沙库巴曲缬沙坦治疗左心室射血分数中间值心力衰竭患者临床疗效

doi:10.3969/j.issn.1004-583X.2021.05.006

摘要/Abstract

摘要：

目的探讨沙库巴曲缬沙坦(Sacubitril/Valsartan)对左心室射血分数中间值心力衰竭(Heart failure with mid-range ejection fraction, HFmrEF)的治疗效果。方法选取2019年8月至2020年8月收治的98例HFmrEF患者, 按照随机数字表法随机分为观察组与对照组,每组各49例。在常规抗心力衰竭治疗的基础上,观察组给予沙库巴曲缬沙坦钠治疗,对照组给予依那普利治疗,分别口服6个月。监测并比较患者试验前后相关心功能指标:N末端前体B型利钠肽(NT-proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、C-反应蛋白(CRP)、左心室射血分数(LVEF)、室间隔厚度(IVST)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、左心房内径(LAD)、NYHA分级、6 min步行试验(6MWT)、收缩压(SBP)以及不良事件等。结果两组治疗后NT-proBNP、sST-2、CRP水平较治疗前均降低,且观察组降低更明显(P<0.05)。两组治疗后LVEF升高,IVST、LVEDD、LVPWT、LAD降低,且观察组LVEF升高更明显,IVST、LVEDD、LVPWT、LAD降低更明显(P<0.05)。观察组6MWT、SBP及NYHA心功能分级改善情况明显优于对照组(P<0.05),且沙库巴曲缬沙坦能明显降低心力衰竭再入院率。结论沙库巴曲缬沙坦对左心室射血分数中间值心力衰竭患者的心功能有明显改善作用。

关键词: 心力衰竭, 心脏功能实验, 每搏输出量, 血管紧张素转换酶抑制药

Abstract:

Objective To investigate the clinical effect of sacubitril/valsartan for heart failure with mid-range ejection fraction(HFmrEF) in left ventricle. Methods Ninety-eight patients with HFmrEF in left ventricle who were recruited from August 2019 to August 2020 were randomly divided into observation group and control group with 49 cases in each group. On the basis of conventional anti-heart failure treatment, the observation group was treated with sacubitril/valsartan sodium, while the control group was treated with enalapril. All the medicines were taken orally for six months by patients in two groups, respectively. The related cardiac indexes were monitored and analyzed before and after the test, such as N-terminal pro-B-type natriuretic peptides(NT-proBNP), soluble growth stimulation expressed gene 2(sST2), C-reactive protein(CRP), left ventricular ejection fraction(LVEF), interventricular septal thickness(IVST), left ventricular end diastolic diameter(LVEDD), left ventricular posterior wall thickness(LVPWT), left atrial diameter(LAD), NYHA classification, 6-minute walk test(6MWT), systolic blood pressure(SBP), as well as the adverse events in two groups after treatment. Results After treatment, NT-proBNP, sST-2, and CRP in the two groups were all lower than those before treatment, and the observation group significantly decreased(P<0.05).LVEF showed an upward trend in the two groups after treatment, while IVST, LVEDD, LVPWT and LAD showed a downward trend in the two groups after treatment; the changes in the observation group were greater than those in the control group (P<0.05). The improvements of 6MWT, SBP and classification of NYHA heart function in the observation group were significantly better than those in the control group (P<0.05), and sacubitril/valsartan could significantly reduce the readmission rate of heart failure. Conclusion Sacubitril/valsartan for patients with HFmrEF in left ventricle can effectively improve cardiac function.

Key words: heart failure, heart function tests, stroke volume, angiotensin converting enzyme inhibitors

中图分类号:

R541.6

徐东蕊, 赵钦徽, 刘同祥. 沙库巴曲缬沙坦治疗左心室射血分数中间值心力衰竭患者临床疗效[J]. 临床荟萃, 2021, 36(5): 416-420.

Xu Dongrui, Zhao Qinhui, Liu Tongxiang. Clinical effect of sacubitril/valsartan for heart failure with mid-range ejection fraction in left ventricle[J]. Clinical Focus, 2021, 36(5): 416-420.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.05.006

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I5/416

图/表 6

参考文献 19

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项目	观察组 (n=49)	对照组 (n=49)	统计值	P值
年龄(岁)	66.6±13.6	69.4±12.8	t=1.065	0.290
男性[例(%)]	32(65.3)	27(55.1)	χ²=1.065	0.302
病程(年)	2.6±2.3	2.7±2.4	t=0.049	0.961
既往病史[例(%)]
冠心病	29(59.2)	26(53.1)	χ²=0.373	0.541
高血压	30(61.2)	27(55.1)	χ²=0.377	0.539
房颤	4(8.2)	6(12.2)	χ²=0.445	0.505
心肌病	12(24.5)	13(26.5)	χ²=0.054	0.817
糖尿病	11(22.4)	15(30.6)	χ²=0.838	0.360
吸烟[例(%)]	8(16.3)	11(22.4)	χ²=0.588	0.443
用药情况[例(%)]
硝酸酯类	16(32.7)	15(30.6)	χ²=0.047	0.828
利尿剂	19(38.8)	18(36.7)	χ²=0.043	0.835
β受体阻滞剂	22(44.9)	25(51.0)	χ²=0.368	0.544
洋地黄类	5(10.2)	3(6.1)	χ²=0.136	0.712
调脂药物	31(63.3)	27(55.1)	χ²=0.676	0.411
抗血小板药物	32(65.3)	27(55.1)	χ²=1.065	0.302
ARB类	5(10.2)	6(12.2)	χ²=0.102	0.749

