低剂量沙库巴曲缬沙坦治疗扩张型心肌病心力衰竭的短期效果观察

Short-term efficacy of low-dose sacubitril/valsartan on dilated cardiomyopathy patients with heart failure

目的探讨低剂量沙库巴曲缬沙坦治疗扩张型心肌病心力衰竭患者的短期效果。方法选取2017年7月至2018年7月郑州大学第一附属医院收治的在常规治疗基础上将血管紧张素转换酶抑制剂(ACEI)类或血管紧张素受体阻滞剂(ARB)类药物换用低剂量沙库巴曲缬沙坦的70例扩张型心肌病心力衰竭患者,因基础血压较低等情况无法上调沙库巴曲缬沙坦剂量,连续应用低剂量沙库巴曲缬沙坦3个月后观察治疗后有效率、心脏彩色多普勒超声、N末端脑利钠肽前体(NT-proBNP)变化及不良反应发生情况。结果治疗后显效29例,有效32例,无效9例,总有效率为87.14%(61/70)。治疗后患者心脏结构改善,NT-proBNP下降,转换前后比较差异有统计学意义(P<0.05);使用低剂量沙库巴曲缬沙坦3个月内因心力衰竭再住院5例,发生不良反应5例,不良反应发生率为7.14%。结论低剂量沙库巴曲缬沙坦治疗扩张型心肌病心力衰竭患者短期内仍可提高其心功能,改善心脏结构,安全性高。

Objective To investigate the short-term effect of low dose sacubitril/valsartan on dilated cardiomyopathy patients with heart failure. Methods Seventy patients with dilated cardiomyopathy and heart failure hospitalized in the First Affiliated Hospital of Zhengzhou University from July 2017 to July 2018 were selected. Based on conventional treatment, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) was replaced by low dose sacubitril/valsartan for these patients. Because of the low basal blood pressure, the dosage of sacubitril/valsartann could not be increased. The efficacy, changes of cardiac color Doppler ultrasound, N-terminal brain natriuretic peptide precursor (NT-proBNP) and adverse reactions were observed after 3 months of continuous application of low-dose Sacubitril/Valsartan. Results After treatment, protocol got remarkable effect in 29 cases, and it was effective in 32 cases and ineffective in 9 cases, with the total effective rate of 87.14%(61/70). After treatment, cardiac structure was improved, however, NT-proBNP was decreased, and there was a significant difference before and after drug conversion (P<0.05). Within 3 months, 5 patients with low-dose sacubitril/valsartan were re-hospitalized due to heart failure, and 5 patients had adverse reactions. The incidence of adverse reactions was 7.14%. Conclusions Low dose of sacubitril/valsartan in the treatment of dilated cardiomyopathy patients with heart failure can still improve their cardiac function, and structure of heart, with high safety.