的治疗策略之一？（B阶段）（RAS/BB/Ald） Part II: Qiliqiangxin protects against cardiac ischemia-reperfusion injury via mTOR pathway Zhou YL, Fang H, Lin SH, et al. Cell Physiol Biochem 2015 in revision (IF:3.55) A. PCR B. C. Ang II CTL Part III: Qiliqiangxin attenuates cardiac hypertrophy by targeting miR-21(撰写中近期投稿 Unpublished Data) Figure 1 CTL Ang II CTL+QL Ang II+QL D. E. F. Figure 2 A. B. C. 心力衰竭治疗的新策略----芪苈强心基础与临床研究证据 CAD Hyp CM Valv LVD Remodeling Low EF Arrhythmias Death Pump Failure CHF Symptoms Non Cardiac Factors From Prof Jay Cohn USA 慢性心力衰竭治疗模式的历史沿革 40-60年代—心肾模式 强心、利尿 60-70年代—血流动力学 强心、利尿、扩血管 β受体激动剂 80年代以后—心室重构 阻滞神经内分泌过度激活、心肌重构 ACEI/ARB β受体阻滞剂 醛固酮受体拮抗剂 现在—器械及辅助装置 ICD CRT/CRTD LVAD 其它…… 将来—基因治疗 ; 细胞植入/ 再生 ; 异种移植; LCZ696,…WASHINGTON -- The first drug to demonstrate a mortality benefit when compared with enalapril for heart failure -- Entresto (sacubitril/valsartan), previously known as LCZ696 -- received FDA approval Tuesday（7.7）. 祖国医药? N Engl J Med. 1987;316:1429-1435. N Engl J Med. 1996;334:1349-1355. N Engl J Med. 1999;341:709-717. N Engl J Med. 1996;335:1933-1940. N Engl J Med. 2002;346:1845-1853. Drug Therapies Demonstrated to Reduce Mortality in HF ACEI/ARB β Blockers MRAs，盐皮质激素受体拮抗剂 Primary Outcomes of ACEI in HF N Engl J Med 1992;316:1429-1435. N Engl J Med 1991;325:293-302. N Engl J Med 1992;327:685-6914. Lancet 1993;342:821-28. N Engl J Med 1992;327 (10) :669-677 Circulation 1994;90:1731-3