沙库巴曲缬沙坦钠片联合卡维地洛治疗老年慢性心力衰竭的临床疗效

Clinical Efficacy of Sacubitril Valsartan Sodium Tablets Combined with Carvedilol in Treatment of Elderly Patients with Chronic Heart Failure

目的探讨沙库巴曲缬沙坦钠片联合卡维地洛治疗老年慢性心力衰竭的临床疗效。方法选取2017年11月至2018年8月在西部战区总医院就诊的118例老年慢性心力衰竭患者,按照随机数字法分为对照组和观察组,各59例。对照组在常规治疗的基础上口服卡维地洛,初始剂量为每次3. 125 mg,最大耐受量为每次25 mg,每日2次;观察组在对照组的基础上口服沙库巴曲缬沙坦钠片,起始剂量为每次50 mg,最大耐受量为每次200 mg,每日2次,连续治疗2个月。观察两组患者的临床疗效,及治疗前后心功能指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)]和血清学指标[生长分化因子-15(GDF-15)、可溶性细胞间黏附因子-1(s ICAM-1)、可溶性基质裂解素2(s ST2)和半乳糖凝集素3(Gal-3)]的变化情况。结果治疗后,观察组的总有效率显著高于对照组[94. 92%(56/59)比81. 36%(48/59)](P <0. 05)。治疗后,两组患者的LVEDD、LVESD较治疗前显著降低,LVEF较治疗前显著升高,且观察组的LVEDD和LVESD明显低于对照组,LVEF明显高于对照组(P <0. 05)。治疗后,两组患者的血清GDF-15、s ICAM-1、s ST2和Gal-3水平较治疗前显著降低,且观察组明显低于对照组(P <0. 05)。结论沙库巴曲缬沙坦钠片联合卡维地洛治疗老年慢性心力衰竭的临床效果显著,可有效改善患者心功能,降低血清GDF-15、s ICAM-1、s ST2和Gal-3水平,具有一定的临床应用价值。

Objective To explore the clinical efficacy of sacubitril valsartan sodium tablets combined with carvedilol in the treatment of elderly patients with chronic heart failure. Methods A total of 118 elderly patients with chronic heart failure in the General Hospital of Western Theater Command from Nov. 2017 to Aug. 2018 were included in the study. They were randomly divided into a control group and an observation group,59 cases in each group. The control group was given carvedilol orally on the basis of routine treatment,the initial dose was 3. 125 mg per time,the maximum tolerance was25 mg per time,twice a day;the observation group was given sacubitril valsartan sodium tablets orally on the basis of the control group,the initial dose was 50 mg per time,the maximum tolerance was 200 mg per time,twice a day,for 2 months.The clinical efficacy of the two groups and the indexes of cardiac function before and after treatment[left ventricular enddiastolic diameter( LVEDD),left ventricular end-systolic diameter( LVESD),left ventricular ejection fraction( LVEF)]and serological indexes[growth differentiation factor-15( GDF-15),soluble intercellular adhesion factor-1( s ICAM-1),soluble suppression of tumorigenicity 2( s ST2) and galectin-3( Gal-3)]were observed. Results After treatment,the total clinical effective rate of the observation group was significantly higher than that in the control group[94. 92%( 56/59) vs 81. 36%( 48/59)]( P < 0. 05). After treatment,the levels of LVEDD,LVESD in the two groups were significantly lower than those before treatment( P < 0. 05),and the levels of LVEF in the two groups was significantly higher than that before treatment( P < 0. 05),and the levels of LVEDD and LVESD in the observation group were significantly lower than those in the control group,LVEF significantly higher than the control group( P < 0. 05). After treatment,the serum levels of GDF-15,s ICAM-1,s ST2 and Gal-3 in the two groups were significantly lower than those before treatment( P < 0. 05),and the above indexes in the observation group were significantly lower than those in the control group( P < 0. 05). Conclusion Sacubitril valsartan sodium tablets combined with carvedilol in the treatment of elderly patients with chronic heart failure has significant curative effect. It can effectively improve the cardiac function and reduce the levels of serum GDF-15,s ICAM-1,s ST2 and Gal-3,therefore it has a certain clinical applicative value.