不同初始剂量沙库巴曲缬沙坦治疗对慢性心力衰竭患者心室重构及心肌酶谱的影响  

Effects of Different Initial Doses of Sacubitril and Valsartan on Ventricular Remodeling and Myocardial Enzymes in Patients with Chronic Heart Failure

作　　者：王寅 韩福生[2] 江映天 康品芳[3] WANG Yin;HAN Fusheng;JIANG Yingtian;KANG Pinfang(Dept.of Emergency and Critical Care Medicine,Anhui Province Lujiang County Hospital of Traditional Chinese Medicine,Anhui Lujiang 231500,China;Dept.of Emergency and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Dept.of Cardiology,the First Affiliated Hospital of Bengbu Medical College,Anhui Bengbu 233004,Anhui)

机构地区：[1]安徽省庐江县中医院急诊和危重症医学科,安徽庐江231500 [2]首都医科大学附属北京安贞医院急诊重症监护室,北京100029 [3]蚌埠医学院第一附属医院心内科,安徽蚌埠233004

出　　处：《中国医院用药评价与分析》2021年第6期667-670,677,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：安徽省科技攻关项目(No.1804h08020246)。

摘　　要：目的:探讨不同初始剂量沙库巴曲缬沙坦治疗对慢性心力衰竭(chronic heart failure,CHF)患者心室重构及心肌酶谱的影响。方法:采用随机数字表法将2018年3月至2019年9月于安徽省庐江县中医院急诊和危重症医学科治疗的CHF患者80例分为观察组和对照组,每组40例。两组患者均给予沙库巴曲缬沙坦钠片口服,对照组患者的初始剂量为1次50 mg,1日2次;观察组患者的初始剂量为1次100 mg,1日2次;两组患者均治疗12周。比较两组患者的疗效及不良反应发生情况的差异,观察两组患者治疗前后心室重塑指标[室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室质量指数(LVMI)]、心肌酶谱[天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)]、神经内分泌激素[去甲肾上腺素(NE)、醛固酮(Ald)及血管紧张素Ⅱ(AngⅡ)]水平,6 min步行距离(6MWD)以及明尼苏达心力衰竭生活质量量表(Minnesota heart failure quality of life scale,MLHFQ)评分。结果:观察组、对照组患者的总有效率分别为97.50%(39/40)、95.00%(38/40),观察组、对照组患者的不良反应总发生率分别为5.00%(2/40)、2.50%(1/40),组间比较,差异均无统计学意义(P> 0.05)。观察组患者治疗后的NE、Ald及AngⅡ水平明显低于对照组,IVST、LVPWT明显小于对照组,IVMI明显大于对照组,差异均有统计学意义(P <0.05);两组患者治疗后的AST、LDH、CK及CK-MB水平比较,差异均无统计学意义(P> 0.05);两组患者治疗后的6MWD、MLHFQ评分比较,差异均无统计学意义(P> 0.05)。结论:不同初始剂量沙库巴曲缬沙坦治疗CHF的临床疗效相当,对心肌酶谱的影响相差不大;但初始高剂量沙库巴曲缬沙坦治疗更能改善患者心肌重构,抑制神经内分泌激素释放。OBJECTIVE: To probe into the effects of different initial doses of sacubitril and valsartan on ventricular remodeling and myocardial enzymes in patients with chronic heart failure( CHF). METHODS: Totally 80 patients with CHF admitted into Emergency and Intensive Care Unit of Lujiang County Hospital of Traditional Chinese Medicine admitted into Mar. 2018 to Sept. 2019 were extracted to be divided into the observation group and the control group via the random number table,with 40 cases in each group. Patients in both groups were given Sacubitril valsartan tablets orally,with an initial dose of 50 mg for twice a day in the control group,and 100 mg for twice a day in the observation group. Both groups were treated for 12 weeks. The clinical efficacy and incidence of adverse drug reactions were compared between two groups. Ventricular remodeling indicators [interventricular septal thickness( IVST),left ventricular posterior wall thickness( LVPWT) and left ventricular mass index( LVMI) ],myocardial enzyme spectrum[aspartate aminotransferase( AST),lactate dehydrogenase( LDH),creatine kinase( CK) and creatine kinase isoenzyme( CK-MB) ],neuroendocrine hormones [norepinephrine( NE),aldosterone( Ald) and angiotensin Ⅱ( AngⅡ) ]levels,6 min walking distance( 6 MWD) and Minnesota heart failure quality of life scale( MLHFQ) score before and after treatment in both groups were compared. RESULTS: The total effective rates in the observation group and control group were respectively 97. 50%( 39/40) and 95. 00%( 38/40),and the total incidences of adverse drug reactions in the observation group and control group were respectively 5. 00%( 2/40) and 2. 50%( 1/40),with no statistically significant differences between two groups( P > 0. 05). After treatment,the levels of NE,ALD and AngⅡin the observation group were significantly lower than those in the control group,IVST,LVPWT were significantly lower than those in the control group,and IVMI were significantly higher than those in the control group,the differences were statistica

关 键 词：慢性心力衰竭 不同初始剂量 沙库巴曲缬沙坦 心室重构 心肌酶谱 

分 类 号：R972[医药卫生—药品]