摘要
目的:探讨沙库巴曲缬沙坦联合螺内酯治疗慢性射血分数降低的心力衰竭(HFrEF)的临床价值。方法:选取HFrEF患者98例,根据随机数字表法将患者分为血管紧张素Ⅱ受体阻滞剂(ARB)组和血管紧张素受体脑啡肽酶抑制剂(ARNI)组,各49例。两组均给予常规抗心衰及螺内酯治疗,ARB组给予缬沙坦口服,ARNI组给予沙库巴曲缬沙坦口服。比较两组临床疗效、心室重构指标[左室舒张末径(LVEDD)、左室后壁厚度(LVPW)、左室射血分数(LVEF)、室间隔厚度(IVST)和左室收缩末径(LVESD)]、血生化指标[N末端B型利钠肽原(NT-proBNP)、心肌钙蛋白I(cTnI)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)]、运动耐力(6 min步行试验)和心肺运动试验指标[峰值氧耗量(Peak VO_(2))、无氧代谢阈值时氧耗量(AT)、二氧化碳通气当量(VE/VCO_(2))]。统计两组治疗期间不良反应及随访1年内心血管不良事件(MACE)发生情况。结果:ARNI组总有效率高于ARB组(P<0.05)。治疗后,两组LVEDD、LVESD、IVST、LVPW较治疗前下降,且ARNI组低于ARB组;LVEF较治疗前增加,且ARNI组高于ARB组(均P<0.05)。治疗后ARNI组NT-proBNP、cTnI、CK-MB低于ARB组(均P<0.05)。治疗后,两组6 min步行距离、Peak VO_(2)、AT较治疗前增加,且ARNI组高于ARB组;VE/VCO_(2)较治疗前下降,且ARNI组低于ARB组(均P<0.05)。两组治疗期间不良反应总发生率及1年内MACE总发生率比较差异无统计学意义(均P>0.05)。结论:沙库巴曲缬沙坦联合螺内酯对慢性HFrEF患者疗效显著,能够改善心功能,逆转心室重构,降低心肺负荷,减轻心肌损伤,提高运动耐力,且安全性较好。
Objective:To explore the clinical value of sacubitril/valsartan combined with spironolactone in the treatment of chronic heart failure with reduced ejection fraction(HFrEF).Methods:A total of 98 HFrEF patients were selected and divided into angiotensinⅡreceptor blocker(ARB)group and angiotensin receptor neprilysin inhibitor(ARNI)group with 49 cases in each group according to random number table method.The two groups were given conventional anti-heart failure and spironolactone treatment,and the ARB group was given valsartan orally while the ARNI group was given sacubitril/valsartan.The therapeutic effect and ventricular remodeling indexes(left ventricular end-diastolic diameter[LVEDD],left ventricular posterior wall thickness[LVPW],left ventricular ejection fraction[LVEF],interventricular septal thickness[IVST],left ventricular end-systolic diameter[LVESD]),blood biochemical indexes(N-terminal pro-B-type natriuretic peptide[NT-proBNP],cardiac troponin I[cTnI],myoglobin[Myo],creatine kinase isoenzyme[CK-MB]),exercise endurance(six-minutes walking test)and cardiopulmonary exercise test indexes(peak oxygen consumption[Peak VO_(2)],anaerobic threshold[AT],carbon dioxide ventilation equivalent slope[VE/VCO_(2)])were compared before and after treatment.The adverse reactions during treatment and the occurrence of major adverse cardiovascular events(MACE)within 1 year of follow-up were statistically analyzed.Results:The total effective rate of ARNI group was higher(P<0.05).After treatment,LVEDD,LVESD,IVST and LVPW in both groups were reduced compared to before treatment,and ARNI group was lower than ARB group,and LVEF was higher than that before treatment,and ARNI group was higher than ARB group(all P<0.05).The levels of NT-proBNP,cTnI and CK-MB in ARNI group after treatment were lower compared to ARB group(all P<0.05).After treatment,six-minutes walking distance,Peak VO_(2)and AT in two groups were increased compared with before treatment,and ARNI group was higher than ARB group(all P<0.05).VE/VCO_(2)was declined than that before treatment,and ARNI group had lower VE/VCO_(2)(all P<0.05).There were no statistical differences in the total incidence of adverse reactions during treatment and MACE within 1 year between the two groups(all P>0.05).Conclusion:Sacubitril/valsartan combined with spironolactone has a significant effect on patients with chronic HFrEF,which can improve heart function,reverse ventricular remodeling,reduce cardiopulmonary load,alleviate myocardial injury,and improve exercise endurance and has a good safety.
作者
王丽辉
徐佳
姜晶
WANG Lihui;XU Jia;JIANG Jing(Department of Cardiology,Beijing Hospital of Integrated Traditional Chinese and Western Medicine,Beijing 100039,China)
出处
《陕西医学杂志》
CAS
2024年第5期675-679,共5页
Shaanxi Medical Journal
基金
北京市海定区预防医学会科研项目(2019HDPMA08)。
关键词
慢性心力衰竭
射血分数降低
沙库巴曲缬沙坦
螺内酯
临床价值
Chronic heart failure
Reduced ejection fraction
Sacubitril/valsartan
Spironolactone
Clinical value
