沙库巴曲缬沙坦治疗射血分数保留心功能衰竭的疗效研究

目的评价同心力衰竭(心衰)治疗指南推荐的最佳治疗相比,加用沙库巴曲缬沙坦是否能够更好的改善射血分数保留心功能衰竭患者的症状及预后。方法连续入选2018年3月至2018年9月于解放军总医院第七医学中心就诊的HFpEF患者42例,其中治疗组20例,对照组22例,两组患者均给予心衰治疗指南推荐的最佳药物治疗,其中治疗组加用沙库巴曲缬沙坦100 mg,2/d。随访3月,观察患者NT-proBNP水平、纽约心功能分级及6 min步行试验改善情况,同时评估两组间主要不良心脏事件发生率。结果两组患者基线资料无统计学差异,随访3月,治疗组纽约心功能分级显著优于对照组(P<0.05);治疗组NT-proBNP水平显著低于对照组[(3311.7±781.4)pg/ml vs.(6879.6±1033.5)pg/ml,P<0.001];治疗组6 min步行试验距离显著优于对照组[(550.2±53.2)m vs.(394.2±62.8)m,P<0.001];治疗组共发生MACE事件3例,对照组共发生重点事件9例,治疗组显著优于对照组(P=0.029)。其获益主要来源于因心衰再次住院率显著减少。结论同心衰治疗指南推荐的最佳药物治疗相比,加用沙库巴曲缬沙坦能够更加有效的改善射血分数保留心衰患者的临床症状,降低NT-proBNP水平,并显著减少患者因再次心衰住院的比率。

Curative effect of sakubitril valsartan on heart failure with preserved ejection fraction

Objective To review the curative effect of sakubitril valsartan,compared with the optimal therapies recommended by the therapeutic guidelines for heart failure(HF),on symptoms and prognosis in patients with heart failure with preserved ejection fraction(HFpEF).Methods HFpEF patients(n=42)were chosen from the Seventh Medical Center of Chinese PLA General Hospital from Mar.2018 to Sept.2018,and divided into treatment group(n=20)and control group(n=22).The patients in 2 groups were treated with the optimal dugs recommended by HF therapeutic guidelines,and treatment group was additionally given sakubitril valsartan(100 mg)twice a day.All groups were followed up for 3 months,and then the level of N-terminal pro-brain natriuretic peptide(NTproBNP),NYHA classification of heart function and 6-minute walk test(6MWT)were observed,and incidence rate of major adverse cardiovascular events(MACE)was reviewed in 2 groups.Results There was no statistical difference in basic data between 2 groups.After followed up for 3 months,NYHA classification of heart function was significant superior in treatment to that in control group(P<0.05).The level of NT-proBNP was significantly lower in treatment group than that in control group[(3311.7±781.4)pg/ml vs.(6879.6±1033.5)pg/ml,P<0.001].The distance of 6MWT was significantly longer in treatment group than that in control group[(550.2±53.2)m vs.(394.2±62.8)m,P<0.001].There were 3 cased of MACE in treatment group and 9 cases in control group(P=0.029).The benefits mainly come from the significant decrease of re-hospitalization rate due to HF in treatment group.Conclusion Sakubitril valsartan,compared with the optimal drugs recommended by the therapeutic guidelines for HF,can effectively relieve clinical symptoms,reduce NT-proBNP level and significantly decrease re-hospitalization rate due to HF in HFpEF patients.