极小剂量滴定沙库巴曲缬沙坦治疗心衰合并低血压的有效性和安全性  

Efficacy and safety of very low-dose titration of sacubitril/valsartan in patients with heart failure with low systolic blood pressure

作　　者：赵希军[1] 张方霞[1] 王新霞[1] 程艳丽[1] ZHAO Xijun;ZHANG Fangxia;WANG Xinxia;CHENG Yanli(Department of Cardiology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,China)

机构地区：[1]滨州医学院附属医院心内科,山东滨州256603

出　　处：《西部医学》2025年第3期408-412,418,共6页Medical Journal of West China

基　　金：山东省中医药科技项目(M-2023209)。

摘　　要：目的探讨极小剂量滴定沙库巴曲缬沙坦治疗合并低收缩压(SBP)的射血分数降低心力衰竭(HFrEF)的有效性和安全性。方法回顾性选取2019年1月—2021年6月滨州医学院附属医院心内科住院的低SBP的HFrEF患者86例为研究对象,根据治疗方式不同分为对照组与观察组各43例。对照组给予沙库巴曲缬沙坦从25 mg每天2次开始,剂量每2~4周倍增1次,直至达到最大耐受剂量;观察组给予沙库巴曲缬沙坦从小剂量25 mg每天1次开始,剂量每4~8周倍增1次,直至达到最大耐受剂量。治疗12个月后,记录两组患者治疗前后左心室射血分数(LVEF)、左心室舒张末期内径(LVDd)和左心室短轴缩短率(LVFS)、N末端B型利钠肽原(NT-proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、血钾、血肌酐、血压的水平变化,并比较两组患者用药情况和安全性。结果治疗后,两组患者NT-proBNP、sST2和LVDd均降低,而LVEF和LVFS均升高,且观察组更为显著(均P<0.001);观察组沙库巴曲缬沙坦最大耐受剂量高于对照组(P<0.001);两组治疗后血钾、血肌酐差异无统计学意义(P>0.05),治疗后对照组SBP低于观察组(P<0.001),舒张压(DBP)差异无统计学意义(P>0.05),症状性低血压、再住院发生率观察组更低(P<0.001,P<0.05)。结论极小剂量缓慢滴定沙库巴曲缬沙坦治疗HFrEF伴低SBP的患者,能明显改善患者心功能,具有较高的安全性。Objective To observe the efficacy and safety of very low-dose titration of sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction(HFrEF)combined with low systolic blood pressure.Methods A total of 86 patients with HFrEF with low systolic blood pressure hospitalized in the Department of Cardiology of Binzhou Medical University Hospital from January 2019 to June 2021 were retrospectively selected as the study subjects.There were 43 cases in the control group and the observation group,and the control group was given sacubitril/valsartan from 25mg twice a day,and the dose was doubled once every 2~4 weeks until the maximum tolerated dose was reached;The observation group was given sacubitril/valsartan from a small dose of 25 mg once a day,and the dose was doubled every 4~8 weeks until the maximum tolerated dose was reached.After 12 months of treatment,the changes of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd)and left ventricular short axis shortening rate(LVFS),N-terminal B-type natriuretic peptide(NT-proBNP),soluble growth-stimulating expression of gene 2 protein(sST2),blood potassium,serum creatinine and blood pressure were recorded before and after treatment,and the medication status and safety of the two groups were compared.Results NT-proBNP,sST2,and LVDd were reduced in both groups,while LVEF and LVFS were elevated,and these improvements were more significant in the observation group(P<0.001),the dose of sacubitril-valsartan in the observation group was higher than that in the control group(P<0.001),the difference in serum potassium and serum creatinine between the two groups was not significant(P>0.05),the systolic blood pressure in the control group after treatment was lower than that in the observation group(P<0.001),the difference in diastolic blood pressure was not statistically significant(P>0.05),and the incidence of symptomatic hypotension and rehospitalization was lower in the observation group(P<0.001 and P<0.05,respectively).Con

关 键 词：心力衰竭 低收缩压 沙库巴曲缬沙坦 滴定 有效性 安全性 

分 类 号：R541.6[医药卫生—心血管疾病]