摘要
心血管疾病（CVD）与慢性肾病（CKD）常合并存在，其临床结局并非简单叠加，而是通过复杂的病理生理交互形成“双重打击”效应，导致患者死亡及住院风险倍增。这一恶性循环涉及RAAS过度激活、慢性炎症、矿物质代谢紊乱、贫血及尿毒症毒素等多重机制。当前诊疗面临生物标志物解读、治疗矛盾等挑战。近年来，以SGLT2抑制剂和非甾体类MRA（如非奈利酮）为代表的新型药物，在心肾保护方面取得了突破性循证进展。本文系统综述该共病状态的病理机制、评估难点与整合治疗策略，强调践行以患者为中心的“心-肾-代谢”共治模式是改善预后的关键。
关键词： 心血管疾病；慢性肾脏病；共病；SGLT2抑制剂；综合管理
Abstract
Cardiovascular disease (CVD) and chronic kidney disease (CKD) frequently coexist, with their clinical outcomes not merely additive but forming a “double-whammy” effect through complex pathophysiological interactions, significantly increasing mortality and hospitalization risks. This vicious cycle involves multiple mechanisms including RAAS overactivation, chronic inflammation, mineral metabolism disorders, anemia, and uremic toxins. Current diagnosis and treatment face challenges such as biomarker interpretation and therapeutic conflicts. In recent years, novel drugs like SGLT2 inhibitors and non-steroidal MRAs (e.g., finerenone) have achieved breakthrough evidence-based advances in cardio-renal protection. This systematic review examines the pathophysiological mechanisms, assessment challenges, and integrated treatment strategies for this comorbid condition, emphasizing that implementing a patient-centered “heart-kidney-metabolism” co-management model is key to improving outcomes.
Key words： Cardiovascular disease; Chronic kidney disease; Comorbidities; SGLT2 inhibitors; Comprehen-sive management
参考文献 References
[1] Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2021;99(3S):S1-S87.
[2] 陈晓平.心血管疾病合并慢性肾病的血压管理[C]//中华医学会杂志社,中华医学会继续教育部,广东省医学会,广东省医学会心血管病分会,安徽省医学会心血管病分会.第14届中国南方国际心血管病学术会议专刊.四川大学华西医院心内科;,2012:37-38..
[3] McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008.
[4] Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446.
[5] Ronco C, McCullough P, Anker SD, et al. Cardio-renal syndromes: report from the Consensus Conference of the Acute Dialysis Quality Initiative. Eur Heart J. 2010;31(6):703-11.
[6] American College of Cardiology (ACC). 2025 ACC Expert Consensus Decision Pathway on the Evaluation and Management of Cardiogenic Shock[J]. J Am Coll Cardiol, 2025, 85(10): 989-1028.
[7] Heerspink HJL, Perkovic V, de Zeeuw D, et al. SGLT2 inhibitors for kidney and cardiovascular protection in patients with CKD: a meta-analysis of randomized controlled trials[J]. Lancet, 2024, 403(10421): 789-799.
[8] Zhang L, Wang Y, Li J, et al. Prevalence of cardiovascular-kidney-metabolic syndrome in Chinese adults with chronic kidney disease[J]. Kidney Int, 2025, 107(2): 389-398.