天津医药

天津医药 ›› 2024, Vol. 52 ›› Issue (2): 177-181.doi: 10.11958/20230587

• 临床研究 • 上一篇    下一篇

沙库巴曲缬沙坦治疗AMI后射血分数中间值心力衰竭的疗效研究

张晓旭1,2(), 杨文奇3,△()   

  1. 1.锦州医科大学研究生学院（邮编121000）
    2.丹东市第一医院心内科
    3.锦州医科大学附属第一医院心内科
  • 收稿日期:2023-04-23 修回日期:2023-08-21 出版日期:2024-02-15 发布日期:2024-01-26
  • 通讯作者: △ E-mail：jzyxy2000@163.com
  • 作者简介:张晓旭（1997），女，硕士在读，主要从事心血管疾病临床方面研究。E-mail：2038546957@qq.com

Clinical study of sacubitril valsartan in the treatment of patients with heart failure of midrange ejection fraction after acute myocardial infarction

ZHANG Xiaoxu1,2(), YANG Wenqi3,△()   

  1. 1. Graduate School of Jinzhou Medical University, Jinzhou 121000, China
    2. Department of Cardiology, the First Hospital of Dandong
    3. Department of Cardiology, the First Affiliated Hospital of Jinzhou Medical University
  • Received:2023-04-23 Revised:2023-08-21 Published:2024-02-15 Online:2024-01-26
  • Contact: △ E-mail: jzyxy2000@163.com

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摘要：

目的 探讨沙库巴曲缬沙坦治疗急性心肌梗死（AMI）后射血分数中间值心力衰竭（HFmrEF）患者的疗效及安全性。方法 将102例AMI后HFmrEF患者依治疗方案的不同分为对照组和试验组，各51例。对照组给予AMI常规治疗及抗心力衰竭（HF）治疗，在无禁忌证前提下使用血管紧张素转化酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）；试验组在对照组治疗的基础上将ACEI/ARB替换为沙库巴曲缬沙坦。治疗6个月，统计2组患者治疗后总有效率，比较治疗前后心功能、N末端B型脑钠钛前体（NT-proBNP）及血清C反应蛋白（CRP），记录治疗后不良反应发生情况，Kaplan-Meier法分析2组患者治疗6个月累积心血管死亡率、HF再住院率及无终点事件生存率。结果 治疗6个月，2组患者不良反应发生率差异无统计学意义（P>0.05），试验组总有效率高于对照组（P<0.05）。与治疗前比较，2组患者治疗后左心室射血分数（LVEF）、每搏输出量（SV）、二尖瓣环E峰与A峰比值（E/A）及6 min步行距离（6MWD）均增加，左心室舒张末期内径（LVEDD）及左房内径（LAD）均降低（均P<0.05）；治疗后，试验组LVEF、SV、E/A及6MWD高于对照组，LVEDD及LAD低于对照组（均P<0.05）。与治疗前比较，2组患者治疗后NT-proBNP和CRP均降低（P<0.05）；治疗后，试验组NT-proBNP及CRP低于对照组（P<0.05）。试验组累积心血管死亡率与对照组差异无统计学意义（3.9% vs. 5.9%，P=0.524），试验组累积HF再住院率低于对照组（9.8% vs. 23.5%，P=0.042），累积无终点事件生存率高于对照组（86.3% vs. 70.6%，P=0.037）。结论 沙库巴曲缬沙坦相较于ACEI/ARB治疗AMI后HFmrEF患者更安全有效，值得临床推广。

关键词: 心肌梗死, 急性病, 心力衰竭, 药物评价, 沙库巴曲缬沙坦, 疗效

Abstract:

Objective To investigate the efficacy and safety of sacubitril valsartan in the treatment of heart failure (HF) of midrange ejection fraction（HFmrEF）in patients after acute myocardial infarction (AMI). Methods A total of 102 patients with HFmrEF after AMI were divided into the control group and the experimental group, with 51 cases in each group. The control group was given conventional treatment for AMI and anti-HF treatment, and the angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin Ⅱ receptor blocker (ARB) was used without contraindications. The experimental group was replaced by ACEI/ARB with sacubitril valsartan on the basis of the control group. After 6 months of treatment, the total effective rates of the two groups after treatment were analyzed, and the cardiac function, N-terminal pro-brain natriuretic peptide (NT-proBNP) and serum inflammatory factor C-reactive protein (CRP) were compared before and after treatment. The occurrence of adverse reactions after treatment was recorded. Kaplan-Meier method was used to analyze the cumulative cardiovascular mortality, HF rehospitalization rate and end-event-free survival after 6 months of treatment in two groups. Results After treatment, there was no significant difference in the occurrence of adverse reactions between the two groups (P>0.05). The total effective rate was higher in the experimental group than that of the control group (P<0.05). Compared with before treatment, left ventricular ejection fraction (LVEF), stroke volume (SV), mitral diastolic blood flow velocity E peak and A peak ratio (E/A) and 6 min walking distance (6MWD) were increased in the two groups, and left ventricular end-diastolic diameter (LVEDD) and left atrial diameter (LAD) were decreased in the two groups after treatment (all P<0.05). After treatment, LVEF, SV, E/A and 6MWD were higher in the experimental group than those in the control group (P<0.05). LVEDD and LAD were lower than those in the control group (all P<0.05). Compared with results before treatment, NT-proBNP and CRP were decreased after treatment in the experiment group than those in the control group (P<0.05). There was no significant difference in the cumulative cardiovascular mortality between the experiment group and the control group (3.9% vs. 5.9%，P=0.524). The cumulative HF rehospitalization rate was lower in the experimental group than that of the control group (9.8% vs. 23.5%，P=0.042). The cumulative end-point-free survival rate was higher in the experiment group than that of the control group (86.3% vs. 70.6%, P=0.037). Conclusion Sacubitril valsartan is safer and more effective than ACEI/ARB in the treatment of AMI patients with HFmrEF, and it is worthy of clinical promotion.

Key words: myocardial infarction, acute disease, heart failure, drug evaluation, sacubitril valsartan, curative effect

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