沙库巴曲缬沙坦对老年高血压合并慢性心衰患者的疗效

Efficacy of sacubitril valsartan in treatment of hypertension and chronic heart failure in elderly patients

目的观察高血压合并慢性心衰(CHF)患者应用沙库巴曲缬沙坦(SVST)联合美托洛尔治疗的效果。方法将2023年6月至2024年3月杭州市临平区第一人民医院高血压合并CHF患者94例经随机数字表法分为观察组与对照组。对照组(47例)给予美托洛尔,观察组(47例)在美托洛尔基础上加用SVST,均治疗3个月。对比两组治疗有效率、血清相关因子[血清同型半胱氨酸(Hcy)、白细胞介素-6(IL-6)、氨基末端脑钠肽前体(NT-proBNP)]和心功能指标[左心室收缩末期内径(LEVSD)、左心室舒张末期内径(LVEDD),左心室射血分数(LVEF)]变化情况。结果观察组治疗总有效率为高于对照组[91.48%(43/47)vs 74.46%(35/47),χ^(2)=4.821,P<0.05)。治疗后,两组患者血清相关因子Hcy、IL-6、NT-pro BNP均低于治疗前(均P<0.05),且观察组患者血清Hcy[(14.53±2.18)μmol·L^(-1)vs(15.71±2.28)μmol·L^(-1)]、IL-6[(102.29±29.38)ng·L^(-1)vs(139.86±28.84)ng·L^(-1)]、NT-proBNP[(861.83±128.91)pg·mL^(-1)vs(971.69±156.22)pg·mL^(-1)]均低于对照组(t=2.564,6.256,3.719,均P<0.05)。治疗后两组患者心功能指标LEVSD、LVEDD和LVEF均低于治疗前(均P<0.05),观察组LEVSD[(54.83±3.12)mm vs(57.42±3.26)mm]、LVEDD[(43.92±2.13)mm vs(45.76±2.16)mm]均低于对照组(t=4.393,P<0.05),LVEF[(50.26±3.41)%vs(47.21±3.32)%]高于对照组(t=3.935,4.158,均P<0.05)。两组不良反应发生率差异无统计学意义(χ^(2)=0.382,P>0.05)。结论SVST联合美托洛尔可有效降低老年高血压合并CHF患者心肌损伤程度,改善心功能,疗效确切,安全性好。

Objective To investigate the clinical efficacy of sacubitril/valsartan sodium tablets(SVST)combined with metoprolol in elderly patients with hypertension and chronic heart failure(CHF).Methods Ninety-four elderly patients with hypertension and CHF admitted to the First People's Hospital of Linping District,Hangzhou,from June 2023 to March 2024 were selected and randomly grouped,with 47 in each group.The patients in the control group were treated with metoprolol while those in the observation group with SVST on the basis of metoprolol.Treatment in both groups lasted for 3 months.The effectiveness of treatment,serum-related factors(serum homocysteine(Hcy),interleukin-6(IL-6),N-terminal pro-brain natriuretic peptide(NT-proBNP)),and cardiac function indicators were compared between the two groups.The cardiac function indicators included left ventricular end-systolic diameter(LEVSD),left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF).Results The total effective rate of treatment in the observation group was significantly higher than that in the control group(91.48%(43/47)vs 74.46%(35/47),χ^(2)=4.821,P<0.05).After treatment,the levels of serum-related factors Hcy,IL-6,and NT-proBNP in both groups were all significantly lower than those before treatment(all P<0.05).The levels of serum Hcy,IL-6 and NT-proBNP were significantly lower in the observation group than in the control((14.53±2.18)μmol·L^(-1)vs(15.71±2.28)μmol·L^(-1)),((102.29±29.38)ng·L^(-1)vs(139.86±28.84)ng·L^(-1))and((861.83±128.91)pg·mL^(-1)vs(971.69±156.22)pg·mL^(-1))(t=2.564,6.256,3.719,all P<0.05).Furthermore,the cardiac function indicators of LEVSD,LVEDD and LVEF in both groups were significantly improved after treatment(all P<0.05).The levels of LEVSD and LVEDD were significantly lower in the observation group than in the control((54.83±3.12)mm vs(57.42±3.26)mm)and((43.92±2.13)mm vs(45.76±2.16)mm)(t=4.393,P<0.05).Additionally,LVEF was significantly higher in the observation group than in the control((50.26±3.41)%vs(47.21±3.32)%)(t=3.935,4.158,both P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(χ^(2)=0.382,P>0.05).Conclusion SVST combined with metoprolol can effectively reduce the degree of myocardial damage and improve cardiac function in elderly patients with hypertension and CHF.Meanwhile,it has definite efficacy and good safety.