沙库巴曲缬沙坦与贝那普利对急性心肌梗死经皮介入治疗后左心室重构影响的对比研究  

Comparison of sacubitril/valsartan with benazepril on the left ventricular remodeling after percutaneous coronary intervention for patients with acute myocardial infarction

作　　者：郑彬彬[1] 刘长乐[2] 王媛媛[2] 邱九纯 富华颖[2] 曹源 徐延敏[2] Zheng Binbin;Liu Changle;Wang Yuanyuan;Qiu Jiucun;Fu Huaying;Cao Yuan;Xu Yanmin(Tianjing Beichen Hospital,Tianjin 300400,China;The Second Hospital of Tianjin Medical University,Tian jin 300211,China)

机构地区：[1]天津市北辰医院,天津市300400 [2]天津医科大学第二医院,天津市300211

出　　处：《中华心力衰竭和心肌病杂志（中英文）》2022年第4期302-309,共8页Chinese Journal of Heart Failure and Cardiomyopathy

摘　　要：目的比较血管紧张素受体-脑啡肽酶抑制剂(ARNI)沙库巴曲缬沙坦与血管紧张素转化酶抑制剂(ACEI)贝那普利对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后左心室重构的作用。方法收集2018年6月至2019年6月期间于天津医科大学第二附属医院诊断急性ST段抬高型心肌梗死(STEMI)行急诊PCI治疗的患者。分为沙库巴曲缬沙坦组(25~100 mg,2次/d)和贝那普利组(5~10 mg,1次/d)。收集患者基线资料,分别于治疗1天、1月、3月后行超声心动图检查测量室间隔厚度(IVST)、间隔运动幅度、左心室后壁厚度(LVPWT)、后壁运动幅度、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室重量(LVM)及左心室重量指数(LVMI)。依据性别、年龄及初始LVEF水平分为三个亚组,分别比较沙库巴曲缬坦与贝那普利对不同人群左心室重构的干预效果。结果本研究共纳入85例患者,沙库巴曲缬沙坦组48例,贝那普利组37例,两组患者的基本资料差异无统计学意义(P均>0.05)。而且,治疗前两组患者的IVST、间隔运动幅度、LVPWT、后壁运动幅度、LVEDD、LVESD、LVEF、LVM及LVMI差异均无统计学意义(P>0.05)。治疗1月后,沙库巴曲缬沙坦组LVESD为(35.90±12.85)mm,低于贝那普利组的(45.50±8.55)mm(P=0.006),余指标差异均无统计学意义(P均>0.05);治疗3月后,沙库巴曲缬沙坦组的室间隔运动幅度(P=0.003)及左心室后壁运动幅度(P=0.006)均高于贝那普利组;与贝那普利组比较,沙库巴曲缬沙坦组的LVESD[(44.85±9.53)mm比(30.45±8.80)mm,P<0.001]更低,LVEDD[(56.21±6.58)mm比(50.19±2.80)mm,P=0.002]更低,LVEF[(42.13±15.35)%比(54.81±59.90)%,P=0.012]更高。亚组分析结果显示,应用沙库巴曲缬沙坦治疗获益优于贝那普利在男性、年轻(年龄<65岁)患者更明显;LVEF降低(<50%)患者沙库巴曲缬沙坦治疗获益明显优于贝那普利,而LVEF保留(≥50%)沙库巴曲缬沙坦Objective To compare the effect of sacubitril/valsartan with benalapril on left ventricular remodeling after percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Patients with the diagnosis of acute ST segment elevation myocardial infarction who were treated with primary PCI in the Second Affiliated Hospital of Tianjin Medical University from June 2018 to June 2019 were enrolled and divided into group with sacubitril/valsartan(25-100 mg,twice daily)and benazepril group(5-10 mg,once daily).Baseline data were collected and echocardiography was performed at 1 day,1 month and 3 months after PCI to evaluate the left ventricular remodeling by using of interventricular septal thickness(IVST),septal motion amplitude,left ventricular posterior wall thickness(LVPWT),posterior wall motion amplitude,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular mass(LVM),left ventricular mass index(LVMI).In addition,subgroup analyses were performed based on gender,age(<65 years vs.≥65 years)and LVEF(<50%vs.≥50%)at baseline to compare the effects of both drugs on left ventricular remodeling.Results A total of 85 patients were enrolled and 48 treated with sacubitril/valsartan and other 37 treated with benazepril.There was no statistically significant difference in the baseline data between the two groups(all P>0.05).In addition,no significant differences were observed in the echocardiographic paramters between the two groups before treatment(all P>0.05).After 1 month of treatment,LVESD in the sacubitril/valsartan group was significantly lower than that in the benazepril group[(35.90±12.85)mm vs.(45.50±8.55)mm,P=0.006]while there was no statistical significance in other parameters(all P>0.05).After 3 months of treatment,septal motion amplitude(P=0.003)and posterior left ventricular wall motion amplitude(P=0.006)in the sacubitril/valsartan group were significantly higher than those in the ben

关 键 词：沙库巴曲缬沙坦 贝那普利 急性心肌梗死 左心室重构 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]