应激性心肌病研究进展

Research Progress in Stress Cardiomyopathy

摘要: 应激性心肌病(stress cardiomyopathy, SC)，又称为Takotsubo综合征，最早于1990年由日本佐藤等人提出，是一种以急性一过性左心室收缩功能障碍为特征的疾病，好发于老年女性。其临床表现与急性心肌梗死类似，支持性和对症药物治疗仍然是主要疗法。目前其可能的病理生理机制包括交感神经系统过度刺激、中枢神经系统的结构和功能改变、儿茶酚胺分泌、炎症反应、微血管功能障碍等。虽然以前认为这是一种良性的自限性疾病，但近期的研究表明，尽管左心室射血分数恢复正常，但许多人仍然有限制性症状。近年来SC的确诊率也在不断提高，备受国内外专家关注。本文将从流行病学、触发因素、病理生理学、临床特征、诊断标准、治疗、预后方面对该病进行综述，以提高临床对SC的认识。

Abstract: Stress cardiomyopathy (SC), also known as Takotsubo syndrome, was first proposed in 1990 by Sato et al. in Japan. It is a condition characterized by acute transient left ventricular systolic dysfunction and is more common in older women. The clinical presentation is similar to that of acute myocardial infarction, and supportive and symptomatic pharmacotherapy remains the mainstay of therapy. At present, the possible pathophysiological mechanisms include sympathetic nervous system hyperstimulation, structural and functional changes of the central nervous system, catecholamine secretion, inflammatory response, and microvascular dysfunction. Although previously thought to be a benign self-limiting condition, recent studies have confirmed that many people still have limiting symptoms despite a return to normal left ventricular ejection fraction. In recent years, the diagnosis rate of SC has been increasing, and it has attracted the attention of experts at home and abroad. This article will review the epidemiology, triggers, pathophysiology, clinical features, diagnostic criteria, treatment and prognosis of SC in order to improve the clinical understanding of SC.