陕西医学杂志2024，Vol.53Issue(5)：675-679,5.DOI:10.3969/j.issn.1000-7377.2024.05.022
沙库巴曲缬沙坦联合螺内酯治疗慢性射血分数降低的心力衰竭临床价值研究
Value of sacubitril/valsartan combined with spironolactone in the treatment of chronic heart failure with reduced ejection fraction
摘要
Abstract
Objective:To explore the clinical value of sacubitril/valsartan combined with spironolactone in the treatment of chronic heart failure with reduced ejection fraction(HFrEF).Methods:A total of 98 HFrEF patients were selected and divided into angiotensin Ⅱ receptor blocker(ARB)group and angiotensin receptor neprilysin in-hibitor(ARNI)group with 49 cases in each group according to random number table method.The two groups were given conventional anti-heart failure and spironolactone treatment,and the ARB group was given valsartan orally while the ARNI group was given sacubitril/valsartan.The therapeutic effect and ventricular remodeling indexes(left ventricular end-diastolic diameter[LVEDD],left ventricular posterior wall thickness[LVPW],left ventricular ejec-tion fraction[LVEF],interventricular septal thickness[IVST],left ventricular end-systolic diameter[LVESD]),blood biochemical indexes(N-terminal pro-B-type natriuretic peptide[NT-proBNP],cardiac troponin Ⅰ[cTnⅠ],myo-globin[Myo],creatine kinase isoenzyme[CK-MB]),exercise endurance(six-minutes walking test)and cardiopul-monary exercise test indexes(peak oxygen consumption[Peak VO2],anaerobic threshold[AT],carbon dioxide ven-tilation equivalent slope[VE/VCO2])were compared before and after treatment.The adverse reactions during treat-ment and the occurrence of major adverse cardiovascular events(MACE)within 1 year of follow-up were statistically analyzed.Results:The total effective rate of ARNI group was higher(P＜0.05).After treatment,LVEDD,LVESD,IVST and LVPW in both groups were reduced compared to before treatment,and ARNI group was lower than ARB group,and LVEF was higher than that before treatment,and ARNI group was higher than ARB group(all P＜0.05).The levels of NT-proBNP,cTnⅠ and CK-MB in ARNI group after treatment were lower compared to ARB group(all P＜0.05).After treatment,six-minutes walking distance,Peak VO2 and AT in two groups were increased compared with before treatment,and ARNI group was higher than ARB group(all P＜0.05).VE/VCO2 was de-clined than that before treatment,and ARNI group had lower VE/VCO2(all P＜0.05).There were no statistical differences in the total incidence of adverse reactions during treatment and MACE within 1 year between the two groups(all P＞0.05).Conclusion:Sacubitril/valsartan combined with spironolactone has a significant effect on pa-tients with chronic HFrEF,which can improve heart function,reverse ventricular remodeling,reduce cardiopulmonary load,alleviate myocardial injury,and improve exercise endurance and has a good safety.关键词
慢性心力衰竭/射血分数降低/沙库巴曲缬沙坦/螺内酯/临床价值Key words
Chronic heart failure/Reduced ejection fraction/Sacubitril/valsartan/Spironolactone/Clinical value分类
医药卫生引用本文复制引用
王丽辉,徐佳,姜晶..沙库巴曲缬沙坦联合螺内酯治疗慢性射血分数降低的心力衰竭临床价值研究[J].陕西医学杂志,2024,53(5):675-679,5.基金项目
北京市海定区预防医学会科研项目(2019HDPMA08) （2019HDPMA08）
