沙库巴曲缬沙坦联合美托洛尔对冠状动脉粥样硬化性心脏病伴慢性心力衰竭的心功能保护作用研究  

Protective effect of sacubitril valsartan combined with metoprolol on heart function in treatment of coronary atherosclerotic heart disease with chronic heart failure

作　　者：张霞[1] 李正章[2] 许英 李慧 ZHANG Xia;LI Zhengzhang;XU Ying;LI Hui(Department of Pharmacy,Gaoyou People's Hospital,Yangzhou 225600,Jiangsu Province,China;Department of Cardiovascular Medicine,Gaoyou People's Hospital,Yangzhou 225600,Jiangsu Province,China;Department of Pharmacy,the 71st Group Army Hospital of the PLA,Xuzhou 221004,Jiangsu Province,China;Department of Critical Medicine,Gaoyou People's Hospital,Yangzhou 225600,Jiangsu Province,China)

机构地区：[1]江苏省高邮市人民医院药剂科,江苏扬州225600 [2]江苏省高邮市人民医院心血管内科,江苏扬州225600 [3]中国人民解放军陆军第七十一集团军医院药剂科,江苏徐州221004 [4]江苏省高邮市人民医院重症医学科,江苏扬州225600

出　　处：《世界临床药物》2022年第11期1462-1469,共8页World Clinical Drug

基　　金：江苏省高邮市人民医院院级基金课题(GYRYKY202003)。

摘　　要：目的 探究沙库巴曲缬沙坦联合美托洛尔治疗冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)伴慢性心力衰竭(chronic heart failure,CHF)的疗效及心功能保护作用。方法 将180例CHD合并CHF患者随机分为两组,每组90例。对照组应用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂联合美托洛尔治疗,干预组应用沙库巴曲缬沙坦联合美托洛尔治疗,疗程6个月。对比两组临床疗效及主要不良心血管事件,测量治疗前后心功能指标左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张早期最大血流速度与舒张末期最大血流速度比(E/A)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)和左心室质量指数(left ventricular mass index,LVMI),检测血浆N-末端脑钠肽(N-terminal brain natriuretic peptide,NTproBNP)、血清心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、肌酐(serum creatinine,Scr)、胱抑素C(cystatin C,CysC)和血钾,评价明尼苏达心功能不全生活量表(Minnesota living with heart failure questionnaire,MLHFQ)评分、Lee氏心力衰竭评分与6 min步行试验(6 min walking test,6MWT)。结果 干预组总有效率高于对照组(P <0.05)。治疗后,两组血压及心率无统计学差异(P> 0.05),但干预组的LVEF、E/A均高于对照组,LVEDD、LVESD及LVMI均低于对照组(P <0.05)。治疗后,干预组的NT-proBNP、c TnⅠ、CK-MB和CysC水平均显著低于对照组(P <0.05),但两组Scr及血钾比较差异无统计学意义(P> 0.05)。治疗后,干预组的6MWT显著高于对照组,而MLHFQ和Lee氏心力衰竭评分低于对照组(P <0.05)。随访结果显示,干预组的因心力衰竭再住院率低于对照组(P <0.05)。2年随访结果显示,干预组主要不良心血管事件(major adverse cardiovascular events,MACE)发生率明显低于�Objective To explore the protective effect of sacubitril valsartan combined with metoprolol in treatment of coronary atheroselerotic heart disease(CHD) with chronic heart failure(CHF). Methods A total of 180 patients with CHD and CHF were randomly divided into intervention group and control group, with 90 cases in each group. The control group were treated with angiotensin-converting enzyme inhibitor or angiotensin Ⅱ receptor antagonist combined with metoprolol,the intervention group were treated with sacubitril valsartan combined with metoprolol for 6 months. Clinical efficacy and major adverse cardiovascular events were compared between two groups. The left ventricular ejection fraction(LVEF),maximum early filling speed/maximum filling speed in late diastole(E/A), left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD) and left ventricular mass index(LVMI) were measured before and after treatment. The plasma N-terminal brain natriuretic peptide(NT-proBNP), serum cardiac troponin Ⅰ(cTn Ⅰ), creatine kinase isoenzyme(CK-MB), serum creatinine(Scr), cystatin C(CysC) and potassium were determined. The Minnesota living with heart failure questionnaire(MLHFQ) score, Lee’s heart failure score and 6 min walking test(6MWT) were measured. Results Total effective rate of intervention group was significantly higher than that of control group(P<0.05).After treatment, there was no significant difference in blood pressure and heart rate between two groups(P>0.05), but the LVEF and E/A of intervention group were higher than those of control group, and LVEDD, LVESD, and LVMI were significantly lower than those of control group(P<0.05). After treatment, the levels of NT-proBNP, cTnⅠ, CK-MB and CysC in intervention group were significantly lower than those of control group(P<0.05), but there was no significant difference in Scr and potassium between two groups(P>0.05). After treatment, the 6MWT of intervention group was significantly higher than that of control group, while the MLHFQ a

关 键 词：冠状动脉粥样硬化性心脏病 慢性心力衰竭 沙库巴曲缬沙坦 心功能 

分 类 号：R972.1[医药卫生—药品] R972.4[医药卫生—药学] R541.4R541.61