沙库巴曲缬沙坦与达格列净治疗血压偏低的扩张型心肌病疗效及安全性比较研究  

Comparative Study of the Efficacy and Safety of Sacubitril/Valsartan and Dapagliflozin in the Treatment of Dilated Cardiomyopathy with Low Blood Pressure

作　　者：张勇[1] 蔡翔 宁菲菲[1] 梁潇 郭宁[1] ZHANG Yong;CAI Xiang;NING Feifei;LIANG Xiao;GUO Ning(Department of Cardiovascular Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西省西安市710061

出　　处：《中国全科医学》2023年第23期2912-2917,2929,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82100373)。

摘　　要：背景扩张型心肌病预后极差,沙库巴曲缬沙坦与达格列净是改善预后的重要药物,但扩张型心肌病患者血压常偏低,两种药物可能无法同时使用,目前尚缺乏沙库巴曲缬沙坦与达格列净在血压偏低的扩张型心肌病中疗效及安全性比较的研究。目的探讨沙库巴曲缬沙坦与达格列净在血压偏低的扩张型心肌病中的疗效与安全性。方法选取2021年3月—2022年5月西安交通大学第一附属医院收治的扩张型心肌病患者124例为研究对象。患者均为首次诊断为扩张型心肌病,服药前收缩压(SBP)为95~110 mmHg,在出院前或出院时处方沙库巴曲缬沙坦(50mg/次,2次/d)或达格列净片(10 mg/次,1次/d),按照临床药物使用情况分为沙库巴曲缬沙坦组(71例)和达格列净组(53例)。在出院后6个月进行门诊随访,随访截至2022年11月。通过医院电子病历系统收集两组患者的年龄、性别等一般资料,并记录患者基线及6个月随访SBP、舒张压(DBP)、BMI等。收集基线及6个月随访生化指标[N末端B型利钠肽原(NT-proBNP)、糖化血红蛋白(HbA_(1c))、空腹血糖(FBG)、估算肾小球滤过率(eGFR)、血钾]、心脏功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心房内径(LAD)]、6 min步行试验(6MWT)及临床事件。比较两组患者治疗前后生化指标、心脏功能指标及临床事件发生率。结果与治疗前相比,治疗6个月后沙库巴曲缬沙坦组与达格列净组患者血钾、LVEF、6MWT水平均升高(P<0.05),且达格列净组患者6MWT升幅高于沙库巴曲缬沙坦组(t=2.444,P=0.016)。与治疗前相比,治疗6个月后沙库巴曲缬沙坦组与达格列净组患者SBP、DBP、BMI、NT-proBNP、HbA_(1c)、FBG、LVEDD、LVESD、LAD水平均下降(P<0.05);且沙库巴曲缬沙坦组SBP(Z=5.217,P<0.001)、DBP(t=3.070,P=0.003)、eGFR(Z=2.495,P=0.013)降幅较高,而达格列净组BMI(Z=4.410,P<0.001)、HbA_(1c)(Background Dilated cardiomyopathy has an extremely poor prognosis,sacubitril/valsartan and dapagliflozin are important drugs to improve the prognosis.However,patients with dilated cardiomyopathy tend to have low blood pressure,which would make it unable to use both drugs at the same time.There is no comparative study of the efficacy and safety of sacubitril/valsartan and dapagliflozin in the treatment of dilated cardiomyopathy with low blood pressure.Objective To investigate the efficacy and safety of sacubitril/valsartan and dapagliflozin in dilated cardiomyopathy patients with low blood pressure.Methods A total of 124 patients with dilated cardiomyopathy admitted to the First Affiliated Hospital of Xi'an Jiaotong University from March 2021 to May 2022 were selected as the study subjects.All patients were diagnosed with dilated cardiomyopathy for the first time,and the systolic blood pressure(SBP)was 95-110 mmHg before medication.Patients were prescribed with sacubitril/valsartan(50 mg/time,twice a day)or dapagliflozin tablets(10 mg/time,once a day)before or at discharge and divided into the sacubitril/valsartan group(71 cases)and dapagliflozin group(53 cases)according to clinical drug use.The outpatient follow-up was performed 6 months after discharge until November 2022.General information of the two groups such as age and gender were collected through the hospital electronic medical record system,baseline and 6-month follow-up SBP,diastolic blood pressure(DBP),and BMI of the two groups were recorded.Baseline and 6-month biochemical indicators〔N-terminal pro-B-type natriuretic peptide(NT-proBNP),glycated hemoglobin(HbA_(1c)),fasting blood glucose(FBG),estimated glomerular filtration rate(eGFR),blood potassium〕,cardiac function indicators〔left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left atrial diameter(LAD)〕,6 min walking test(6MWT)and clinical events were collected.The biochemical indicators,cardiac function indic

关 键 词：心肌病 扩张型 沙库巴曲缬沙坦 达格列净 血压偏低 疗效 安全性 对比研究 

分 类 号：R541[医药卫生—心血管疾病]