老年慢性心力衰竭患者应用沙库巴曲缬沙坦和厄贝沙坦的临床效果比较

Comparison of Clinical Effects of Sacubitril Valsartan and Irbesartan in Elderly Patients with Chronic Heart Failure

目的 将沙库巴曲缬沙坦和厄贝沙坦分别用于老年慢性心力衰竭(chronic heart failure,CHF)患者治疗当中,分析其对患者左心室重构和生活质量的影响。方法 前瞻性纳入2018年3月至2020年3月于四川大学华西医院住院治疗的CHF患者182例为研究对象,分层随机法分为两组,分别采用沙库巴曲缬沙坦钠(n=92)和厄贝沙坦(n=90)治疗。对比两组患者治疗前后生活质量评分、超声心动图相关指标及6 min行走距离的变化,以探讨最佳用药方案。结果 两组患者治疗1年后随访,氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、6 min步行距离、超声心动图等临床检查指标较治疗前均有显著改善,差异有统计学意义(P<0.05);且治疗后沙库巴曲缬沙坦钠组NT-proBNP浓度[(1 964±174)pg/mL vs.(3 486±1 550)pg/mL]、6 min步行距离[(348.9±41.6)m vs.(326.3±35.5)m]、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)[(61.2±7.7)mm vs.(65.3±8.3)mm]与左心室质量指数(left ventricular mass index,LVMI)[(122.6±5.1)g/cm^(2)vs.(126.8±4.3)g/cm^(2)]指标改善均优于厄贝沙坦组,差异有统计学意义(P<0.05)。随访终点两组患者用药剂量均有减少,厄贝沙坦组有18例(20.00%)、沙库巴曲缬沙坦钠组有22例(23.91%)停药。结论 在老年CHF治疗中厄贝沙坦与沙库巴曲缬沙坦均有较好的临床效果,但总体而言沙库巴曲缬沙坦对患者左心室重构的改善以及生活质量的提高效果更佳,值得优先选择。

Objective Sacubitril valsartan and irbesartan were used in the treatment of elderly patients with chronic heart failure(CHF),and their effects on left ventricular remodeling and quality of life were analyzed.Methods Prospectively enrolled 182 patients with CHF who were hospitalized in West China Hospital of Sichuan University from March 2018 to March 2020 as the research objects.They were divided into two groups by stratified and randomized method,with sacubitril valsartan sodium(n=92)and irbesartan(n=90)treatment.The changes in quality of life scores,echocardiogram-related indicators and 6-min walking distance before and after treatment were compared between the two groups to explore the best medication regimen.Results The two groups of patients were followed up after 1 year of treatment,and clinical examination indicators such as N-terminal pro-brain natriuretic peptide(NT-proBNP),6-min walking distance,and echocardiography indexes were significantly improved compared to those before treatment(P<0.05);and in sacubitril valsartan sodium group after treatment,the improvements of NT-proBNP[(1964±174)pg/mL vs.(3486±1550)pg/mL],6-min walking distance[(348.9±41.6)m vs.(326.3±35.5)m],left ventricular end-diastolic diameter(LVEDD)[(61.2±7.7)mm vs.(65.3±8.3)mm]and left ventricular mass index(LVMI)[(122.6±5.1)g/cm^(2) vs.(126.8±4.3)g/cm^(2)]were better than those of irbesartan group,and the differences were statistically significant(P<0.05).At the end of the follow-up,the dosage of the two groups was reduced.The discontinuation cases were 18 cases(20.00%)in irbesartan group and 22 cases(23.91%)in sacubitril valsartan sodium group.Conclusion In the treatment of elderly patients with CHF,irbesartan and sacubitril valsartan both have good clinical benefits,but in general,sacubitril valsartan has a better effect on the improvement of left ventricular remodeling and quality of life in patients,which is worthy of priority.