项目	观察组 (n=49)	对照组 (n=49)	统计值	P值
年龄(岁)	66.6±13.6	69.4±12.8	t=1.065	0.290
男性[例(%)]	32(65.3)	27(55.1)	χ²=1.065	0.302
病程(年)	2.6±2.3	2.7±2.4	t=0.049	0.961
既往病史[例(%)]
冠心病	29(59.2)	26(53.1)	χ²=0.373	0.541
高血压	30(61.2)	27(55.1)	χ²=0.377	0.539
房颤	4(8.2)	6(12.2)	χ²=0.445	0.505
心肌病	12(24.5)	13(26.5)	χ²=0.054	0.817
糖尿病	11(22.4)	15(30.6)	χ²=0.838	0.360
吸烟[例(%)]	8(16.3)	11(22.4)	χ²=0.588	0.443
用药情况[例(%)]
硝酸酯类	16(32.7)	15(30.6)	χ²=0.047	0.828
利尿剂	19(38.8)	18(36.7)	χ²=0.043	0.835
β受体阻滞剂	22(44.9)	25(51.0)	χ²=0.368	0.544
洋地黄类	5(10.2)	3(6.1)	χ²=0.136	0.712
调脂药物	31(63.3)	27(55.1)	χ²=0.676	0.411
抗血小板药物	32(65.3)	27(55.1)	χ²=1.065	0.302
ARB类	5(10.2)	6(12.2)	χ²=0.102	0.749

组别	例数		NT-proBNP(ng/L)				sST-2(pg/ml)			CRP(μg/ml)			SCr(μg/L)
组别	例数		治疗前		治疗后		治疗前	治疗后		治疗前	治疗后		治疗前	治疗后
观察组	49		2762.8±557.9		851.2±323.1^b		75.1±8.5	62.8±7.1^b		9.6±7.8	3.1±2.3^b		86.9±32.2	92.2±27.7
对照组	49		2812.0±402.8		1580.8±333.9^b		73.3±7.0	66.7±10.4^b		9.6±8.1	4.5±3.7^b		86.9±34.7	104.0±28.2^a
t值			-0.500		-10.990		1.195	-2.165		-0.049	-2.302		-0.003	-2.096
P值			0.618		0.001		0.235	0.033		0.961	0.023		0.998	0.039
组别		例数		总蛋白(g/L)			总胆红素(μmol/L)			TC(mmol/L)			LDL-C(mmol/L)
组别		例数		治疗前		治疗后	治疗前		治疗后	治疗前		治疗后	治疗前		治疗后
观察组		49		65.6±8.1		65.0±8.8	23.2±13.6		23.0±14.6	3.8±1.0		3.7±1.0	2.3±0.5		2.4±0.7
对照组		49		65.3±7.4		64.2±6.0	23.3±15.3		23.4±15.7	3.9±1.0		3.8±0.9	2.3±0.8		2.3±0.9
t值				0.162		0.517	-0.057		-0.148	-0.421		-0.507	-0.335		0.212
P值				0.872		0.606	0.955		0.882	0.675		0.613	0.739		0.832

组别	例数		NT-proBNP(ng/L)				sST-2(pg/ml)			CRP(μg/ml)			SCr(μg/L)
组别	例数		治疗前		治疗后		治疗前	治疗后		治疗前	治疗后		治疗前	治疗后
观察组	49		2762.8±557.9		851.2±323.1^b		75.1±8.5	62.8±7.1^b		9.6±7.8	3.1±2.3^b		86.9±32.2	92.2±27.7
对照组	49		2812.0±402.8		1580.8±333.9^b		73.3±7.0	66.7±10.4^b		9.6±8.1	4.5±3.7^b		86.9±34.7	104.0±28.2^a
t值			-0.500		-10.990		1.195	-2.165		-0.049	-2.302		-0.003	-2.096
P值			0.618		0.001		0.235	0.033		0.961	0.023		0.998	0.039
组别		例数		总蛋白(g/L)			总胆红素(μmol/L)			TC(mmol/L)			LDL-C(mmol/L)
组别		例数		治疗前		治疗后	治疗前		治疗后	治疗前		治疗后	治疗前		治疗后
观察组		49		65.6±8.1		65.0±8.8	23.2±13.6		23.0±14.6	3.8±1.0		3.7±1.0	2.3±0.5		2.4±0.7
对照组		49		65.3±7.4		64.2±6.0	23.3±15.3		23.4±15.7	3.9±1.0		3.8±0.9	2.3±0.8		2.3±0.9
t值				0.162		0.517	-0.057		-0.148	-0.421		-0.507	-0.335		0.212
P值				0.872		0.606	0.955		0.882	0.675		0.613	0.739		0.832

组别	例数	LVEF(%)		LVEDD(mm)		IVST(mm)		LVPWT(mm)		LAD(mm)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	49	43.9±3.2	53.2±4.1^b	57.9±6.5	47.6±5.2^b	10.1±1.5	7.9±1.1^b	10.1±1.5	8.1±0.9^b	39.6±3.5	37.1±3.4^b
对照组	49	43.0±2.8	45.6±3.4^b	57.8±5.7	54.5±6.1^b	9.4±1.5	8.4±1.1^b	9.7±1.3	8.5±0.8^b	39.3±2.9	38.4±2.1^a
t值		1.364	9.924	0.088	-6.085	1.869	-2.193	1.583	-2.134	0.487	-2.332
P值		0.176	0.001	0.930	0.001	0.065	0.031	0.117	0.035	0.627	0.022