沙库巴曲缬沙坦在5例儿童扩张型心肌病中的应用并文献复习

Application of Shakubatrivalsartan in 5 cases of pediatric dilated cardiomyopathy: case report and literature review

目的探讨沙库巴曲缬沙坦在儿童扩张型心肌病中用药的安全性及治疗效果。方法回顾性分析2018年6月至2020年12月在新乡医学院第一附属医院住院治疗的扩张型心肌病5例患儿的临床资料、治疗及预后,并复习相关文献。结果5例扩张型心肌病患儿中,男3例,女2例;年龄12~17岁,发病时左心室射血分数(LVEF)中位数为37%(20%~41%),左心室舒张末期内径(LVDd)中位数为61 mm(59~67 mm),N末端B型利钠肽原(NT-proBNP)中位数为13250 ng/L(12310~21823 ng/L)。中位常规治疗时间为5个月(1~12个月),心力衰竭病情逐渐进展,LVEF中位数为33%(19%~37%),LVDd中位数为61 mm(60~74 mm),NT-proBNP中位数为13144 ng/L(8086~15137 ng/L)。常规治疗加用沙库巴曲缬沙坦,随访不少于3个月,5例患儿NT-proBNP均明显下降,其中4例患儿心功能改善,日常活动不受影响,1例用药后心功能改善不明显。5例患儿用药后血压均有不同程度下降,药物滴定过程中需密切注意血压。无其他不良反应。结论沙库巴曲缬沙坦用于治疗扩张型心肌病患儿用药安全,无明显不良反应,可延缓或逆转心肌重塑进程,提高心脏射血分数,改善预后。

Objective To investigate the safety and therapeutic effect of Shakubatrivalsartan in the treatment of pediatric dilated cardiomyopathy.Methods Clinical information,treatment and prognosis of 5 cases with dilated cardiomyopathy in the First Affiliated Hospital of Xinxiang Medical University from June 2018 to December 2020 were retrospectively analyzed,and relevant literatures were reviewed.Results A total of 5 cases of children with dilated cardiomyopathy were analyzed,including 3 males and 2 females with age of 12-17 years.Their median left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVDd),N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels were 37%(20%-41%),61 mm(59-67 mm),and 13250 ng/L(12310-21823 ng/L),respectively.The median conventional treatment time was 5 months(1-12 months),in which,the condition of heart failure gradually progressed,and the median LVEF,LVDd and NT-proBNP levels were reduced to 33%(19%-37%),61 mm(60-74 mm),13144 ng/L(8086-15137 ng/L).After less than 3 months of follow-up following conventional treatment plus Shakubatrivalsartan,NT-proBNP level significantly decreased in 5 cases.Besides,4 cases had improved cardiac function,and the other one′s improvement was not obvious.The blood pressure of 5 cases decreased at varying degrees after medication of Shakubatrivalsartan,which should be closely monitored during drug titration.No adverse reactions were reported.Conclusions Shakubatrivalsartan for the treatment of pediatric dilated cardiomyopathy is safe and effective,which can alleviate or reverse the process of myocardial remodeling and improve cardiac ejection fraction,thus improving the prognosis.