沙库巴曲缬沙坦对心功能Ⅳ级患者左房重构的影响  

Effect of sacubitril/valsartan on left atrial remodeling in patients with classⅣcardiac function

作　　者：朱章进 黎敬锋 王超[1] 李银[1] 牛杰[1] 徐晓飞[1] 胡昊[2] ZHU Zhangjin;LI Jingfeng;WANG Chao;LI Yin;NIU Jie;XU Xiaofei;HU Hao(Department of Cardiology,the First People's Hospital of Chuzhou,Chuzhou,Anhui 239000,China;不详)

机构地区：[1]滁州市第一人民医院心血管内科,安徽滁州239000 [2]安徽省立医院心血管内科,安徽合肥230001

出　　处：《中华全科医学》2023年第4期602-605,697,共5页Chinese Journal of General Practice

基　　金：安徽省卫生健康委科研项目(AHWJ2021b080)。

摘　　要：目的 观察沙库巴曲缬沙坦对心功能Ⅳ级患者左房超声指标的变化,并探讨其对左房重构的影响。方法 回顾性分析2020年1月—2021年4月于滁州市第一人民医院住院治疗的NYHAⅣ级的射血分数降低心力衰竭(HFrEF)患者90例,按药物治疗分为血管紧张素脑啡肽酶抑制剂沙库巴曲缬沙坦(ARNI)组(48例)和血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)组(42例),比较2组治疗1年后左房重构超声指标变化以及变化幅度。结果 随访时,ARNI组左房横径(LATD)较ACEI/ARB组缩短更明显[(-6.92±4.09)mm vs.(-3.60±4.48)mm,P<0.001];ARNI组左房容积(LAV)较ACEI/ARB组缩小更明显[(-11.76±5.73)mL vs.(-8.14±6.21)mL,P=0.005];ARNI组左房容积指数(LAVI)较ACEI/ARB组减小更明显[(-6.38±4.55)mL/m^(2)vs.(-4.16±3.69)mL/m^(2),P=0.014];ARNI组左房球形指数(LASI)较ACEI/ARB组减小更明显(-0.09±0.14 vs. 0.01±0.11,P=0.003)。此外,ARNI组达到左房逆重构(LARR)患者数更高[26(54.2%) vs. 14(33.3%),P=0.047]。结论 在NYHAⅣ级的HFrEF患者中,与ACEI/ARB组相比,应用沙库巴曲缬沙坦治疗可更好地减低患者的LATD、LAV、LAVI、LASI,提高LARR率。Objective To investigate the effects of sacubitril/valsartan on the left atrial parameters and remodeling in echocardiography among patients with New York Heart Association(NYHA)classⅣheart failure.Methods A total of 90 heart failure and a reduced ejection fraction(HFrEF)patients with NYHA classⅣhospitalized in the First People's Hospital of Chuzhou were retrospectively analyzed.According to drug treatment,they were divided into two groups:the angiotensin enkephalin inhibitor(ARNI)group(48 cases)and the angiotensin converting enzyme inhibitor/angiotensinⅡreceptor antagonist(ACEI/ARB)group(42 cases),and the changes and amplitude of left atrial remodeling ultrasound indexes in the two groups after 1 year of treatment were compared.Results During follow up,the left atrial transverse diameter(LATD)in ARNI group was significantly shorter than that in ACEI/ARB group[(-6.92±4.09)mm vs.(-3.60±4.48)mm,P<0.001];the left atrial volume(LAV)of ARNI group was significantly smaller than that of ACEI/ARB group[(-11.76±5.73)mL vs.(-8.14±6.21)mL,P=0.005];the left atrial volume index(LAVI)in ARNI group decreased more significantly than that in ACEI/ARB group[(-6.38±4.55)mL/m^(2) vs.(-4.16±3.69)mL/m^(2),P=0.014];the left atrial globular index(LASI)in ARNI group decreased more significantly than that in ACEI/ARB group(-0.09±0.14 vs.0.01±0.11,P=0.003).In addition,the number of patients with left atrial reverse remodeling(LARR)in ARNI group was higher[26(54.2%)vs.14(33.3%),P=0.047].Conclusion Compared with ACEI/ARB group,the treatment of sacubitril/valsartan can better reduce the LATD,LAV,LAVI,LASI,and improve LARR in HFrEF patients with NYHA classⅣ.

关 键 词：心力衰竭 沙库巴曲缬沙坦 左房重构 

分 类 号：R541.6[医药卫生—心血管疾病] R972.4[医药卫生—内科学]