沙库巴曲缬沙坦治疗冠心病致慢性心力衰竭老年患者临床观察

目的：观察沙库巴曲缬沙坦治疗冠心病致慢性心力衰竭（CHF）老年患者的临床效果及对神经内分泌激素、生活质量的影响。方法：95例患者分为对照组48例和观察组47例，对照组接受常规治疗，观察组患者将 ACEI/ARB换为沙库巴曲缬沙坦钠，6个月为一个疗程。比较2组临床疗效，心功能指标左室射血分数（LVEDD）、左室舒张末期内径（LVESD）、左室收缩末期内径（LVEF），神经内分泌激素如肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、促肾上腺皮质激素（ACTH）、去甲肾上腺素（NE）、6 min步行距离（6MWT）和明尼苏达心力衰竭生活质量量表（MLHFQ），记录治疗期间不良反应。结果：观察组总有效率为93.5%，高于对照组的75.0%（P<0.05）。治疗后，2组患者LVEF、6MWT明显升高，LVEDD、LVESD，PRA、AngⅡ、ALD、NE、ACTH水平，MLHFQ量表评分明显降低（P<0.05）。组间相比，观察组LVEF和6MWT较高，PRA、AngⅡ、ALD水平及MLHFQ量表中身体领域及总分较低（P<0.05）。2组不良反应发生率相近（P>0.05）。结论：沙库巴曲缬沙坦钠可以调节冠心病致CHF老年患者神经内分泌激素，提高患者心功能、生活质量和临床疗效。

Clinical observations of sacubitril/valsartan for elders with chronic heart failure due to coronary heart disease

OBJECTIVE To observe the clinical efficacy of sacubitril/valsartan for elders with chronic heart failure(CHF) due to coronary heart disease(CHD) and explore the impacts on neuroendocrine hormones and quality-of-life.METHODS A total of 95 elders were randomly divided into control group(n=48) and treatment group(n=47).The control group received conventional treatment while the treatment group switched from angiotensin-converting enzyme inhibitor/angiotensin Ⅱ receptor blocker(ACEI/ARB) to sacubitril/valsartan.The treatment course was 6 months.Curative efficacy, heart function parameters[left ventricular ejection fraction(LVEF), left ventricular end-diastolic dimension(LVEDD)& left ventricular end-systolic diameter(LVESD)], neuroendocrine hormones[plasma renin activity(PRA), angiotensin Ⅱ(AngⅡ), aldosterone(ALD), norepinephrine(NE)& adrenocorticotropic hormone(ACTH)], 6-minute walking distance(6MWT) and Minnesota heart failure quality-of-life questionnaire(MLHFQ) were compared.And adverse reactions were recorded.RESULTS The effective rate of treatment group was significantly higher than that of control group(93.5% vs. 75.0%, P<0.05).After treatment, LVEF and 6MWT increased while the levels of PRA, AngⅡ, ALD, NE & ACTH and MLHFQ scale scores declined in both groups(P<0.05).As compared with control group, LVEF and 6MWT were higher;the levels of PRA, AngⅡand ALD, body area score and total MLHFQ score were lower in treatment group(P<0.05).The incidence of adverse reactions was similar in both groups(P<0.05).CONCLUSION Sacubitril/valsartan could modulate neuroendocrine hormones, improve heart function, quality-of-life and clinical efficacy for elders with CHF due to CHD.