诺欣妥对射血分数降低的心力衰竭患者血管内皮损伤及生活质量的影响

Effects of Entresto on the Vascular Endothelial Injury and Quality of Life in Heart Failure Patients with Reduced Ejection Fraction

目的:探讨诺欣妥对射血分数降低的心力衰竭(heart failure patients with reduced ejection fraction,HFrEF)患者血管内皮损伤及生活质量的影响。方法:将复旦大学附属闵行医院心内科2017年9月~2018年6月收治的170例HFrEF患者随机分为两组,每组各85例。对照组均给予心衰(heart failure,HF)标准化治疗,研究组在此基础上给予诺欣妥治疗,起始剂量50 mg/次,2次/d,每隔2-4周增加1倍剂量,逐步调整至200 mg/次并作为维持剂量,2次/d。所有患者均连续治疗10周。比较两组患者治疗前后血管内皮功能指标、生活质量评分的变化,住院及随访期间的预后转归。结果:治疗后,两组血清一氧化氮(nitric oxide,NO)、降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平均较治疗前明显升高,血清内皮素-1(endothelin 1,ET-1)水平较治疗前明显下降,且研究组上述指标水平明显优于对照组(P<0.05)。两组治疗后躯体、情绪、其他领域及总分均较治疗前明显降低,且研究组除其他领域评分外其余维度评分及总分均明显低于对照组(P<0.05)。与对照组比较,研究组住院期间全因死亡率、30 d内HF再住院率及随访期间不良心血管事件(adverse cardiovascular events,MACEs)发生率均显著降低(P<0.05)。结论:诺欣妥治疗可使HFrEF患者明显获益,在改善血管内皮损伤、生活质量及近期预后方面效果显著优于心衰标准化治疗。

Objective: To explore the effect of Entresto on the vascular endothelial injury and quality of life in heart failure patients with reduced ejection fraction(HFrEF). Methods: 170 patients with refractory heart failure admitted in the department of Cardiology,Minhang Hospital, Fudan University from September 2017 to June 2018 were divided into two groups. The control group(n=85) was given standard treatment of heart failure(HF), and the research group(n=85) was given Entresto on this basis of control group, with a starting dose of 50 mg/time and 2 times/d, doubling every 2-4 weeks until the dose reached the maintenance dose of 200 mg/time and 2 times/d. All the patients were treated for 10 weeks. The changes of vascular endothelial function and quality of life before and after treatment, the outcome of hospitalization and follow-up were compared between two groups. Results: After treatment, the levels of serum nitric oxide(NO) and calcitonin gene-related peptide(CGRP) in the two groups were significantly increased compared with those before treatment, the levels of serum endothelin 1(ET-1) were significantly decreased, and the above indicators in the research group were significantly better than those in the control group(P<0.05). After treatment, the scores of body, emotion, other fields and the total scores of both groups were significantly reduced compared with before treatment, and the scores of other dimensions and the total scores of the research group were significantly lower than those of the control group except for the scores of other fields(P<0.05). Compared with the control group, the all-cause mortality during hospitalization, HF rehospitalization within 30 d and incidence of adverse cardiovascular events(MACEs) during follow-up were significantly reduced in the research group(P<0.05). Conclusions: Entresto had better effect than the standard treatment for the HFrEF patients, on the improvement of vascular endothelial injury, quality of life and short-term prognosis.