血管紧张素受体脑啡肽酶抑制剂在射血分数降低心力衰竭患者急性期治疗的应用初探  

Application of angiotensin receptor-neprilysin inhibitor in treatment of acute heart failure patients with reduced ejection fraction

作　　者：康铁朵[1] 刘文娴[1] KANG Tieduo;LIU Wenxian(Department of Cardiology Intensive Care Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科监护室,100029

出　　处：《心肺血管病杂志》2018年第8期740-742,750,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:射血分数降低性心力衰竭患者在我国人群众多,治疗效果仍有一定改善空间。本文旨在探讨血管紧张素受体脑啡肽酶抑制剂(ARNI)在射血分数降低心力衰竭患者急性期治疗的效果。方法:回顾性收录2017年1月至2017年12月,于我院心内科住院的年龄>18岁的射血分数降低性心力衰竭(HF-REF)且使用ARNI的患者45例,匹配年龄(±3)岁,性别,射血分数(±5%)后单纯使用血管紧张素Ⅱ受体抑制剂药物治疗的心力衰竭患者90例,对比两组患者的临床特点、治疗情况、住院结局等。结果:入组人群入院时ARNI组中NYHA分级II-III级的比例是46.7%,在ARB组比例是38.9%,两组人群差异无统计学意义。肌酐在ARB组有低于ARNI组趋势,但差异无统计学意义[(87.56±31.20)vs.(94.57±29.97)mmol/L,P=0.064]。在两组人群住院期间并发症及转归情况发现,ARNI组较ARB组在住院期间急性肾损伤发病率高(11%vs.6.7%,P<0.001)。但在转归情况如心源性休克,住院期间死亡、住院天数上无明显差异。结论:ARNI在HF-REF人群中初次用药时有肾功能恶化的风险,需要严密观察。Objective： The heart failure patients with reduced ejection fractions have a large population in China and there is still room for improvement in therapeutic effectiveness. The aim of this study is to investigate the effect of angiotensin receptor-neprilysin inhibitor（ ARNI） on the treatment of in heart failure patients with reduced ejection fractions. Methods： We retrospectively collected patients who were with heart failure with reduced ejection fractions（ HF-REF） were hospitalized in our Department of Cardiology from January2017 to December 2017. Forty-five patients were treated with ARNI. After matching age（ ± 3）,gender,and ejection fraction（ ± 5%）,ninety patients were treated with angiotensin II receptor inhibitor（ ARB） Clinical characteristics,treatment and clinical outcome during hospitalization between the two groups were compared.Results： The proportion of NYHA class II-III in the ARNI group when admitted to the hospital was 46. 7%,and in the ARB group was 38. 9%. There was no significant difference between the two groups. Creatinine had a tendency to be lower than ARNI group in ARB group,but there was no statistical difference [（ 87. 56 ±31. 20） vs.（ 94. 57 ± 29. 97） mmol/L,P = 0. 064]. The complications and outcomes during hospitalization in the two groups were found higher in the ARNI group than in the ARB group during hospitalization（ 11% vs.6. 7%,P〈0.001） However,there was no significant difference in outcomes such as cardiogenic shock,hospital death and hospital stay. Conclusion： ARNI may has a risk of worsening renal function when initially use inHF-REF people and requires close observation.

关 键 词：血管紧张素受体-脑啡肽酶抑制剂 射血分数降低心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]