沙库巴曲缬沙坦与缬沙坦治疗射血分数降低的心力衰竭合并肺动脉高压的临床疗效对比研究

Comparative Study of Clinical Efficacy of Sacubitril Valsartan and Valsartan in the Treatment of Heart Failure with Reduced Ejection Fraction and Pulmonary Hypertension

目的比较沙库巴曲缬沙坦与缬沙坦治疗射血分数降低的心力衰竭(HFrEF)合并肺动脉高压(PH)的临床疗效。方法选取2021年12月—2022年6月扬州大学附属医院收治的HFrEF合并PH患者146例,根据患者用药情况,将其分为沙库巴曲缬沙坦组(n=88)和缬沙坦组(n=58)。两组患者均给予常规治疗,在此情况下,沙库巴曲缬沙坦组患者接受沙库巴曲缬沙坦治疗,缬沙坦组患者接受缬沙坦治疗,治疗疗程为6个月。比较两组患者治疗前后超声心动图检查指标[左心房内径(LAD)、左心室舒张末期内径(LVEDD)、右心室舒张末期内径(RVEDD)、左心室射血分数(LVEF)、三尖瓣反流峰值流速(TRV)及肺动脉收缩压(PASP)]、6分钟步行距离(6MWD)、N末端脑钠肽前体(NT-proBNP)、堪萨斯城心肌病调查问卷(KCCQ)评分及治疗期间因HF再入院率。结果治疗后,沙库巴曲缬沙坦组LVEDD小于缬沙坦组,LVEF高于缬沙坦组,PASP低于缬沙坦组(P<0.05)。治疗后,沙库巴曲缬沙坦组6MWD长于缬沙坦组,NT-proBNP低于缬沙坦组(P<0.05)。治疗期间,沙库巴曲缬沙坦组因心力衰竭(HF)再入院率为22.7%(20/88),低于缬沙坦组的39.7%(23/58)(χ^(2)=4.82,P=0.03)。结论与缬沙坦相比,沙库巴曲缬沙坦可更有效地改善HFrEF合并PH患者心功能,降低肺血管压力,增加运动耐量,提高患者生活质量,降低因HF再入院率。

Objective To compare the clinical efficacy of sacubitril valsartan and valsartan in the treatment of heart failure with reduced ejection fraction(HFrEF)complicated with pulmonary hypertension(PH).Methods From December 2021 to June 2022,a total of 146 patients with HFrEF complicated with PH admitted to Affiliated Hospital of Yangzhou University were selected.According to the patients'medication,they were divided into sacubitril valsartan group(n=88)and valsartan group(n=58).Patients in both groups were given routine treatment.On this basis,patients in the sacubitril valsartan group were treated with sacubitril valsartan,and patients in the valsartan group were treated with valsartan.The treatment course was 6 months.Echocardiographic examination indexes[left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),right ventricular end-diastolic diameter(RVEDD),left ventricular ejection fraction(LVEF),tricuspid regurgitation velocity(TRV)and pulmonary artery systolic pressure(PASP)],6-minute walking distance(6MWD),N-terminal pro-brain natriuretic peptide(NT-proBNP),Kansas City Cardiomyopathy Questionnaire(KCCQ)score before and after treatment and readmission rate due to heart failure(HF)during the treatment were compared between the two groups.Results After treatment,LVEDD in the sacubitril valsartan group was smaller than that in the valsartan group,LVEF was higher than that in the valsartan group,and PASP was lower than that in the valsartan group(P<0.05).After treatment,the 6MWD of the sacubitril valsartan group was longer than that of the valsartan group,the NT-proBNP was lower than that of the valsartan group(P<0.05).During the treatment,the readmission rate due to HF in the sacubitril valsartan group was 22.7%(20/88),which was lower than 39.7%(23/58)in the valsartan group(χ^(2)=4.82,P=0.03).Conclusion Compared with valsartan,sacubitril valsartan can more effectively improve the cardiac function of patients with HFrEF and PH,reduce pulmonary vascular pressure,increase exercise tolerance,improve the quality of life of patients,and reduce the readmission rate due to HF.