沙库巴曲缬沙坦治疗左心室射血分数中间值心力衰竭患者临床疗效

目的 探讨沙库巴曲缬沙坦(Sacubitril/Valsartan)对左心室射血分数中间值心力衰竭(Heart failure with mid-range ejection fraction, HFmrEF)的治疗效果。方法 选取2019年8月至2020年8月收治的98例HFmrEF患者, 按照随机数字表法随机分为观察组与对照组,每组各49例。在常规抗心力衰竭治疗的基础上,观察组给予沙库巴曲缬沙坦钠治疗,对照组给予依那普利治疗,分别口服6个月。监测并比较患者试验前后相关心功能指标:N末端前体B型利钠肽(NT-proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、C-反应蛋白(CRP)、左心室射血分数(LVEF)、室间隔厚度(IVST)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、左心房内径(LAD)、NYHA分级、6 min步行试验(6MWT)、收缩压(SBP)以及不良事件等。结果 两组治疗后NT-proBNP、sST-2、CRP水平较治疗前均降低,且观察组降低更明显(P<0.05)。两组治疗后LVEF升高,IVST、LVEDD、LVPWT、LAD降低,且观察组LVEF升高更明显,IVST、LVEDD、LVPWT、LAD降低更明显(P<0.05)。观察组6MWT、SBP及NYHA心功能分级改善情况明显优于对照组(P<0.05),且沙库巴曲缬沙坦能明显降低心力衰竭再入院率。结论 沙库巴曲缬沙坦对左心室射血分数中间值心力衰竭患者的心功能有明显改善作用。

Clinical effect of sacubitril/valsartan for heart failure with mid-range ejection fraction in left ventricle

Objective To investigate the clinical effect of sacubitril/valsartan for heart failure with mid-range ejection fraction(HFmrEF) in left ventricle. Methods Ninety-eight patients with HFmrEF in left ventricle who were recruited from August 2019 to August 2020 were randomly divided into observation group and control group with 49 cases in each group. On the basis of conventional anti-heart failure treatment, the observation group was treated with sacubitril/valsartan sodium, while the control group was treated with enalapril. All the medicines were taken orally for six months by patients in two groups, respectively. The related cardiac indexes were monitored and analyzed before and after the test, such as N-terminal pro-B-type natriuretic peptides(NT-proBNP), soluble growth stimulation expressed gene 2(sST2), C-reactive protein(CRP), left ventricular ejection fraction(LVEF), interventricular septal thickness(IVST), left ventricular end diastolic diameter(LVEDD), left ventricular posterior wall thickness(LVPWT), left atrial diameter(LAD), NYHA classification, 6-minute walk test(6MWT), systolic blood pressure(SBP), as well as the adverse events in two groups after treatment. Results After treatment, NT-proBNP, sST-2, and CRP in the two groups were all lower than those before treatment, and the observation group significantly decreased(P<0.05).LVEF showed an upward trend in the two groups after treatment, while IVST, LVEDD, LVPWT and LAD showed a downward trend in the two groups after treatment; the changes in the observation group were greater than those in the control group (P<0.05). The improvements of 6MWT, SBP and classification of NYHA heart function in the observation group were significantly better than those in the control group (P<0.05), and sacubitril/valsartan could significantly reduce the readmission rate of heart failure. Conclusion Sacubitril/valsartan for patients with HFmrEF in left ventricle can effectively improve cardiac function.