小剂量沙库巴曲缬沙坦治疗心力衰竭的效果观察

Observation on the effect of low-dose sacubitril/valsartan in the treatment of heart failure

目的比较小剂量沙库巴曲缬沙坦与培哚普利治疗心力衰竭的效果和安全性。方法160例左室射血分数(left ventricular ejection fraction,LVEF)下降的心力衰竭患者分为观察组和对照组各80例,分别采用沙库巴曲缬沙坦、培哚普利治疗,观察两组治疗前后的N末端B型钠尿肽前体(N-terminal pronatriuretic peptide,NT-proBNP)、左室舒张末径(left ventricular end diastolic diameter,LVEDD)、左室收缩末径(left ventricular end systolic diameter,LVESD)、左室射血分数(left ventricular ejection fraction,LVEF)、6分钟步行距离(6 minute walk distance,6MWD)、纽约心功能分级、生活质量评分(quality of life,QOL)、干咳、低血压、高钾血症,血管性水肿情况。结果治疗6个月后,2组NT-proBNP、LVEDD、LVESD均明显下降,且观察组NT-proBNP低于对照组,差异均有统计学意义(P<0.05);2组间LVEDD、LVESD无统计学差异(P>0.05)。治疗后,2组LVEF、QOL、6MWD、心功能均明显改善,且观察组优于对照组,差异均有统计学意义(P<0.05)。治疗期间,观察组干咳发生率(1.25%)低于对照组(10.00%),差异有统计学意义(χ^(2)=5.77,P=0.03)。结论小剂量沙库巴曲缬沙坦与足剂量的培哚普利均能有效治疗EF降低的心力衰竭,但沙库巴曲缬沙坦效果更佳,且副作用小。

Objective To compare the efficacy and safety of low-dose sacubitril/valsartan and perindopril in the treatment of heart failure.Methods 160 patients with heart failure whose left ventricular ejection fraction(LVEF)was decreased were divided into observation group and control group,with 80 cases in each.The two groups were treated with sacubitril/valsartan and perindopril respectively.Before and after treatment,N-terminal pronatriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),6-minute walk distance(6MWD),New York Heart Association classification,quality of life(QOL),dry cough,hypotension,hyperkalemia,and angioedema were observed in the two groups.Results Six months after treatment,NT-proBNP,LVEDD and LVESD were significantly decreased in the two groups,NT-proBNP of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).There were no significant differences in LVEDD and LVESD between the two groups(P>0.05).After treatment,LVEF,QOL and 6MWD were significantly improved in the two groups and were better in the observation group than the control group.The differences were statistically significant(P<0.05).During the treating period,the incidence of dry cough of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusions Both low-dose sacubitril/valsartan and full-dose perindopril could effectively treat heart failure with reduced EF,but sacubitril/valsartan was more effective and had less side effects.