沙库巴曲缬沙坦对不同病因的慢性心力衰竭患者疗效比较  

Comparison of efficacy of sacubitril/valsartan in patients with chronic heart failure of different etiology

作　　者：孙洁[1] 陈欣[2] 陈巧 邢璐宇 张峰[2] SUN Jie;CHEN Xin;CHEN Qiao;XING Lu-yu;ZHANG Feng(The First Central Clinical College of Tianjin Medical University,Tianjin 300070,China;Department of Cardiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,天津300070 [2]天津市第一中心医院心内科,天津300192

出　　处：《中国医院药学杂志》2022年第4期422-425,共4页Chinese Journal of Hospital Pharmacy

基　　金：天津市第一中心医院科技基金(编号:2019CF07)。

摘　　要：目的:回顾性分析比较扩张型心肌病(dilated cardiomyopathy,DCM)与缺血性心肌病(ischemic cardiomyopathy,ICM)心力衰竭患者应用沙库巴曲缬沙坦治疗的临床疗效是否存在差异。方法:收集2018年8月1日至2020年6月30日在天津市第一中心医院心内科住院并首次服用沙库巴曲缬沙坦治疗的慢性心力衰竭患者,纳入符合标准的DCM患者50例,ICM患者50例。对所有患者进行为期1年的回访,观察心脏指标包括左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末内径(left ventricular end-diastolic diameter,LVEDD)及1年内因心衰加重再入院和因心血管疾病死亡的终点事件。结果:随时间推移DCM、ICM两组患者LVEF呈上升趋势,LVEDD均呈下降趋势(P_(时间)<0.01),DCM、ICM两组组间心脏指标比较存在统计学差异(LVEF:P_(组间)=0.029,LVEDD:P_(组间)=0.040),两组LVEF、LVEDD随时间变化幅度有统计学差异(P_(分组*时间)<0.01)。DCM、ICM两组组间累积无心衰加重再入院生存率比较有统计学差异(34.6%vs.53.4%,P=0.027),组间累积无心血管死亡生存率比较无统计学差异(95.9%vs.100%,P=0.153)。结论:沙库巴曲缬沙坦对DCM、ICM心衰患者均能改善左心功能,逆转心肌重构,减少再住院和终点事件的发生;对ICM患者疗效更佳。OBJECTIVE The retrospective study is to compare the clinical efficacy of sacubitril/valsartan in heart failure patients with dilated cardiomyopathy(DCM)and ischemic cardiomyopathy(ICM).METHODS A total of 50 patients with DCM and 50 patients with ICM who were hospitalized in the Department of Cardiology of Tianjin First Central Hospital from August 1,2018 to June 30,2020 and were treated with sacubitril/valsartan for the first time were collected.All patients were followed up for one year to observe cardiac indicators including left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and the end points of hospitalization due to exacerbation of heart failure and death due to cardiovascular disease within one year,and compare the differences of cardiac structural indicators and prognosis among groups.RESULTS Over time,LVEF of DCM and ICM groups showed an upward trend and LVEDD showed a downward trend(P_(time)<0.01).There was a statistical difference between DCM and ICM groups(LVEF:P_(group)=0.029,LVEDD:P_(group)=0.040),and there was a statistical difference in the amplitude of change of LVEF and LVEDD over time between the two groups(P_(group*time)<0.01).The cumulative survival rate of readmission without exacerbation of heart failure was significantly different between DCM and ICM groups(34.6%vs.53.4%,P=0.027),and the cumulative survival rate without cardiovascular death was not significantly different between DCM and ICM groups(95.9%vs.100%,P=0.153).CONCLUSIONS Sacubitril/Valsartan can improve left ventricular function in heart failure patients with DCM or ICM,reverse myocardial remodeling,and reduce rehospitalization and end point events.Patients with ICM had better outcomes.

关 键 词：沙库巴曲缬沙坦 慢性心力衰竭 扩张型心肌病 缺血性心肌病 

分 类 号：R969.3[医药卫生—药理学]