沙库巴曲缬沙坦治疗原发性高血压合并慢性心力衰竭患者的临床研究  

Clinical trial of sacubitril valsartan in the treatment of patients with essential hypertension complicated with chronic heart failure

作　　者：刘继文[1] 黄婷 朱保成[1] 汤曾耀[1] LIU Ji-wen;HUANG Ting;ZHU Bao-cheng;TANG Zeng-yao(Department of Cardiovascular Medicine,Jiujiang First People's Hospital,Jiujiang332000,Jiangxi Province,China)

机构地区：[1]九江市第一人民医院心血管内科,江西九江332000

出　　处：《中国临床药理学杂志》2024年第22期3224-3228,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的 观察沙库巴曲缬沙坦钠片联合呋塞米片对原发性高血压(PH)合并慢性心力衰竭(CHF)患者N末端脑钠肽前体(NT-proBNP)、血管紧张素(AngⅡ)的影响。方法 将PH合并CHF患者按队列法分为对照组和试验组,对照组在限钠、利尿等常规治疗的基础上,予以呋塞米片,每次服用20 mg,bid;试验组在对照组治疗的基础上,加用沙库巴曲缬沙坦钠片,每次服用50 mg,bid,根据耐受情况增量至每次100 mg;均连续治疗8周。比较2组患者的临床疗效、心功能[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)]、心肌酶[肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LD)]、动态血压、血清NT-proBNP、AngⅡ,并进行安全性评价。结果 试验组和对照组分别纳入47例和51例。治疗后,试验组和对照组的总有效率分别为87.23%(41例/47例)和68.63%(35例/51例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组与对照组的LVEF分别为(43.91±3.64)%和(37.72±3.28)%,LVESD分别为(43.64±2.29)和(47.88±2.13)mm, LVEDD分别为(52.47±2.05)和(57.31±2.29)mm, cTnⅠ分别为(0.57±0.18)和(0.86±0.27)μg·L^(-1), CK-MB分别为(22.93±4.76)和(31.48±5.36)U·L^(-1), LD分别为(196.82±17.42)和(269.72±19.34)U·L^(-1),24 h平均收缩压分别为(138.63±1.95)和(140.27±2.41)mmHg,夜间平均收缩压分别为(133.76±1.84)和(135.73±1.65)mmHg,夜间平均舒张压分别为(82.14±1.47)和(83.68±1.55)mmHg, NT-proBNP分别为(1 041.54±261.73)和(1 695.73±294.58)pg·mL^(-1),AngⅡ分别为(47.61±9.62)和(64.39±10.45)pg·mL^(-1),试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组发生的药物不良反应主要有头痛头晕、低血压、高钾血症;对照组发生的药物不良反应主要有消化道不适,头痛头晕,心动过缓,便秘。试验组的药物不良反应总发生率为12.76%,对照组为9.80%,在统计学上差异�Objective To explore the effects of sacubitril valsartan tablets combined with furosemide tablets on serum N-terminal pro brain natriuretic peptide(NT-proBNP)and angiotensinⅡ(AngⅡ)in patients with primary hypertension(PH)and chronic heart failure(CHF).Methods Patients with PH and CHF were divided into control group and treatment group according to cohort method.The control group was treated with furosemide tablets(20 mg,bid)on basis of routine treatments(sodium restriction,diuresis),while treatment group was treated with sacubitril valsartan tablets(50 mg,bid;increase to 100 mg/once according to tolerance)on basis of control group.All patients were treated for 8 weeks.The clinical curative effect,cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)],myocardial enzymes[cardiac troponin I(cTn I),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LD)]ambulatory blood pressure,serum NT-proBNP and AngⅡwere compared between the two groups.Results There were 47 cases in treatment group and 51 cases in control group,respectively.Afer treatment,total response rates of treatment group and control group were 87.23%(41 cases/47 cases)and 68.63%(35 cases/51 cases),and the difference was statistically significant(P<0.05).After treatment,LVEF in treatment group and control group were(43.91±3.64)%and(37.72±3.28)%;LVESD were(43.64±2.29)and(47.88±2.13)mm;LVEDD were(52.47±2.05)and(57.31±2.29)mm;cTnl levels were(0.57±0.18)and(0.86±0.27)μg·L^(-1);CK-MB levels were(22.93±4.76)and(31.48±5.36)U·L^(-1);LD levels were(196.82±17.42)and(269.72±19.34)U·L^(-1);the 24 h average systolic blood pressure were(138.63±1.95)and(140.27±2.41)mmHg;the nighttime mean systolic blood pressure were(133.76±1.84)and(135.73±1.65)mmHg;the nighttime mean diastolic blood pressure were(82.14±1.47)and(83.68±1.55)mmHg;NT-proBNP were(1041.54±261.73)and(1695.73±294.58)pg·mL^(-1);AngⅡwere(47.61±9.62)and(64.39±10.45)pg·mL^(-1).Compar

关 键 词：沙库巴曲缬沙坦钠片 呋塞米片 原发性高血压 慢性心力衰竭 N末端脑钠肽前体 血管紧张素 

分 类 号：R972[医药卫生—药品]