沙库巴曲缬沙坦在射血分数下降心衰患者中的应用分析

Real-world application of sacubitril/valsartan in patients suffering from heart failure with reduced ejection fraction

目的探讨射血分数下降心衰患者(heart failure with reduced ejection fraction,HFrEF)在真实临床实践中使用沙库巴曲缬沙坦(sacubitril/valsartan,ARNI)的治疗效果、对心脏结构和功能的影响以及治疗的剂量。方法收集本院2017年9月至2020年2月启用ARNI治疗HFrEF患者共118例,中位随访8(6~12)个月,通过对比ARNI治疗前后的临床资料,回顾性分析HFrEF患者的纽约心功能分级(New York Heart Association,NYHA)改善、心肌结构改变及心力衰竭再入院率情况,并观察ARNI治疗HFrEF患者的药物副作用及用药现状。结果118例HFrEF患者经ARNI治疗后心功能分级改善≥1级占83.1%,治疗总有效率为83.1%,左室射血分数(left ventricular ejection fraction,LVEF)明显升高,左房前后径(left atrial diameter,LAD)、左室舒张末内径(left ventricular end-diastolic diameter,LVEDD)、右房横径(right atrium left-right dimension,RA)、右室横径(right ventricle left-right dimension,RV)均明显减小,差异均有统计学意义(P<0.001)。ARNI目标维持剂量(200 mg,bid)达标率为3.4%,心力衰竭再入院率为24.6%,药物的不良反应包括症状性低血压(14例,11.9%)和皮肤瘙痒(2例,1.7%)。结论尽管ARNI在临床应用中存在维持剂量偏低的问题,但仍可显著改善HFrEF患者的心脏结构和功能。症状性低血压是ARNI的常见不良反应以及造成ARNI目标维持剂量达标率低的主要原因。

Objective To observe and analyze the efficacy,the effect on cardiac structure and function and the dosage of sacubitril/valsartan(ARNI)in real clinical practice in patients with heart failure with reduced ejection fraction(HFrEF).Methods A total of 118 HFrEF patients treated with ARNI in our hospital from September 2017 to February 2020 were recruited in this study.Their clinical data before and after treatment were collected.After all of them were followed up for a median time of 8(6 to 12)months,the changes of New York Heart Association(NYHA)classification of cardiac function and myocardial structure,and the readmission due to heart failure were analyzed retrospectively.The side effects and current situation of drug use were also observed among these patients.Results After ARNI treatment,the improvement of NYHA grade≥1 accounted for 83.1%of the HFrEF patients,and the total effective rate of treatment was 83.1%.They obtained significantly increased left ventricular ejection fraction(LVEF)(P<0.001),and obviously decreased left atrial anterior and posterior diameter(LAD),left ventricular end-diastolic diameter(LVEDD),right atrial left-right diameter(RA)and right ventricular left-right dimension(RV)(P<0.001).During the follow-up period,the target dose(200 mg,bid)rate of ARNI was 3.4%and the readmission rate of heart failure was 24.6%.Adverse reactions of drugs included symptomatic hypotension(14 cases,11.9%)and skin pruritus(2 cases,1.7%).Conclusion Although ARNI has the problem of being maintained at low dose in clinical application,it can still significantly improve the cardiac structure and function of HFrEF patients.Symptomatic hypotension is the common adverse reaction in the use of ARNI and the main reason for the low rate of ARNI target maintenance dose.