沙库巴曲缬沙坦对射血分数降低型心力衰竭的临床疗效及安全性

Clinical Efficacy and Safety of Sacubitril Valsartan on Heart Failure with Reduced Ejection Fraction

目的:探讨沙库巴曲缬沙坦对射血分数降低型心力衰竭(HFrEF)的临床疗效和安全性。方法:选取2020年10月~2021年10月期间某院收治的180例慢性HFrEF患者作为研究对象,采用随机数字表法分为对照组和观察组,每组90例。在常规抗心衰药物的基础上,对照组给予盐酸贝那普利片治疗,观察组给予沙库巴曲缬沙坦片治疗,均连续治疗3个月。比较两组临床疗效、心功能指标[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左室射血分数(LVEF)]、6min步行试验(6MWT)、明尼苏达生活质量调查表(MLHFQ)评分及神经内分泌因子[N-末端脑钠肽前体(NT-proBNP)、醛固酮(ALD)和血管紧张素Ⅱ(AngⅡ)],并记录两组随访3个月内患者再住院率及不良反应发生率。结果:观察组总有效率(83.33%)高于对照组(70.00%,P<0.05);治疗后,观察组LVEDD、LVESD水平和MLHFQ评分均低于对照组(P<0.05),LVEF和6MWT均高于对照组(P<0.05);观察组NT-proBNP、ALD和AngⅡ水平均低于对照组(P<0.05);随访3个月内,观察组因心衰再入院率(13.33%)低于对照组(27.78%,P<0.05)。两组不良反应发生率比较无统计学差异(P>0.05)。结论:对于HFrEF,在常规抗心衰药物治疗基础上使用沙库巴曲缬沙坦治疗可较好地提高临床疗效,改善患者心功能和生活质量,下调NT-proBNP、ALD和AngⅡ水平,显著降低了患者的再住院率。

Objective:To investigate the clinical efficacy and safety of sacubitril valsartan in combination with conventional anti-heart failure drugs in the treatment of heart failure with reduced ejection fraction(HFrEF).Methods:A total of 180 patients with chronic HFrEF admitted into Zhengzhou Central Hospital Affiliated to Zhengzhou University from October 2020 to October 2021 were enrolled and randomly assgined into the control group and the observation group,90 cases in each group.On the basis of conventional antiheart failure drugs,the control group was given benazepril hydrochloride orally,and the observation group was given sacubitril valsartan orally.Both groups were treated continuously for 3 months.The clinical efficacy,cardiac function indexes such as left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF),6-minute walking test(6MWT),minnesota living with heart failure questionnaire(MLHFQ)score and neuroendocrine factors such as N-terminal pro-brain natriuretic peptide(NT-proBNP),aldosterone(ALD)and angiotensinⅡ(AngⅡ)were compared between the two groups.The rehospitalization rate of the two groups within 3 months of follow-up and adverse reactions were recorded.Results:The overall response rate in the observation group was 83.33%,which was significantly higher than 70.00%in the control group(P<0.05).After treatment,the LVEDD,LVESD and MLHFQ score in the observation group were significantly lower than those in the control group(P<0.05),and the LVEF and 6MWT were significantly higher than those in the control group(P<0.05).After treatment,the levels of NT-proBNP,ALD and AngⅡin the observation group were significantly lower than those in the control group(P<0.05).Within 3 months of follow-up,the rehospitalization rate due to heart failure in the observation group was 13.33%,which was significantly lower than 27.78%in the control group(P<0.05).No significant difference in the incidence of adverse reactions between the two groups was observed(P>0.05).Conclusion:For HFrEF,sacubitril valsartan in combination with conventional anti-heart failure drugs can improve the clinical efficacy,improve the cardiac function and quality of life of patients,downregulate the levels of NT-proBNP,ALD and AngⅡ,and significantly reduce the rehospitalization rate.