Những tiến bộ trong điều trị suy tim
Tóm tắt
Suy tim cấp và suy tim mạn là một trong các nguyên nhân gây tử vong hàng đầu trên thế giới và ở Việt Nam. Cho đến nay, đã có nhiều đột phá trong nghiên cứu tìm hiểu cơ chế bệnh sinh của suy tim ở mức phân tử và đã có nhiều tiến bộ trong chẩn đoán và điều trị suy tim.
Vai trò của các marker sinh học trong suy tim.Marker sinh hoc NTpro-BNP đóng vai trò quan trọng trong chẩn đoán và tiên lượng bệnh nhân suy tim, nhất là đối với suy tim với phân số tống máu bảo tồn (HFpEF) và suy tim với phân số tống máu ở mức trung gian HFmrEF[1]. Gần đây, đã ra đời các marker sinh học mới nâng cao độ chính xác của chẩn đoán và giúp tăng cường hiệu quả lâm sàng của điều trị suy tim. Yếu tố biệt hoá tăng trưởng GDF-15 (growth-differentiation factor-15), một cyto-kine liên quan đến yếu tố tăng trưởng chuyển dạng đáp ứng với stress là một marker sinh học mới của bệnh tim mạch[2]. Nồng độ lưu hành trong máu của GDF-15 tăng dự báo biến chứng của hội chứng vành cấp và tiên lượng biến cố ở cả các bệnh nhân suy tim trái và và các bệnh nhân suy tim phải. Điều này cho thấy vai trò tiên lượng quan trọng của các marker về sinh hoá đối với lâm sàng tim mạch[3-5]. Bên cạnh đó, GDF-15 không chỉ là marker sinh học về suy tim mà còn là yếu tố tiên lượng trong các bệnh lý khác như ung thư[3,5-8]. Một peptid khác, osteoponin cũng được chứng minh là yếu tố tiên lượng độc lập trong suy tim và các bệnh nội khoa nặng khác[9,10]. Nồng độ Galectin-3, một marker sinh học khác về tình trạng viêm và xơ hoá cũng có mối tương quan với khả năng gắng sức ở các bệnh nhân suy tim với phân số tống máu bảo tồn, độc lập với nồng độ NT-proBNP[11]. Troponin, một marker chẩn đoán hội chứng vành cấp cũng có giá trị tiên lượng biến cố ở các bệnh nhân suy tim, tương tự như BNP[12,13]. Các nghiên cứu mới đây về di truyền học cho thấy ARNs là một marker sinh học tiềm năng về suy tim[16,17,18].
Tài liệu tham khảo
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