沙库巴曲缬沙坦治疗急性心肌梗死合并射血分数保留型心力衰竭的疗效及预后分析  

Effect of sacubitril valsartan on acute myocardial infarction complicated with heart failure with preserved ejection fraction and its influence on prognosis

作　　者：陈利 赵一奇 葛宏想 薛杰 CHEN Li;ZHAO Yiqi;GE Hongxiang;XUE Jie(Department of General Practice,Suixi County Hospital of Huaibei City,Suixi 235100,China)

机构地区：[1]安徽省淮北市濉溪县医院全科医学科,235100 [2]安徽省淮北市濉溪县医院重症医学科,235100

出　　处：《心肺血管病杂志》2023年第5期400-405,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:本研究分析比较沙库巴曲缬沙坦(sacubitril valsartan,ARNI)对比ACEI/ARB治疗急性心肌梗死合并射血分数保留型心力衰竭(post myocardial infarction heart failure with preserved ejection fraction,P-MI-HFpEF)患者预后的差异。方法:本研究为回顾性研究,连续纳入从2020年8月至2021年8月,于濉溪县医院住院的P-MI-HFpEF患者共231例。根据出院服用药物情况分为ARNI组和ACEI/ARB组。对两组的一般资料、实验室检验检查、合并症及出院带药情况进行比较。利用Kaplan-Meier分析与Cox回归模型分析两组与主要不良事件(major adverse events,MAE)的关系。结果:在P-MI-HFpEF患者中,与ACEI/ARB相比,ARNI组患者的年龄更小、血钾水平偏高、有高血压病史患者人数偏少。ARNI使用与更多的LVEF提高,LVEDD缩小、NT-proBNP减低和MAE(包括因心力衰竭住院和死亡)的发生率减少相关。即使调整了年龄、吸烟、性别、BMI、心肌梗死类型、收缩压、舒张压、心率、血肌酐、cTnI、NT-proBNP、心房颤动病史、高血压病史、卒中史、糖尿病史、β受体阻滞剂、PCI治疗后,ARNI使用者发生MAE风险较ACEI/ARB仍显著下降(HR=0.52,95%CI:0.28~0.97,P=0.041)。结论:在P-MI-HpEF患者中,ARNI相较于ACEI/ARB使用者,可以更好的改善患者的心功能,减少近期主要不良事件的发生。Objective:In this study,we analyzed and compared the difference between sackubactril valsartan(ARNI)and ACEI or ARB in the treatment of post myocardial infarction heart failure with preserved ejection fraction(P-MI-HFpEF).Methods:This study was a retrospective study,and 231 patients suffered from P-MI-HFpEF who were admitted to the Suixi Hospital from August 2020 to August 2021 were included.They were divided into ARNI group and ACEI/ARB group according to discharge medication.General information,laboratory tests,comorbidities and medications taken at discharge were compared between the two groups.Kaplan-Meier analysis and Cox model were used to analyze the relationship between the two groups and major adverse events(MAE).Results:In patients with acute myocardial infarction combined with preserved ejection fraction heart failure,patients in the ARNI group were younger,had higher blood potassium levels,and fewer patients suffered hypertension compared with ACEI/ARB.ARNI users were associated with increased LVEF,decreased LVEDD,decreased NT-proBNP,and decreased incidence of MAE in patients with P-MI-HFpEF.Even after adjusting for age,smoking,sex,BMI,infarct type,systolic blood pressure,diastolic blood pressure,heart rate,creatinine,cTnI,NT-proBNP,history of atrial fibrillation,history of hypertension,history of stroke,history of diabetes mellitus,beta-blockers and PCI,ARNI users had a significantly lower risk of having an adverse outcome compared with ACEI/ARB(HR=0.52,95%CI:0.28-0.97,P=0.041).Conclusions:Compared with ACEI/ARB users,ARNI can better improve patients'cardiac function,reduce the occurrence of MAE,and bring better benefits to patients in patients with P-MI-HFpEF.

关 键 词：沙库巴曲缬沙坦 血管紧张素转化酶抑制剂β受体拮抗剂 急性心肌梗死 射血分数保留型心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]