沙库巴曲缬沙坦钠治疗老年女性射血分数保留心力衰竭患者中期预后研究  

Mid-Term Prognosis Study of Sacubitril and Valsartan Sodium in the Treatment of Elderly Women with Heart Failure with Preserved Ejection Fraction

作　　者：杨鲲[1] 刘文娴[1] 徐冠一 朱佳佳[1] 李鹏[2] Yang Kun;Liu Wenxian;Xu Guanyi;Zhu Jiajia;Li Peng(CCU Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院心内科监护室北京市心肺血管疾病研究所,北京市100029 [2]国家老年医学中心北京医院老年医学科中国医学科学院老年医学研究院,北京市100730

出　　处：《中国病案》2021年第12期105-109,共5页Chinese Medical Record

基　　金：国家自然科学基金面上项目(82070371)。

摘　　要：目的评价沙库巴曲/缬沙坦治疗老年女性射血分数保留心力衰竭患者的中期疗效。方法连续性纳入2017年7月1日-2019年7月31日某院应用沙库巴曲/缬沙坦治疗≥60岁老年女性HFpEF患者86例作为研究组,按照1:3选择年龄和左室射血分数匹配、且应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)治疗的HFpEF患者129例作为对照组,随访截止时间为2020年7月31日,主要结局指标为不良心血管事件,包括死亡、因心力衰竭加重住院,次要结局指标为左心室射血分数、N末端B型利钠肽原和6分钟步行距离,安全性指标为症状性低血压。结果258例患者中,平均年龄为(71.2±8.3)岁。两组的年龄、肾功能、血压、合并疾病、心功能和药物治疗等基线资料差异无统计学意义,P>0.05。平均随访(22.5±11.6)个月。研究组的因心力衰竭再入院率23.3%比38%,(P=0.035)和不良心血管事件发生率(27.9%比44.2%,P=0.027)均明显低于对照组,但两组的总病死率为7%比10.1%,心血管病死率为4.6%比6.2%,差异无统计学意义,P>0.05。研究组的NT-proBNP较对照组显著降低,(304.5±183.2)pg/ml比(388.3±129.7)pg/ml,P=0.032;6MWT显著增加(337.4±116.4)m比(281.1±94.3)m,P=0.002,且心功能明显改善,P<0.05;症状性低血压发生率高于对照组为10.2%比6.2%。多因素Logistic回归分析:年龄≥70岁(OR=1.824,95%CI:1.246~2.672,P=0.002)、肾小球滤过率<60ml/min(OR=1.507,95%CI:1.116~2.042,P=0.007)、糖尿病(OR=2.317,95%CI:1.534~3.516,P=0.001)、NT-proBNP≥862.4pg/ml(OR=3.826,95%CI:1.107~13.328,P=0.035)是患者预后不良的危险因素,而沙库巴曲/缬沙坦(OR=0.767,95%CI:0.604~0.976,P=0.029)是保护因素。结论沙库巴曲/缬沙坦能改善老年女性HFpEF患者的左心功能及运动耐力,并降低因心力衰竭加重再住院率和不良心血管事件发生风险。Objective To evaluate the mid-term efficacy of sacubitril/valsartan in the treatment of elderly women with heart failure with preserved ejection fraction(HFpEF).Methods This was a retrospective case-control study.A total of 86 cases of elderly female HFpEF patients treated with sacubitril/valsartan who were diagnosed and treated in our hospital from July 2017 to July 2019 were enrolled as the observation group,and according to a 1:3 ratio,258 patients with HFpEF,who were treated with angiotensin-converting enzyme inhibitors/angiotensinⅡreceptor antagonists(ACEI/ARB)and with similar age and left ventricular ejection fraction,were used as the control group.The follow-up deadline was On July 31,2020,and the main outcome indicators were adverse cardiovascular events(including death and hospitalization due to heart failure),and the secondary outcome indicators were left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proBNP)and 6-min walking distance(6 MWT).The safety index was symptomatic hypotension.Results Among the 344 patients,the average age was(71.2±8.3)years.There were no significant difference between the two groups in baseline data such as age,renal function,blood pressure,comorbid diseases,heart function,and drug therapy(all P>0.05).The average follow-up was 22.5±11.6 months.The rate of readmissions due to heart failure(23.3%vs.38.0%,P=0.035)and adverse cardiovascular events(27.9%vs.44.2%,P=0.027)in the observation group were significantly lower than the control group,but the rates of all-cause mortality(7.0%vs.10.1%)and cardiovascular mortality(4.6%vs.6.2%)between the two groups were not statistically different(all P>0.05).The NT-proBNP of the observation group was significantly lower than that of the control group[(304.5±183.2)pg/ml to(388.3±129.7)pg/ml,P=0.032],and 6 MWT was significantly higher than that of the control group[(337.4±116.4)m compared to(281.1±94.3)m,P=0.002],and the cardiac function was improved compared with the control group(all P<0.05).The incide

关 键 词：心力衰竭 老年 女性 沙库巴曲/缬沙坦 再住院 

分 类 号：R541.6[医药卫生—心血管疾病]