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沙库巴曲缬沙坦治疗慢性心力衰竭的临床研究

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摘要:

目的 研究沙库巴曲缬沙坦对慢性心力衰竭患者心功能及运动耐力的影响。方法 选取2017 年12月至2018年12月保定市第一中心医院心内科收治的98例心功能Ⅱ-Ⅲ级的慢性心力衰竭患者为研究 对象,随机分成观察组(n=47)和对照组(n=51)。两组患者均给予利尿、降低心肌氧耗、扩张血管、 抗血小板等常规抗心力衰竭治疗。在此治疗基础上,观察组加用沙库巴曲缬沙坦(口服,起始剂量为50 mg/次,2/d;根据患者耐受情况,每2至4周倍增一次,直至达到200 mg/次,2/d的目标维持剂量);对照 组在常规治疗基础上加用盐酸咪达普利(口服,5~10 mg/次,1/d)。两组患者均连续治疗6个月。对比 分析两组患者治疗前、治疗1个月与连续治疗6个月时纽约心脏病学会(NYHA)心功能分级、6分钟步行 实验(6-MWT)、血浆N末端脑钠肽前体(NT-proBNP)、血清高敏肌钙蛋白T(hs-TnT)及超声心动 图所示左心室射血分数(LVEF)、左心房内径(LA)、左心室舒张末期内径(LVEDD)等指标的变化 情况。结果 治疗前,两组患者血浆NT-proBNP、血清hs-TnT、LVEF、LA、LVEDD、6MWT水平比较, 差异均无统计学意义(P均>0.05)。血浆NT-proBNP、血清hs-TnT水平在治疗1月时及连续治疗6月时 均较治疗前均明显降低,且观察组低于对照组,差异均有统计学意义(P<0.05);LVEF、6-MWT水平 均较治疗前明显升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。LA、LVEDD指标在治 疗1个月时,与治疗前相比,差异无统计学意义(P>0.05);治疗6个月时,较治疗前及治疗1个月时均 降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。连续治疗6个月后,观察组总有效率为 93.62 %,优于对照组(74.51%),差异有统计学意义(P<0.05)。结论 相比于盐酸咪达普利,沙库巴 曲缬沙坦对于慢性心力衰竭患者心功能的改善和运动耐力的提高有更加显著的效果,且安全性良好。

Abstract:

Objective To study the influence of sacubitril/valsartan on heart function and exercise endurance in patients with chronic heart failure (CHF). Methods CHF patients (grades from II to III of NYHA classification, n=98) were chosen from Department of Cardiology in the First Central Hospital of Baoding City from Dec. 2017 to Dec. 2018, and divided randomly into observation group (n=47) and control group (n=51). The routine anti-CHF therapies were given to 2 groups including diuresis, reduction of myocardial oxygen consumption, dilation of blood vessels and anti-platelet. On the above basis, the observation group was orally given sacubitril/valsartan (started with 50 mg/time twice a day, then doubled every 2 weeks to 4 weeks, and reached to target maintenance dose-200 mg/time twice a day) for 6 months. The control group was orally given imidapril hydrochloride (5 mg-10 mg/time once a day) for 6 months. The changes of NYHA classification index, 6-minute walk test (6MWT), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), serum high-sensitivity cardiac troponin T (hs-cTnT), left ventricular ejection fraction (LVEF), left atrial diameter (LAD) and left ventricular end-diastolic inner diameter (LVEDd) were compared and analyzed in 2 groups before, and 1 month and 6 months after treatment. Results Before treatment, the difference in NT-proBNP, hs-cTnT, LVEF, LAD, LVEDd and 6MWT had no statistical significance between 2 groups (all P>0.05). NT-proBNP and hs-cTnT decreased significantly after treatment for 1 month and for 6 months in 2 groups, and were lower in observation group than those in control group (P<0.05). LVEF and 6-MWT increased after treatment in 2 groups, and were higher in observation group than those in control group (P<0.05). The difference in LAD and LVEDd had no statistical significance after treatment for 1 month compared with before treatment (P>0.05), and decreased after treatment for 6 months compared with before and 1 month after treatment (P<0.05). After treatment for 6 months, the total effective rate was 93.62 % in observation group and 74.51% in control group (P<0.05). Conclusion Compared with imidapril hydrochloride, sacubitril/valsartan has more significant effect of improving heart function and promoting exercise endurance with higher safety in CHF patients.

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  • 2008

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