LCZ696在慢性心力衰竭治疗中的研究进展

Research progress of LCZ696 in patients with chronic heart failure

慢性心力衰竭是心血管疾病终末期的表现和最主要的死因，近年来医疗水平飞速发展，但心力衰竭的病死率仍然较高，是21世纪心血管领域的两大挑战之一。新药LCZ696是血管紧张素受体拮抗剂及脑啡肽酶的双重抑制剂，该药的研发可能会给心力衰竭患者带来新的希望。为明确LCZ696在治疗心力衰竭中的有效性及安全性，国外已开展了如PARAMOUT、PARADIGM、TITRATION等大型试验，各研究结果均反映了LCZ696较依那普利、缬沙坦等在治疗慢性心力衰竭方面的优势，血管紧张素受体拮抗剂／血管紧张素转化酶抑制剂类药物靶向作用于血管紧张素受体使血管扩张、抑制交感神经，但其排钠利尿作用较弱。LCZ696中的沙库必曲阻止利钠肽降解，加强利钠利尿及进一步舒张血管，从而改善水、钠潴留和改善心功能，与缬沙坦联合可以更好地发挥协同作用。

Chronic heart failure （CHF） is the performance of end-stage cardiovascular disease and the leading cause of death in recent years. With the rapid development of medical care, the mortality rate of heart failure is still high. This is one in the two major challenges in the cardiovascular field in the 21st century. The new drug LCZ696 is a dual inhibitors of angiotensin receptor blockers （ARB） and neprilysin （ NEP）, which may lead to new hope for patients with heart failure. In order to determine the efficacy and safety of LCZ696 in the treatment of heart failure, foreign countries have carried out some large-scale trials, such as PARAMOUT, PARADIGM, TITRATION and so on. The results of these studies reflected the superiority of LCZ696 compared with enalapril, valsartan and other drugs in the treatment of chronic heart failure. ARB/antiotensin converting enzyme inhibitors （ACEI） targets the angiotensin receptor to dilate blood vessels and inhibits the sympathetic nerve, but their effects on sodium withdrawal and diuresis are weak. The sacubitril in LCZ696 prevents natriuretic peptide from degrading, strengthens the natriuretic diuretic and further expansion of blood vessels. Thereby it improves water and sodium retention and cardiac function. It can play a better synergistic role combined with valsartan.