概述CHF的病理生理学 cHF时β受体的信号传导变化 β受体密度 Gs蛋白数量或和活性↓ GRKs(G蛋白偶联受体激酶)活性个
CHF时 受体的信号传导变化 - 1 受体密度 - Gs 蛋白数量或/和活性 11 概述-CHF的病理生理学 - GRKs（G蛋白偶联受体激酶）活性
CHF的治疗策略 A抑制RAAS:ACEs,ARBs,醛固酮拮抗剂 B降低交感神经活性:ACEs,β blockers C降低循环血容量:利尿药 D增强心肌收缩力:强心苷类,PDEⅢ抑制剂,其他正性肌 力药物 E扩血管药:血管扩张药
CHF的治疗策略 A 抑制RAAS：ACEIs, ARBs, 醛固酮拮抗剂 B 降低交感神经活性： ACEIs, β blockers C 降低循环血容量：利尿药 D 增强心肌收缩力：强心苷类, PDE III 抑制剂, 其他正性肌 力药物 E 扩血管药：血管扩张药 12
ACEIs and arbs ACEIs Captopril(卡托普利), enalapril(依那普利) lisinopril(赖诺普利), benazepril(贝那普利) fosinopril(福辛普利),etc ARBS Losartan(氯沙坦), valsartan(缬沙坦) erbesartan(厄贝沙坦), candesartan(坎地沙 坦, telmisartan(替米沙坦),etc
ACEIs Captopril (卡托普利), enalapril (依那普利), lisinopril (赖诺普利), benazepril (贝那普利), fosinopril (福辛普利), etc. ACEIs and ARBs 13 ARBs Losartan (氯沙坦), valsartan (缬沙坦), erbesartan (厄贝沙坦), candesartan (坎地沙 坦), telmisartan (替米沙坦), etc
ACEIs and arBs Angiotensinogen血管紧张素原 Kininogen激肽原 Renin Kallikrein 激肽释放酶 Increased prostaglandin and No Angiotensin I Bradykinin synthesis Converting enzyme Chymase (kininase Angiotensin ll Inactive AT2 receptor AT, receptor Vasodilation Vasoconstriction Vasodilation Inhibition of cell growth Sympathetic Activation anti-proliferation, Apoptosis Cell growth anti-hypertrophy Sodium and fluid retention
Chymase 激肽释放酶 血管紧张素原 激肽原 and NO Vasodilation, anti-proliferation, anti-hypertrophy ACEIs and ARBs
ACEs and arBs ACEIs Actions ◆抑制Ang合成( dilate vessels, decrease sympathetic activity, protect renal and cardiac function inhibit release of aldosterone, anti-hypertrophy) ◆抑制缓激肽降解( vasodilation,anti- ypertrophy, myocardial protection, improvement of insulin receptor sensitivity) 15
ACEIs Actions 抑制Ang II合成 (dilate vessels, decrease sympathetic activity, protect renal and cardiac function, inhibit release of aldosterone, anti-hypertrophy) 抑制缓激肽降解 (vasodilation, antihypertrophy, myocardial protection, improvement of insulin receptor sensitivity) ACEIs and ARBs 15