沙库巴曲缬沙坦和依那普利对心力衰竭患者心血管标志物影响的对比研究

Comparative study of the effects of sacubitril and enalapril on cardiovascular markers in patients with heart failure

目的观察沙库巴曲缬沙坦和依那普利对于急性失代偿性心力衰竭患者心功能以及心血管标志物高敏肌钙蛋白T(hs-cTnT),N端脑钠肽前体(NT-proBNP)和环磷酸鸟苷(cGMP)的影响,比较患者两类药物获益的差异。方法入组左心室射血分数≤40%并存在心衰临床症状和体征的患者,以血流动力学、收缩压及用药史作为筛选指标,所有符合入选标准的患者73例,随机分为沙库巴曲缬沙坦治疗组43例和依那普利治疗组31例,持续用药8周,在治疗前及治疗后8周经超声心动图检测心功能,指标包括左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及心输出量(CO),同时在1周,4周,8周四个时间点进行血样和尿样收集,并检测血液hs-cTnT,NT-proBNP和尿液中的cGMP。结果两组患者治疗前心功能及三类心血管标志物浓度均无显著性差异(P>0.05)。经沙库巴曲缬沙坦或依那普利治疗8周后,LVEF和CO均显著性增高(P<0.05),同时LVEDD显著性缩小(P<0.05)。与依那普利相比,沙库巴曲缬沙坦治疗组中LVEF和CO的增长及LVEDD的下降更显著(P<0.05)。在心血管标志物上,两个治疗组的hs-TnT均呈显著性降低趋势,直到第4周时在两个治疗组间出现统计学差异,沙库巴曲缬沙坦治疗组的降低幅度显著性高于依那普利组(P<0.05),且这种差异一直维持到第8周。NT-proBNP在两个治疗组均呈现显著性下降的趋势,两组间在第1周时开始出现统计学差异(P<0.05),且沙库巴曲缬沙坦治疗组在第4周前的下降效率显著性超过依那普利治疗组。对于尿cGMP,沙库巴曲缬沙坦治疗组的水平持续性升高,在第1周时达到高峰,此后缓慢下降,而依那普利治疗组的尿cGMP一直低于基线水平。两个处理组之间从第1周到第8周,尿cGMP均有统计学差异(P<0.05)。另外,与依那普利治疗组相比,沙库巴曲缬沙坦可显著性降低心力衰竭患者远期不良心血管事件的发生率(P<0.05)。结论沙库巴曲缬沙坦相对于依那普利,显著改善急性失代偿性心力衰竭患者的心功能,同时显著性影响心血管标志物的浓度,具有更好疗效。

Objective To observe the effects of sacubitril and enalapril on cardiac function as well as the cardiovascular markers high-sensitivity troponin T(hs cTnT),N-terminal pro brain natriuretic peptide(NT-proBNP)and cyclic guanosine monophosphate(cGMP)in patients with acute decompensated heart failure,thereby comparing differences in patient benefit from the two classes of drugs.Methods 73 patients with left ventricular ejection fraction≤40%and clinical symptoms and signs of heart failure were randomly divided into the treatment group(43 patients)and the enalapril treatment group(31 patients).The treatment lasted for 8 weeks.The patients were evaluated by echocardiography before and 8 weeks after treatment Cardiac function was measured,including left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd)and cardiac output(CO).Blood and urine samples were collected at 1 week,4 weeks,8 weeks and 4 weeks,and blood HS cTnT,NT proBNP and urine cGMP were detected.Results There was no significant difference in cardiac function and three kinds of cardiovascular markers between the two groups before treatment(P>0.05).After 8 weeks of treatment,LVEF and co increased significantly(P<0.05),while LVEDd decreased significantly(P<0.05).Compared with enalapril,the increase of LVEF and CO and the decrease of LVEDd in the treatment group were more significant(P<0.05).In terms of cardiovascular markers,the hstnt of the two treatment groups showed a significant downward trend,and there was a statistical difference between the two treatment groups until the fourth week.The reduction of the hstnt of the treatment group was significantly higher than that of the enalapril group(P<0.05),and the difference remained until the eighth week.NT-proBNP in the two treatment groups showed a significant downward trend,and there was a statistical difference between the two treatment groups at the first week(P<0.05),and the decline rate of the treatment group was significantly higher than that of the enalapril treatment group before the fourth week.For urinary cGMP,the level of the treatment group increased continuously,peaked at the first week,and then decreased slowly,while that of the enalapril group was lower than the baseline level.There were significant differences in urine cGMP between the two treatment groups from the first week to the eighth week(P<0.05).In addition,compared with the enalapril treatment group,the incidence of long-term adverse cardiovascular events in patients with heart failure was significantly reduced(P<0.05).Conclusion Compared with enalapril,salkubatrovalsartan can significantly improve the cardiac function of patients with acute decompensated heart failure,and also significantly affect the concentration of cardiovascular markers,so it has better curative effect.