沙库巴曲缬沙坦和盐酸贝那普利对急性失代偿性心力衰竭患者血清NT-proBNP cTnT水平和心脏超声功能指标的影响

doi:10.3969/j.issn.1006-6233.2023.05.032

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摘要 目的:分析沙库巴曲缬沙坦与盐酸贝那普利对急性失代偿性心力衰竭(ADHF)患者的干预效果。方法:选取2019年12月至2022年2月我院急诊医学科及心血管内科收治的126例ADHF患者,采用非随机同期对照研究及患者自愿原则分为观察组(常规西药+沙库巴曲缬沙坦,n=63例)和对照组(常规西药+贝那普利,n=63例),两组均治疗8周。比较两组治疗前后的心功能分级、6min步行试验(6MWT)、心功能超声指标及血清学指标水平;比较两组治疗期间用药不良反应;记录两组出院3个月内的预后情况。结果:治疗期间对照组剔除1例,剩余62例有效病例。两组治疗后的NYHA心功能分级及6MWT距离较治疗前明显改善(P<0.05),观察组治疗前后的6MWT距离提高幅度明显高于对照组[116.17±12.25)VS(99.95±10.64)](P<0.05);观察组治疗后LVEF的升高幅度[(7.73±1.03)VS(4.95±0.89)]明显高于对照组(P<0.05),LVIDd[(-7.74±1.05)VS(-3.60±0.42)]、LVIDs[(-8.91±1.89)VS(-6.74±1.15)]、LA[(-4.62±0.51)VS(-1.81±0.20)]的降低幅度明显低于对照组(P<0.05);观察组治疗后血清NT-proBNP[(1243.25±100.64)VS(1060.88±110.35)]、cTnT[(0.07±0.02)VS(0.06±0.01)]、CK-MB[(14.57±3.27)VS(11.15±4.60)]的降低幅度明显高于对照组(P<0.05);观察组治疗期间不良反应发生率为6.35%(4/63),对照组为4.84%(3/62),组间比较无明显差异(P>0.05);随访期间观察组再入院6例,全因死亡2例,对照组再入院10例,全因死亡3例,两组预后不良发生率比较无明显差异(P>0.05)。结论:与盐酸贝那普利相较,沙库巴曲缬沙坦治疗ADHF可明显改善心功能,降低血清标志物水平,疗效更佳。

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关键词 ：急性失代偿性心力衰竭, 沙库巴曲缬沙坦, 盐酸贝那普利, 心功能

Abstract：Objective: To analyze the intervention effects of sacubitril/valsartan and benazepril Hydrochloride on patients with acute decompensated heart failure (ADHF). Methods: A total of 126 patients with ADHF who were treated in Department of Emergency Medicine and Department of Cardiovascular Medicine of our hospital between December 2019 and February 2022 were selected and divided into observation group (conventional western medicine+sacubitril/valsartan, n=63) and control group (conventional western medicine+benazepril, n=63) by the non-randomized concurrent control trial and voluntary principle of patients. Both groups were treated for 8 weeks. The cardiac function grading, 6-minute walk test (6MWT), cardiac function ultrasound indicators and serological indicators before and after treatment and adverse drug reactions during treatment were compared between the two groups. The prognosis within 3 months after discharge was recorded in the two groups. Results: During treatment, 1 case was excluded from control group and the remaining 62 effective cases were obtained. The NYHA cardiac function grading and 6MWT distance in the two groups after treatment were significantly improved compared with those before treatment (P<0.05), and the improvement of 6MWT distance before and after treatment in observation group was significantly higher than that in control group [116.17±12.25) VS (99.95±10.64)] (P<0.05). After treatment, the increase of LVEF in observation group was significantly higher than that in control group [(7.73±1.03) VS (4.95±0.89)] while the decreases of LVIDd, LVIDs and LA were significantly lower than those in control group [(-7.74±1.05) VS (-3.60±0.42), (-8.91±1.89) VS (-6.74±1.15), (-4.62±0.51) VS (-1.81±0.20)] (P<0.05). The reductions of serum NT-proBNP, cTnT and CK-MB levels in observation group after treatment were significantly higher compared with those in control group [(1243.25±100.64) VS (1060.88±110.35), (0.07±0.02) VS (0.06±0.01), (14.57±3.27) VS (11.15±4.60)] (P<0.05). The incidence rate of adverse reactions during treatment in observation group was 6.35% (4/63) and was 4.84% (3/62) in control group (P>0.05). During follow-up, there were 6 cases of readmission and 2 cases of all-cause death in observation group, and 10 cases of readmission and 3 cases of all-cause death in control group, and there was no significant difference in the incidence rate of poor prognosis between the two groups (P>0.05). Conclusion: Compared with benazepril hydrochloride, sacubitril/valsartan in the treatment of ADHF can more significantly improve the cardiac function and reduce the levels of serum markers with a better efficacy.

Key words： Acute decompensated heart failure Sacubitril/valsartan Benazepril hydrochloride Cardiac function

基金资助:国家青年基金项目,(编号:81800445)

通讯作者: 鲁俊

引用本文:

王牛牛, 鲁大胜, 杨卿青, 梅勇, 宋晨旭, 鲁俊. 沙库巴曲缬沙坦和盐酸贝那普利对急性失代偿性心力衰竭患者血清NT-proBNP cTnT水平和心脏超声功能指标的影响[J]. 河北医学, 2023, 29(5): 861-866.
WANG Niuniu, LU Dasheng, YANG Qingqing, et al. Effects of Sacubitril/Valsartan and Benazepril Hydrochloride on Serum NT-proBNP cTnT Levels and Cardiac Ultrasound Function Indicators in Patients with Acute Decompensated Heart Failure. HeBei Med, 2023, 29(5): 861-866.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.05.032 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I5/861

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