沙库巴曲缬沙坦治疗慢性充血性心力衰竭患者的临床研究

Clinical research on sacubitril/valsartan treating patients with chronic congestive heart failure

目的探讨沙库巴曲缬沙坦治疗慢性充血性心力衰竭患者的临床效果。方法选取2017年12月至2019年1月在首都医科大学附属北京安贞医院住院或门诊就诊的慢性充血性心力衰竭患者196例,按照随机数字表法分为观察组和对照组,各98例。观察组在一般治疗的基础上加用沙库巴曲缬沙坦治疗,对照组在一般治疗的基础上加用雷米普利治疗。比较2组临床疗效和治疗前及治疗6个月后血浆N末端脑钠肽前体(NT-proBNP)、去甲肾上腺素、醛固酮、血管紧张素Ⅱ、6min步行距离(6MWD),左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF),并记录药物不良反应。结果治疗后观察组总有效率明显高于对照组[82.7%(81/98)比54.1%(53/98)],差异有统计学意义(P=0.011)。2组患者治疗期间均未发生明显不良反应。治疗6个月后,2组NT-proBNP、去甲肾上腺素、醛固酮、血管紧张素Ⅱ、LVESD、LVEDD水平明显低于治疗前,且观察组明显低于对照组[1680(211,3626)ng/L比2351(231,4346)ng/L、(1657±244)pmol/L比(2061±288)pmol/L、(247±12)ng/L比(283±18)ng/L、(99±8)ng/L比(114±8)ng/L、(33.1±0.9)mm比(37.0±1.0)mm、(51±5)mm比(56±5)mm],2组6MWD、LVEF明显高于治疗前,且观察组明显高于对照组[(199±56)m比(162±57)m、(40±5)%比(36±8)%],差异均有统计学意义(均P<0.05)。结论沙库巴曲缬沙坦治疗慢性充血性心力衰竭患者能够抑制神经内分泌激活,降低血浆NT-proBNP浓度,提高6MWD,缩小LVESD及LVESD,提高LVEF,疗效优于雷米普利。

Objective To evaluate the clinical effect of sacubitril/valsartan on chronic congestive heart failure(HF).Methods Totally 196 hospitalized patients and outpatients with chronic congestive HF were enrolled from December 2017 to January 2019 in Beijing Anzhen hospital,Capital Medical University.They were randomly divided into observation group and control group,with 98 cases in each group.The observation group was treated with sacubitril/valsartan and the control group was treated with ramipril on the basis of routine therapy.Plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),norepinephrine(NE),aldosterone(ALD)and angiotensinⅡ(AngⅡ),6-min walk distance(6MWD),left ventricular end-systolic dimension(LVESD),left ventricular end-diastolic dimension(LVEDD)and left ventricular ejection fraction(LVEF)were measured before and 6 months after treatment.Clinical efficacy and adverse effects were recorded.Results The total effective rate in observation group was significantly higher than that in control group[82.7%(81/98)vs 54.1%(53/98)](P=0.011).No obvious adverse reactions was observed.After 6 months treatment,levels of NT-proBNP,NE,ALD,AngⅡ,LVESD and LVEDD significantly decreased and the levels in observation group were significantly lower than those in control group[1 680(211,3 626)ng/L vs 2 351(231,4 346)ng/L,(1 657±244)pmol/L vs(2 061±288)pmol/L,(247±12)ng/L vs(283±18)ng/L,(99±8)ng/L vs(114±8)ng/L,(33.1±0.9)mm vs(37.0±1.0)mm,(51±5)mm vs(56±5)mm];6MWD and LVEF significantly increased and they were higher in observation group than those in control group[(199±56)m vs(162±57)m,(40±5)%vs(36±8)%](all P<0.05).Conclusion Sacubitril/valsartan treating patients with chronic congestive HF can inhibit neuroendocrine activation,reduce serum concentration of NT-proBNP,improve 6MWD,reduce LVESD and LVEDD,and increase LVEF;the therapeutic effect is better than that of ramipril.