沙库巴曲缬沙坦与传统血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂治疗阵发性房颤疗效对比观察

Comparison in efficacy of sacubitril/valsartan and traditional ACEI/ARB in patients with paroxysmal atrial fibrillation

目的:观察沙库巴曲缬沙坦对比传统血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)在阵发性房颤患者中的疗效。方法:选取诊断为阵发性房颤患者共100例,随机分为沙库巴曲缬沙坦组50例及ACEI/ARB组50例,治疗时间均为1年。观察两组治疗后1年房颤复发率、左房内径、左房容积、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、N末端脑利钠肽前体(NT-proBNP)、再住院率。结果:患者在用药过程中出现心慌、气短等症状立即做心电图或24 h动态心电图,沙库巴曲缬沙坦组与ACEI/ARB组房颤发生率分别为10%与36%,比较差异有统计学意义(均P<0.05);沙库巴曲缬沙坦组与ACEI/ARB组比较,左房内径、左房容积、LVEDD降低,LVEF值升高,差异有统计学意义(均P<0.05)。沙库巴曲缬沙坦组NT-proBNP下降更明显;沙库巴曲缬沙坦组再住院率低于ACEI/ARB组(10%与34%,P<0.05),沙库巴曲缬沙坦组有7例出现血压偏低,药物减量后仍能坚持服药。结论:沙库巴曲缬沙坦与传统ACEI/ARB比较可以降低房颤复发率,改善心功能,降低再住院率。

Objective:To compare the efficacy of sacubitril/valsartan and traditional angiotensin converting enzyme inhibitor/angiotensin receptor blockers(ACEI/ARB)in patients with paroxysmal atrial fibrillation.Methods:A total of 100 patients with paroxysmal atrial fibrillation were randomly divided into sacubitril/valsartan group(50 cases)and ACEI/ARB group(50 cases).The treatment time was 1 year.The recurrence rate of atrial fibrillation,left atrial diameter,left atrial volume,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),forebrain natriuretic peptide(NT-proBNP)and rehospitalization rate one year after treatmentwere observed in the two groups.Results:Electrocardiogram or 24-hour dynamic electrocardiogram was performed immediately when patients had symptoms such as palpitation and shortness of breath during the medication.The incidence of atrial fibrillation in sacubitril/valsartan group and ACEI/ARB group was 10% and 36%,respectively,and the difference was statistically significant(P<0.05).Compared with ACEI/ARB group,left atrial diameter,left atrial volume and LVEDD were decreased,and LVEF was increased in sacubitril/valsartan group(all P<0.05).The decrease of NT-proBNP in sacubitril/valsartan group was more significant.The rehospitalization rate of sacubitril/valsartan group was lower than that of ACEI/ARB group(10%vs.34%,P<0.05).Seven patients in sacubitril/valsartan group had low blood pressure,but could still adhere to medication after drug reduction.Conclusion:Compared with ACEI/ARB,Sacubitril/valsartan can reduce the recurrence rate of atrial fibrillation,improve cardiac function,and reduce the rehospitalization rate.