ARNI对90岁以上老年慢性心力衰竭患者心功能及衰弱的影响

Influence of ARNI on heart function and debility in elderly patients aged over 90 with chronic heart failure

目的 探讨血管紧张素受体脑啡肽酶抑制剂(ARNI)对90岁以上慢性心力衰竭(CHF)患者心功能及衰弱的影响。方法 选取2018年1月至2021年1月于解放军总医院第七医学中心老年医学科心血管病区住院的>90岁的CHF患者,根据是否使用ARNI分为观察组和对照组,其中观察组45例,年龄为92.6±2.2岁;对照组47例,年龄为91.6±1.2岁。观察两组患者治疗前及治疗6个月后心功能指标:N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)的变化,纽约心功能分级,衰弱评分及不良反应的发生情况。结果 与治疗前相比,治疗6个月后两组NT-ProBNP、衰弱指数显著降低(P<0.05)。LVEF与治疗前比较明显升高,差异有统计学意义(P<0.05)。治疗6个月后观察组NT-proBNP、衰弱指数低于对照组,LVEF高于对照组,差异有统计学意义(P<0.05)。结论 ARNI对90岁以上老年CHF患者可显著减低NT-proBNP水平,提高LVEF水平,改善心功能分级,改善衰弱程度且不良反应少,具有较好的安全性。可为90岁以上CHF患者提高生活质量提供新的治疗策略。

Objective To investigate the influence of angiotension receptor neprilysin inhibitor(ARNI)on heart function and debility in elderly patients aged over 90 with chronic heart failure(CHF).Methods CHF patients aged>90 were chosen from Department of Geriatric Medicine in the Seventh Medical Center of Chinese PLA General Hospital from Jan.2018 to Jan.2021.All patients were divided,according to ARNI administration,into observation group(n=45,age=92.6±2.2)and control group(n=47,age=91.6±1.2).The changes of heart function indexes,including N-terminal pro-brain natriuretic peptide(NT-proBNP)and left ventricular ejection fraction(LVEF),NYHA classification of heart function,debility scores and adverse reactions were observed in 2 groups before and 6 months after treatment.Results The indexes of NT-ProBNP and debility decreased significantly(P<0.05),and LVEF increased significantly(P<0.05)in 2 groups after treatment for 6 months.The indexes of NTProBNP and debility were lower,and LVEF was higher in observation group than those in control group(P<0.05)after treatment for 6 months.Conclusions ARNI can reduce NT-proBNP level,rise LVEF level,improve NYHA classification of heart function and debility degree,and reduce adverse reactions with higher safety.It provides a new therapy for CHF patients aged over 90 to improve their quality of life.