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沙库巴曲缬沙坦对不同射血分数心力衰竭患者的疗效及预后

黎冉 谢丽娟 焦长青 陆红红 周碧蓉

黎冉, 谢丽娟, 焦长青, 陆红红, 周碧蓉. 沙库巴曲缬沙坦对不同射血分数心力衰竭患者的疗效及预后[J]. 中华全科医学, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716
引用本文: 黎冉, 谢丽娟, 焦长青, 陆红红, 周碧蓉. 沙库巴曲缬沙坦对不同射血分数心力衰竭患者的疗效及预后[J]. 中华全科医学, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716
LI Ran, XIE Li-juan, JIAO Chang-qing, LU Hong-hong, ZHOU Bi-rong. Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with different ejection fraction[J]. Chinese Journal of General Practice, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716
Citation: LI Ran, XIE Li-juan, JIAO Chang-qing, LU Hong-hong, ZHOU Bi-rong. Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with different ejection fraction[J]. Chinese Journal of General Practice, 2021, 19(1): 10-13. doi: 10.16766/j.cnki.issn.1674-4152.001716

沙库巴曲缬沙坦对不同射血分数心力衰竭患者的疗效及预后

doi: 10.16766/j.cnki.issn.1674-4152.001716
基金项目: 

安徽省卫生健康适宜技术推广项目 2018-TG03

安徽省教育厅医学科研课题重点项目 KJ2018A0708

安徽省学术和技术带头人及后备人选学术科研项目 2017H118

详细信息
    通讯作者:

    周碧蓉,E-mail: ahmubrz@163.com

  • 中图分类号: R541.6  R972

Clinical effect and prognosis of sacubitril-valsartan in treating heart failure patients with different ejection fraction

  • 摘要:   目的  观察沙库巴曲缬沙坦对于不同射血分数慢性心力衰竭(chronic heart failure, CHF)患者的疗效、预后及治疗安全性。   方法  选取2019年1—12月于安徽医科大学第一附属医院心内科住院的CHF患者78例,根据射血分数情况分为射血分数减少(HFrEF)组(共40例)和射血分数保留(HFpEF)组(共38例)。2组患者均接受常规心力衰竭治疗,在此基础上均接受沙库巴曲缬沙坦治疗。比较2组治疗6个月后脑钠肽(BNP)、血钾、肾功能和左房内径(LAD)、左室舒张末内径(LVEDD)及纽约心功能分级(NYHA)变化,并记录治疗的安全性。同时以心血管死亡或心衰再住院为终点事件,采用Kaplan-Meier生存曲线法比较2组患者治疗6个月内累积无终点事件生存率。   结果  HFrEF组治疗6个月后较其治疗前BNP水平下降,LAD、LVEDD减低,NYHA分级改善(均P<0.05);HFpEF组治疗6个月后亦较其治疗前BNP水平下降,LAD、LVEDD减低,NYHA分级改善(均P<0.05);HFrEF组患者BNP水平的下降程度和NYHA分级的改善程度较HFpEF组更佳;HFrEF组和HFpEF组累积无终点事件生存率比较差异无统计学意义(81.9% vs. 85.0%, P=0.694)。2组安全性均较好。   结论  沙库巴曲缬沙坦对于射血分数保留性心衰有一定的疗效,在临床上值得推荐使用,但与射血分数减低性心衰相比疗效稍差。两者6个月累积无终点事件生存率和安全性方面未见明显差异。

     

  • 图  1  2组慢性心力衰竭患者随访期内累计无终点事件生存曲线

    表  1  2组慢性心力衰竭患者基线资料比较[例(%)]

    组别 例数 年龄(x ±s,岁) 女性 NYHA分级 LAD[M(P25,P75),cm] LVEDD(x ±s,cm) 高血压
    Ⅰ级和Ⅱ级 Ⅲ级 Ⅳ级
    HFrEF组 40 61.5±17.5 15(37.5) 5(12.5) 22(55.0) 13(32.5) 4.6(4.2, 5.2) 6.53±0.70 16(40.0)
    HFpEF组 38 71.0±9.5 18(47.4) 13(34.2)c 19(50.0) 6(15.8) 4.6(4.5, 5.1) 5.39±0.84 26(68.4)
    统计量 -2.181a 0.778b -2.444d -0.065d 5.318a 6.334b
    P 0.014 0.378 0.015 0.948 <0.001 0.012
    组别 例数 冠心病 糖尿病 房颤 BNP[M(P25,P75),pg/mL] Scr[M(P25,P75),μmol/L] eGFR[x ±s,mL/(min·1.73m2)] 血钾(x ±s,mmol/L)
    HFrEF组 40 14(35.0) 8(20.0) 9(22.5) 1 327.9(957.0, 2 672.7) 84.2(74.3, 96.9) 83.0±26.9 4.0±0.5
    HFpEF组 38 12(31.6) 10(26.3) 18(47.4) 833.7(607.5, 1 117.0) 67.3(56.1, 88.1) 84.4±18.5 3.9±0.5
    统计量 0.103b 0.438b 5.325b -2.652d -2.189d -0.201a 0.905a
    P 0.749 0.508 0.021 0.008 0.029 0.842 0.370
    注:at值,bχ2值,dZ值; HFpEF组与HFrEF组比较,cP < 0.05。
    下载: 导出CSV

    表  2  2组慢性心力衰竭患者治疗前后各指标比较[M(P25,P75)]

    组别 例数 BNP(pg/mL) LAD(cm) LVEDD(x ±s,cm) NYHA Ⅰ级和Ⅱ级[例(%)] NYHA Ⅲ级[例(%)]
    治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
    HFrEF组 40 1 327.9(905.7, 2 921.6) 165.9(56.9, 545.5)b 4.6(4.2, 5.2) 4.4(4.0, 4.9)b 6.53±0.70 6.34±0.80b 5(12.5) 20(50.0) 22(55.0) 13(32.5)
    HFpEF组 38 833.7(607.5, 1 117.0) 175.2(80.0, 393.2)b 4.6(4.5, 5.1) 4.5(4.2,5.1)b 5.39±0.84 5.28±0.78b 13(34.2) 19(50.0) 19(50.0) 14(36.8)
    统计量 -2.652a -0.297a -0.065a -0.614a 5.318c 4.404c 5.174d < 0.001d 0.195d 0.162d
    P 0.008 0.767 0.948 0.539 <0.001 <0.001 0.023 >0.999 0.659 0.687
    组别 例数 NYHA Ⅳ级[例(%)] Scr(μmol/L) eGFR[mL/(min·1.73m2)] 血钾(x ±s,mmol/L)
    治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
    HFrEF组 40 13(32.5) 7(17.5) 84.2(74.3, 96.9) 83.2(69.1,99.6) 84.5(65.3,97.5) 75.0(60.0, 104.0) 4.0±0.5 4.3±0.8
    HFpEF组 38 6(15.8) 5(13.2) 67.3(56.1, 88.1) 82.2(58.8,95.7) 84.0(75.0,99.0) 75.0(61.0, 96.0) 3.9±0.5 4.1±0.5
    统计量 2.953d 0.282d -2.189a -0.600a -0.201a -0.431a 0.905c -0.996c
    P 0.086 0.595 0.029 0.549 0.842 0.668 0.370 0.319
    注:治疗前,2组NYHA分级比较,Z=-2.444,P=0.015;治疗后,2组NYHA分级比较,Z=-0.181,P=0.856。与治疗前比较,bP<0.05;aZ值;ct值,dχ2值。
    下载: 导出CSV
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  • 收稿日期:  2020-08-25
  • 网络出版日期:  2022-02-19

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