目的 评价沙库巴曲缬沙坦治疗原发性高血压并射血分数保留心力衰竭(heart failure with preserved ejection fraction, HFpEF)患者疗效及预后。方法 选取2018-01至2020-06武警新疆总队医院收治的原发性高血压合并HFpEF患者63例,随机分为试验组32例,对照组31例,试验组给予沙库巴曲缬沙坦,对照组给予缬沙坦,其他药物按指南推荐的使用,随访3个月,观察患者血压水平、NT-proBNP水平、左房内径(LAD)、左室舒张末期内径(LVEDD)、射血分数(LVEF)、E/A值、纽约心功能分级及6 min步行试验改善情况。结果 随访3个月,试验组6 min步行试验距离提高优于对照组[(516.8±47.5)m vs. (425.7±68.5)m],E/A比值提高优于对照组[(0.97±0.15) vs. (0.87±0.16)],试验组NT-proBNP水平低于对照组[(2528.3±761.3)pg/ml vs. (4897.8±966.3) pg/ml];试验组心功能改善有效率为87.5%,明显高于对照组(61.2%),差异有统计学意义(P＜0.05)。治疗后,两组血压均有不同程度的降低,但治疗后两组收缩压及舒张压差异无统计学意义(P>0.05); EF值、LAD、LVEDD治疗前后差异无统计学意义。结论 沙库巴曲缬沙坦能明显提高患者6 min步行试验距离、NYHA心功能分级、E/A值,有效缓解HFpEF患者的临床症状,明显降低其NT-proBNP水平。
Abstract
Objective To evaluate the curative effect and prognosis of sakubitril valsartan in treating patients with heart failure with preserved ejection fraction (HFpEF) and primary hypertension.Methods Sixty-three patients with primary hypertension with HFpEFwere chosen from Xinjiang Provincial Corps Hospital between January 2018 and June 2020 and divided into the experimental group (n=32) and control group (n=31). The experimental group was given sakubitril valsartan, while the control group was treated with valsartan. Both groups were followed up for 3 months before the level of N-terminal pro-brain natriuretic peptide (NT-proBNP), NYHA classification of heart function and 6-minute walk test (6MWT), blood pressure, left atrial diameter (LAD), E/A ratio, left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were observed.Results The distance of 6MWT in the experimental group was improved more significantly than that in the control group [(516.8±47.5)m vs. (425.7±68.5)m], so was the ratio of E/A[(0.97±0.15) vs. (0.87±0.16)].The level of NT-proBNP in the experimental group was lower than that of the control group (2528.3±761.3)pg/ml vs. (4897.8±966.3) pg/ml. The rate of cardiac function improvement in the treatment group was 87.5%, which was significantly higher than that in the control group (61.2%). The level of blood pressure in both groups was significantly decreased, but there was no significant difference between the two groups after treatment. LVEF, LAD and LVEDD were not statistically significant between the two groups after treatment.Conclusions Sakubitril valsartan can effectively relieve clinical symptoms, improve the distance of 6MWT and E/A ratio, and reduce NT-proBNP levels in patients of primary hypertension with HFpEF.
关键词
原发性高血压 /
射血分数保留心力衰竭 /
沙库巴曲缬沙坦
Key words
primary hypertension /
heart failure with preserved ejection fraction /
sakubitril valsartan
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参考文献
[1] 王洁好,华 琦.左心室射血分数保留的心力衰竭研究进展[J].中华老年心脑血管病杂志,2016,18(7):766-769.
[2] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志,2018,46(10):760-789.
[3] Ponikowski P, Voors A A, Anker S D, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)[J]. Eur J Heart Fail, 2016, 18(8): 891-975.
[4] 中国高血压防治指南修订委员会,高血压联盟(中国),中华医学会心血管病学分会,中国医师协会高血压专业委员会,中国医疗保健国际交流促进会高血压分会,中国老年医学学会高血压分会. 中国高血压防治指南(2018年修订版)[J]. 中国心血管病杂志,2019,24(1):24-56.
[5] 周 华,王丽萍. 沙库巴曲缬沙坦钠片治疗左心室射血分数保留心力衰竭的疗效分析[J]. 现代实用医学,2020,32(5):484-485.
[6] Buggey J,Alenezi F,Yoon H J,et al. Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization[J]. ESC Heart Fail, 2017,4( 4):432-439.
[7] Dunlay S M,Roger V L,Redfield M. Epidemiology of heart failure with preserved ejection fraction[J].Nat Rev Cardiol, 2017, 14(10):591-602.
[8] 洪华山.老年慢性心力衰竭的药物和非药物治疗现状[J].中华老年心脑血管病杂志,2015,17(2):785-788.
[9] Catena C,Colussi G,Brosolo G,et al. Aldosterone and left ventricular remodeling[J], Horm Metab Res,2015,47( 13) :981-986.
[10] Te Riet L,van Esch J H,Roks A J,et al.Hypertension: renin-angiotensin-aldosterone system alterations[J]. Circ Res, 2015, 116( 6) :960-975.
[11] 黄明辉,胡 钰,汤玲玲, 等. 高血压在射血分数保留的心力衰竭发展中的作用[J].心血管病学进展, 2019,40(2):294-296.
[12] Teng T K, Tay W T, Dahlstrom U, et al.Different relationships between pulse pressure and mortality in heart failure with reduced,midrange and preserved ejection fraction[J].Int J Cardiol,2018,25(4):203-209.
[13] Sartipy U,Dahlstrm U,Fu M,et al. Atrial fibrillation in heart failure with preserved,midrange,and reduced ejection fraction[J].JACC Heart Fail,2017,5(8):565-574.
[14] Welsh P, Kou L, Yu C, et al. Prognostic importance of emerging cardiac, inflammatory, and renal biomarkers in chronic heart failure patients with reduced ejection fraction and anaemia: REDHF study [J]. Eur J Heart Fail, 2018, 20(2):268-277.
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