沙库巴曲缬沙坦治疗缺血性与非缺血性心力衰竭患者短期临床疗效的对比研究

Short-term Clinical Effect of Sacubitril/Valsartan in Treating Ischemic or Non-ischemic Heart Failure:a Comparative Study

目的比较沙库巴曲缬沙坦治疗缺血性与非缺血性心力衰竭患者短期临床疗效。方法选取2018年1-10月徐州医科大学附属医院收治的缺血性心力衰竭(ICM)患者40例(ICM组),非缺血性心力衰竭(NICM)患者40例(NICM组)。两组患者均采用常规抗心力衰竭方案并将血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)替换为沙库巴曲缬沙坦,连续治疗3个月。比较两组患者治疗期间沙库巴曲缬沙坦最终用药剂量,治疗前后6分钟步行距离(6MWD)、血清氨基末端脑钠肽前体(NT-proBNP)水平、左心室舒张末期内径(LVEDd)及左心室射血分数(LVEF);记录两组患者治疗期间不良反应发生情况。结果(1)两组患者沙库巴曲缬沙坦最终用药剂量比较,差异无统计学意义(P>0.05)。(2)两组患者治疗前6MWD、血清NT-proBNP水平比较,差异无统计学意义(P>0.05);NICM组患者治疗后6MWD长于ICM组,血清NT-proBNP水平低于ICM组(P<0.05)。治疗后两组患者6MWD长于治疗前,血清NT-proBNP水平低于治疗前(P<0.05)。(3)两组患者治疗前后LVEDd、LVEF比较,差异无统计学意义(P>0.05)。(4)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦对ICM和NICM患者心脏结构的影响相似,用药安全性较高;但与ICM患者相比,沙库巴曲缬沙坦能更有效地改善NICM患者心功能。

Objective To compare the short-term clinical effect of sacubitril/valsartan in treating ischemic or nonischemic heart failure.Methods Forty patients with ischemic heart failure(ICM group) and forty patients with non-ischemic heart failure(NICM group)admitted to the Affiliated Hospital of Xuzhou Medical University from January to October in 2018 were selected.Patients in the two groups received conventional anti-heart failure regimens,but ACEI/ARB was replaced by sacubitril/valsartan for the 3-month continuous treatment.The final dose of sacubitril/valsartan during treatment,as well as6-minute walking distance(6 MWD),serum NT-proBNP level,LVEDd and LVEF before and after treatment were compared between the two groups,and incidence of adverse reactions during treatment was recorded.Results(1)There was no statistically significant difference in final dose of sacubitril/valsartan during treatment between the two groups(P>0.05).(2)There was no statistically significant difference in 6 MWD or serum NT-proBNP level between the two groups before treatment(P>0.05);after treatment,6 MWD in NICM group was statistically significantly longer than that in ICM group,while serum NT-proBNP level in NICM group was statistically significantly lower than that in ICM group(P<0.05).After treatment,6 MWD in the two groups was statistically significantly longer than that before treatment,respectively,while serum NT-proBNP level in the two groups was statistically significantly lower than that before treatment,respectively(P<0.05).(3)There was no statistically significant difference in LVEDd or LVEF between the two groups before or after treatment(P>0.05).(4)There was no statistically significant difference in incidence of adverse reactions during treatment between the two groups(P>0.05).Conclusion Effect of sacubitril/valsartan on cardiac structure is similar with relatively high safety in treating patients with ICM or NICM,but sacubitril/valsartan is more effective in improving cardiac function in NICM patients than in ICM patients.