急性失代偿性心力衰竭患者早期启动血管紧张素受体-脑啡肽酶抑制剂治疗的有效性和安全性

Efficacy and safety of early initiation of angiotensin receptor neprilysin inhibitor therapy in patients with acute decompensated heart failure

目的分析急性失代偿性心力衰竭(ADHF)患者早期启动血管紧张素受体-脑啡肽酶抑制剂(ARNI)治疗的有效性和安全性。方法回顾性分析2019年12月至2020年12月延安大学咸阳医院心血管病院收治的122例ADHF患者的临床资料,根据血流动力学稳定后早期用药情况将患者分为ARNI组(69例,沙库巴曲缬沙坦钠片)和ACEI/ARB组(53例,马来酸依那普利片或缬沙坦分散片)。比较两组治疗前、后的NT-proBNP水平、LVEF、LVEDD及安全性指标。结果治疗1、4周后,ARNI组的血清NT-proBNP水平明显低于ACEI/ARB组(P<0.05)。治疗4周后,ARNI组的LVEF明显高于ACEI/ARB组及治疗前(P<0.05);治疗4周后,ARNI组的LVEDD明显低于治疗前(P<0.05)。ARNI组的心衰再入院率、全因死亡率明显低于ACEI/ARB组(P<0.05)。结论ADHF患者血流动力学稳定后早期应用ARNI可明显降低NT-proBNP水平,提升LVEF,改善心功能,且安全性良好。

Objective To analyze the efficacy and safety of early initiation of angiotensin receptor neprilysin inhibitor(ARNI)therapy in patients with acute decompensated heart failure(ADHF).Methods The clinical data of 122 patients with ADHF treated in the cardiovascular hospital of Xianyang hospital of Yan'an university from December 2019 to December 2020 were analyzed retrospectively.According to the early medication after hemodynamic stability,the patients were divided into ARNI group(69 cases,sacubitril valsartan sodium tablets)and ACEI/ARB group(53 cases,enalapril maleate tablets or valsartan dispersible tablets).The levels of NT-proBNP,LVEF,LVEDD before and after treatment and safety indexes were compared between the two groups.Results After 1 and 4 weeks of treatment,the serum NT-proBNP level in the ARNI group was significantly lower than that in the ACEI/ARB group(P<0.05).After 4 weeks of treatment,LVEF in the ARNI group was significantly higher than that in the ACEI/ARB group and before treatment(P<0.05);after 4 weeks of treatment,LVEDD in the ARNI group was significantly lower than that before treatment(P<0.05).The readmission rate of heart failure and the all-cause mortality in the ARNI group were significantly lower than those in the ACEI/ARB group(P<0.05).Conclusion Early application of ARNI after hemodynamic stability in patients with ADHF can significantly reduce the level of NT-proBNP,improve LVEF and cardiac function,and has good safety.