LCZ696对HFrEF及HFmrEF合并心房颤动患者心脏保护作用的临床研究  

Clinical Study on Cardioprotective Effect of LCZ696 on HFrEF and HFmrEF Patients with Atrial Fibrillation

作　　者：陈旭松 简春燕[1] 彭畅第 李山岳 吴一帆[1] CHEN Xusong;JIAN Chunyan;PENG Changdi;LI Shanyue;WU Yifan(Cardiology DepartmentⅡ,Zhanjiang Central People's Hospital,Zhanjiang 524000,China)

机构地区：[1]湛江中心人民医院心内二科,广东湛江524000

出　　处：《中国医学创新》2025年第4期24-30,共7页Medical Innovation of China

基　　金：湛江市非资助科技攻关计划项目(2021B01460)。

摘　　要：目的:探讨沙库巴曲缬沙坦(LCZ696)对射血分数降低的心力衰竭(HFrEF)及射血分数轻度降低型心力衰竭(HFmrEF)合并心房颤动患者心脏保护作用。方法:以2021年10月—2022年9月经湛江中心人民医院收治的HFrEF及HFmrEF合并心房颤动患者80例为研究对象,按随机数字表法分为对照组及观察组,观察组按心力衰竭类型分为两个亚组:HFrEF组及HFmrEF组,按照心力衰竭指南及心房颤动指南,根据患者的具体情况予以利尿剂、β-受体阻断剂、醛固酮受体拮抗剂、地高辛、伊伐布雷定、华法林或利伐沙班等常规治疗,对照组予常规血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB),试验组在常规治疗基础上予以LCZ696口服治疗。比较两组及观察组亚组临床疗效、心脏功能[6分钟步行试验(6MWT)、心肌标志物N末端B型利钠肽原(NT-proBNP)、左心房内径(LAD)、左心房容积指数(LAVI)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左室收缩末期内径(LVESD)],并统计心血管事件发生率。结果:与对照组相比,观察组总有效率较高(95.00%vs 80.00%)(P<0.05),且HFrEF组、HFmrEF组总有效率比较,差异无统计学意义(P>0.05);两组治疗前6MWT、NT-proBNP、LAD、LAVI、LVEF、LVEDD及LVESD比较,差异均无统计学意义(P>0.05)。治疗后,两组6MWT、LVEF均升高,NT-proBNP、LAD、LAVI、LVEDD及LVESD均降低,观察组6MWT、LVEF均高于对照组,NT-proBNP、LAD、LAVI、LVEDD及LVESD均低于对照组(P<0.05)。观察组两亚组治疗后6MWT、LVEF均高于治疗前,NT-proBNP、LAD、LAVI、LVEDD及LVESD均低于治疗前,且HFrEF组6MWT、LVEF升高幅度均高于HFmrEF组,NT-proBNP下降幅度高于HFmrEF组(P<0.05);两组及观察组亚组心血管事件发生率比较,差异均无统计学意义(P>0.05)。结论:HFrEF及HFmrEF合并心房颤动患者应用LCZ696治疗均可获有较佳效果,并保护心脏功能,且心血管事件较少。其中,主要获益人群为HFObjective:To investigate the cardioprotective effect of Sacubitril Valsartan(LCZ696)on heart failure with reduced ejection fraction(HFrEF)and heart failurewith mid-range ejection fraction(HFmrEF)combined with atrial fibrillation.Method:A total of 80 patients with HFrEF and HFmrEF combined with atrial fibrillation admitted to Zhanjiang Central People's Hospital from October 2021 to September 2022 were selected as the study objects,and were divided into control group and observation group according to random number table method.The observation group was divided into two subgroups according to the type of heart failure:HFrEF group and HFmrEF group.Patients were given diuretics,β-blockers,aldosterone receptor antagonists,Digoxin,Ivabradine Hydrochlorid,Warfarin or Rivaroxaban according to the specific conditions of patients follow the guidelines for heart failure and atrial fibrillation,the control group was given conventional ACEI or ARB,and the experimental group was given LCZ696 oral therapy on the basis of conventional treatment.The clinical efficacy and cardiac function[6 min walk test(6MWT),myocardial marker N-terminal pro brain natriuretic peptide(NT-proBNP),left atrial diameter(LAD),left atrial volume index(LAVI),left ventricular ejection fraction(LVEF),left ventricular enddiastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)]of the two groups and subgroups of observation group were compared,and the incidence of cardiovascular events were calculated.Result:Compared with the control group,the total effective rate of observation group was higher(95.00%vs 80.00%)(P<0.05),and there was no statistical significance in the total effective rate of HFrEF group and HFmrEF group(P>0.05).There were no significant differences in 6MWT,NT-proBNP,LAD,LAVI,LVEF,LVEDD and LVESD between the two groups before treatment(P>0.05).After treatment,6MWT and LVEF of two groups were increased,while NTproBNP,LAD,LAVI,LVEDD and LVESD were decreased,the 6MWT and LVEF of the observation group were higher than those of

关 键 词：心力衰竭 射血分数 沙库巴曲缬沙坦 心脏功能 

分 类 号：R541.75[医药卫生—心血管疾病] R541.6[医药卫生—内科学]