沙库巴曲缬沙坦治疗慢性心力衰竭患者的疗效观察

The efficiency of sacubitril/valsartan therapy in patients with chronic heart failure

目的观察慢性心力衰竭(心衰)患者应用沙库巴曲缬沙坦的临床疗效。方法连续入选88例慢性心衰患者,分为ARNI组(47例)和对照组(41例)。ARNI组接受沙库巴曲缬沙坦治疗,对照组接受盐酸贝那普利或缬沙坦治疗。记录2组患者服药1个月时体质量、24h尿量、服用利尿剂剂量、N末端B型利钠肽原(N T-proBNP)水平的变化情况及3个月时心脏结构及心功能的改善情况。结果 ARNI组服药后与服药前比较,患者体质量、服用利尿剂剂量、NT-proBNP水平均降低,24h尿量增加,左室舒张末内径(LVDD)及左房内径(LA)均缩小,每搏输出量(SV)、心输出量(CO)及左室射血分数(LVEF)均升高,二尖瓣环E峰与A峰比值(E/A)较前升高(均P<0.05);ARNI组服药后与对照组比较,患者NT-proBNP水平减低,24h尿量增多,LVDD及LA均缩小,SV、LVEF和E/A均升高(均P<0.05);心功能分级也较对照组有所改善(P<0.05)。结论与盐酸贝那普利/缬沙坦比较,沙库巴曲缬沙坦可进一步减轻钠水潴留并改善心功能。

Objective To observe the clinical efficacy of sacubitril/valsartan in patients with chronic heart failure. Methods Eighty-eight patients with chronic heart failure were enrolled in this study. They were divided into angiotensin receptor enkephalinase inhibitor (ARNI, n=47) group and control group (n= 41). ARNI group was treated with sacubitril/ valsartan, while control group received benazepril hydrochloride or valsartan. Data of body weight, 24-hour urine volume, dosage of diuretics, N-terminal pro-brain natriuretic peptid (NT-proBNP) level before treatment and 1 month after treatment, and cardiac structure and function before treatment and three months after treatment were compared between the two groups respectively. Results In ARNI group,the body weight, diuretic dosage and NT-proBNP level decreased, 24- hour urine volume increased, while left ventricular end-diastolic diameter (LVDD) and left atrium (LA) reduced, stroke volume (SV), cardiac output (CO), left ventricular ejection fraction (LVEF) and mitral diastolic blood flow velocity E peak and A peak ratio (E/A) increased after treatment compared to the baseline (all P<0.05). Data of the NT-proBNP level decreased, 24-hour urine volume increased, LVDD and LA reduced, SV, LVEF and E/A increased (all P<0.05) in ARNI group after treatment compared with those of the control group (P<0 .05). Cardiac function also improved in ARNI group after treatment compared to that of the control group (P<0.05). Conclusion Compared with benazepril / valsartan, sacubitril/valsartan can further reduce water-sodium retention and improve cardiac function.