沙库巴曲缬沙坦治疗老年人扩张型心肌病致慢性心力衰竭的疗效观察  

Efficacy of Sacubitril/Valsartan in the treatment of chronic heart failure in elderly patients with dilated cardiomyopathy

作　　者：李江[1] 曹佳宁[1] 刘文娴[1] 吴山[2] 康云鹏[1] Li Jiang;Cao Jianing;Liu Wenxian;Wu Shan;Kang Yunpeng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029 [2]首都医科大学附属北京安贞医院心脏超声科,100029

出　　处：《中华老年医学杂志》2019年第5期520-524,共5页Chinese Journal of Geriatrics

基　　金：北京市卫生与健康科技成果和适宜技术推广项目(TG-2017-34).

摘　　要：目的评价沙库巴曲缬沙坦治疗老年扩张型心肌病致慢性心力衰竭(CHF)患者的短期疗效。方法入选2017年1-12月北京安贞医院诊治的因扩张型心肌病导致的老年CHF患者126例,应用随机数字法分为实验组(62例)和对照组(64例),所有患者均给予常规抗心力衰竭药物治疗,实验组同时给予沙库巴曲缬沙坦(100mg,3次/d),对照组给予贝那普利(10mg,1次/d),治疗12个月,比较两组患者的左心室射血分数(LVEF)、N末端B型利钠肽原(NT-proBNP)、6min步行距离实验(6MWT)和不良心血管事件(死亡、心力衰竭再入院率)。结果126例患者中,男性73例(57.9%),女性53例(42.1%),平均年龄为(67.2±5.8)岁。两组的年龄、性别、高血压、糖尿病、LVEF、NT-proBNP和6MWT等基线资料差异无统计学意义(均P>0.05)。治疗12个月后,两组各1例患者发生症状性低血压。对照组的NT-proBNP较治疗前降低[(983.3±326.1)ng/L比(1779.1±478.1)ng/L,P<0.05)],LVEF和6MWT较治疗前有部分改善,但差异无统计学意义(均P>0.05);实验组的LVEF、NT-proBNP和6MWT治疗后较治疗前均改善(均P<0.05),且实验组LVEF、NT-proBNP、GMWT均优于对照组,分别为(38.5±3.1)%比(36.9±3.0)%、(744.5±246.7)ng/L比(983.3±326.1)ng/L和(323.4±60.5)m比(283.5±45.9)m(均P<0.05);因心力衰竭再入院率实验组低于对照组[26.6%(19例)比46.8%(30例),P<0.05],但两组的总死亡率和心原性死亡率差异无统计学意义(均P>0.05)。结论沙库巴曲缬沙坦较贝那普利能改善扩张型心肌病CHF患者的左心功能及运动耐力、减少因心力衰竭再入院率。但需更多研究评估其对高龄(年龄>88岁)、开始服药时间(出院前或出院后)、LVEF保留的心力衰竭和终末期心力衰竭(NYHAⅣ级)患者的预后。Objective To evaluate the efficacy of Sacubitril/Valsartan in the treatment of chronic heart failure in elderly patients with dilated cardiomyopathy. Methods A total of 126 elderly patients with dilated cardiomyopathy-induced chronic heart failure who were treated in Beijing Anzhen Hospital from January 2017 to December 2017 were enrolled and randomly divided into the experimental group(n=62)and the control group(n=64). All patients were given a standard heart failure treatment, and the experimental group underwent sacubitril/valsartan(100 mg Bid)and the control group received benazepril(10 mg Qd)additionally for 12 months.Left ventricular ejection fraction(LVEF), N-terminal pro-brain natriuretic peptide(NT-proBNP), six-minute walk test(6MWT)and major adverse cardiovascular events(mortality and readmission for heart failure)were compared between the two groups. Results Of 126 elderly patients, 73 patients(57.9%)were male, and 53 were female, with a mean ±SD age of(67.2±5.8)years.Basic characteristics, including age, gender, clinical history of hypertension and diabetes, LVEF, NT-proBNP and 6MWT, showed no significant difference between two groups(P<0.05). After 12 months of treatment, symptomatic hypotension occurred in one cases in each group.In the control group, NT-proBNP level was decreased after treatment as compared with before treatment[(983.3±326.1)ng/L vs.(1 779.1±478.1)ng/L, P<0.05], and no significant difference was found in LVEF and 6MWT at post-treatment versus pre-treatment(P>0.05). In the experimental group, LVEF, NT-proBNP level and 6MWT were significantly improved in post-treatment versus pre-treatment(P>0.05). And LVEF, NT-proBNP level and 6MWT were significantly better in the experimental group than in the control group[(38.5±3.1)% vs.(36.9±3.0)%,(744.5±246.7)ng/L vs.(983.3±326.1)ng/L,(323.4±60.5)m vs.(283.5±45.9)m, P<0.05]. The readmission rate for heart failure was lower in the experimental group than in the control group(26.6% or 19 cases vs.46.8% or 30 cases, P<0.05), while no sig

关 键 词：心肌病 扩张型 心力衰竭 沙库巴曲缬沙坦 

分 类 号：R542.2[医药卫生—心血管疾病] R541.6[医药卫生—内科学]