李 欢,黄维义

急性心肌梗死后心室重构的治疗策略，已由神经内分泌抑制（ACEI/ARB、β受体阻滞剂、MRA）拓展到兼顾器官保护（ARNI、SGLT2抑制剂）的综合干预模式，在一定程度上改善患者预后。近年来，研究关注点进一步延伸至代谢调控（FGF21）、基因层面干预（miRNA）、免疫微环境调节及中医药多靶点整合作用等方向。相关探索正朝向更加精准的治疗策略发展，但在临床应用中仍面临递送效率、靶点选择及个体差异等方面的挑战。

急性心肌梗死；心室重构；研究进展；精准治疗

[1] PFEFFER M A,BRAUNWALD E,MOYE L A,et al.Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.Results of the survival and ventricular enlargement trial.The SAVE Investigators[J].N Engl J Med, 1992,327(10):669–77. [2] DARGIE H J.Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction:the CAPRICORN randomised trial[J].Lancet,2001,357(9266):1385–90. [3] PITT B,ZANNAD F,REMME W J,et al.The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators[J].N Engl J Med,1999,341(10):709–17. [4] PETRIE M C,VERMA S,DOCHERTY K F,et al.Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients With Heart Failure With and Without Diabetes[J].JAMA,2020,323(14):1353–68. [5] RUAN C C,KONG L R,CHEN X H,et al.A(2A)Receptor Activation Attenuates Hypertensive Cardiac Remodeling via Promoting Brown Adipose Tissue-Derived FGF21[J].Cell Metab,2018,28(3):476–89 e5. [6] KAWAKAMI R,SUNAGA H,ISO T,et al.Ketone body and FGF21 coordinately regulate fasting-induced oxidative stress response in the heart[J].Sci Rep,2022,12(1):7338. [7] SUNAGA H,KOITABASHI N,ISO T,et al.Activation of cardiac AMPK-FGF21 feed-forward loop in acute myocardial infarction:Role of adrenergic overdrive and lipolysis byproducts[J].Sci Rep,2019,9(1):11841. [8] GENG L,LAM K S L,XU A.The therapeutic potential of FGF21 in metabolic diseases:from bench to clinic[J].Nat Rev Endocrinol, 2020,16(11):654–67. [9] MATSUMOTO S,SAKATA Y,SUNA S,et al.Circulating p53-responsive microRNAs are predictive indicators of heart failure after acute myocardial infarction[J].Circ Res,2013,113(3):322–6. [10] LIU N,XIE L,XIAO P,et al.Cardiac fibroblasts secrete exosome microRNA to suppress cardiomyocyte pyroptosis in myocardial ischemia/reperfusion injury[J].Mol Cell Biochem,2022,477(4):1249–60. [11] BANG C,BATKAI S,DANGWAL S,et al.Cardiac fibroblast-derived microRNA passenger strand-enriched exosomes mediate cardiomyocyte hypertrophy[J].J Clin Invest,2014,124(5):2136–46. [12] TOMIMARU Y,EGUCHI H,WADA H,et al.Surgical Outcomes of Liver Resection Combined with Inferior Vena Cava Resection and Reconstruction with Artificial Vascular Graft[J].Dig Surg,2019,36(6):502–8. [13] LI L,CAO J,LI S,et al.M2 Macrophage-Derived sEV Regulate Pro-Inflammatory CCR2(+)Macrophage Subpopulations to Favor Post-AMI Cardiac Repair[J].Adv Sci(Weinh),2023,10(14):e2202964. [14] XIA N,JIAO J,TANG T T,et al.Activated regulatory T-cells attenuate myocardial ischaemia/reperfusion injury through a CD39-dependent mechanism[J].Clin Sci(Lond),2015,128(10):679–93. [15] ZACCHIGNA S,MARTINELLI V,MOIMAS S,et al.Paracrine effect of regulatory T cells promotes cardiomyocyte proliferation during pregnancy and after myocardial infarction[J].Nat Commun,2018,9(1):2432. [16] CHENG S,ZHANG X,FENG Q,et al.Astragaloside IV exerts angiogenesis and cardioprotection after myocardial infarction via regulating PTEN/PI3K/Akt signaling pathway[J].Life Sci,2019,227:82–93. [17] 陈芬燕,郭韧,张毕奎｡丹参酮ⅡA的心血管药理作用研究进展[J].中国中药杂志,2015,40(09):1649–53. [18] WANG Y,FU M,WANG J,et al.Qiliqiangxin Improves Cardiac Function through Regulating Energy Metabolism via HIF- 1alpha- Dependent and Independent Mechanisms in Heart Failure Rats after Acute Myocardial Infarction[J].Biomed Res Int,2020, 2020:1276195.

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