扩张型心肌病与缺血性心肌病致慢性心力衰竭患者应用沙库巴曲缬沙坦治疗的效果差异

Efficacy of Sarkubatrivalsartan in Patients with Chronic Heart Failure Caused by Dilated Cardiomyopathy and Ischemic Cardiomyopathy

目的分析沙库巴曲缬沙坦治疗扩张型心肌病与缺血性心肌病致慢性心力衰竭患者的效果差异。方法选取2019年11月至2021年12月本院收治的扩张型心肌病(DCM)致慢性心力衰竭患者57例,缺血性心肌病(ICM)致慢性心力衰竭患者57例,根据病因分为DCM组和ICM组。两组患者均采用沙库巴曲缬沙坦治疗。比较两组患者治疗前后NYHA心功能分级、超声心动图情况、6 min步行试验(6MWT)情况、N末端B型脑钠肽前体(NT proBNP)水平变化情况及不良反应发生情况。结果治疗前,两组患者NYHA心功能分级情况差异无统计学意义(P>0.05),治疗后,ICM组患者心功能分级情况明显优于DCM组(Ⅱ级56.14%vs.33.33%,Ⅲ级36.84%vs.52.63%,Ⅳ级7.02%vs.14.04%,P<0.05);治疗前,两组患者左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室射血分数(LVEF)情况差异无统计学意义(P>0.05),治疗后,与DCM组相比,ICM组LVEDD数值明显低[(6.01±0.39)cm vs.(6.31±0.84)cm,P<0.05],LVESD数值明显低,且变化幅度更大[(3.59±0.35)cm vs.(3.91±0.41)cm,P<0.05],LVEF明显高[(41.52±5.49)%vs.(38.57±4.78)%,P<0.05];治疗前,两组患者6MWT情况比较差异无统计学意义(P>0.05),治疗后,ICM组患者6MWT明显优于DCM组,且变化幅度更大[(421.68±57.35)m vs.(389.24±54.24)m,P<0.05];治疗前,两组患者NT proBNP水平差异无统计学意义(P>0.05),治疗后,ICM组患者NT proBNP水平明显低于DCM组,且变化幅度更大[(1067.16±216.58)ng/L vs.(1379.21±235.69)ng/L,P<0.05];ICM组不良反应发生情况显著少于DCM组(3.51%vs.14.04%,P<0.05)。结论沙库巴曲缬沙坦可有效改善慢性心力衰竭患者心功能和心室重构,但相比DCM所致慢性心力衰竭,对ICM所致慢性心力衰竭患者疗效更加显著,安全性更高。

Objective To analyze the difference of the therapeutic effect of sakubactrovalsartan on patients with chronic heart failure caused by dilated cardiomyopathy and ischemic cardiomyopathy.Methods From November 2019 to December 2021,57 patients with chronic heart failure caused by dilated cardiomyopathy(DCM)and 57 patients with chronic heart failure caused by ischemic cardiomyopathy(ICM)were selected and divided into DCM group and ICM group according to the etiology.Both groups of patients were treated with sarkubatrivalsartan.The NYHA cardiac function grading,echocardiography,6-minute walking test(6MWT),N-terminal precursor of B-type brain natriuretic peptide(NT proBNP)level and adverse reactions were compared between the two groups before and after treatment.Results There was no significant difference in NYHA cardiac function grading between the two groups before treatment(P>0.05).After treatment,the cardiac function grading of ICM group was significantly better than that of DCM group(56.14%vs.33.33%,36.84%vs.52.63%,7.02%vs.14.04%,P<0.05).Before treatment,there was no significant difference in left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)between the two groups(P>0.05).After treatment,compared with the DCM group,the LVEDD value in the ICM group was significantly lower[(6.01±0.39)cm vs.(6.31±0.84)cm,P<0.05],the LVESD value was significantly lower,and the change value was greater[(3.59±0.35)cm vs.(3.91±0.41)cm,P<0.05],LVEF was significantly higher[(41.52±5.49)%vs.(38.57±4.78)%,P<0.05].Before treatment,there was no significant difference in 6MWT between the two groups(P>0.05).After treatment,the 6MWT in ICM group was significantly better than that in DCM group,and the change value was greater[(421.68±57.35)m vs.(389.24±54.24)m,P<0.05].Before treatment,there was no significant difference in NT proBNP level between the two groups(P>0.05).After treatment,the NT proBNP level in ICM group was significantly lower than that in DCM group,and the change value was greater[(1067.16±216.58)ng/L vs.(1379.21±235.69)ng/L,P<0.05].The incidence of adverse reactions in ICM group was significantly less than that in DCM group(3.51%vs.14.04%,P<0.05).Conclusion Sarcubatrix valsartan can effectively improve cardiac function and ventricular remodeling in patients with chronic heart failure,but compared with chronic heart failure caused by DCM,it is more effective and safer in patients with chronic heart failure caused by ICM.