沙库巴曲缬沙坦钠治疗慢性心力衰竭患者的临床疗效分析

doi:10.12092/j.issn.1009-2501.2019.07.014

中国临床药理学与治疗学 ›› 2019, Vol. 24 ›› Issue (7): 810-814.doi: 10.12092/j.issn.1009-2501.2019.07.014

沙库巴曲缬沙坦钠治疗慢性心力衰竭患者的临床疗效分析

范剑峰，方译，郑春华

南昌大学第三附属医院，南昌 330000，江西

收稿日期:2019-04-15 修回日期:2019-07-14 出版日期:2019-07-26 发布日期:2019-07-29
通讯作者: 郑春华，男，硕士生导师，教授，主任医师，研究方向：心血管疾病。 Tel：0791-88862237 E-mail：fangyi98@126.com
作者简介:范剑峰，男，硕士，副主任医师，研究方向：心力衰竭疾病。 Tel：0791-88862237 E-mail：fjf2008250@sohu.com
基金资助:
江西省教育厅科学技术研究项目（GJJ180110）

Clinical efficacy of sacubitril valsartan in the treatment of chronic heart failure

FAN Jianfeng，FANG Yi，ZHENG Chunhua

The Third Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi, China

Received:2019-04-15 Revised:2019-07-14 Online:2019-07-26 Published:2019-07-29

摘要/Abstract

摘要：

目的:探究沙库巴曲缬沙坦钠与盐酸贝那普利治疗射血分数降低的慢性心力衰竭（HFrEF）患者12周后的临床疗效。方法:选取2017年11月至2018年9月在南昌大学第三附属医院诊治的射血分数降低的慢性心衰患者52例，随机分成对照组（25例）及治疗组（27例）。两组分别给与常规抗心衰治疗，对照组给与盐酸贝那普利10 mg每日一次口服治疗，每两周调整一次剂量（根据患者对药物的耐受情况），直至目标剂量20 mg每日一次。治疗组在停血管紧张素转换酶抑制剂（ACEI） 36 h后转化为沙库巴曲缬沙坦钠50 mg每日两次口服治疗，每两周调整一次剂量（根据患者对药物的耐受情况），直至达目标剂量200 mg每日两次。两组患者均持续治疗12周。观察两组患者用药后临床疗效，同时比较治疗前后两组患者氨基末端脑钠尿肽(NT-proBNP)、6 min步行距离、左室射血分数（LVEF）、左室舒张末径（LVEDD）和明尼苏达生活量表（MLHFQ）评分。结果:治疗后，对照组临床治疗有效率达72.00%，但明显低于治疗组的92.60%，两组比较差异有统计学意义（P＜0.05）。治疗后，两组患者 6 min步行距离、NT-proBNP、LVEF、LVEDD和明尼苏达生活量表（MLHFQ）评分均较治疗前改善，差异有统计学意义（P＜0.05），且治疗组改善更明显（P＜0.05）。结论:沙库巴曲缬沙坦钠治疗慢性心衰临床疗效好，安全性高，可以进一步临床推广应用。

关键词: 沙库巴曲缬沙坦钠片, 盐酸贝那普利片, 慢性心力衰竭, 6 min步行距离, 明尼苏达生活量表, 氨基末端脑钠尿肽, 超声心动图

Abstract:

AIM: To investigate the clinical effects of sacubitril valsartan and benazepril hydrochloride on heart function in patients with heart failure reduced ejection fraction（HFrEF）after two months of treatment. METHODS: Patients (52 cases) with heart failure reduced ejection fraction hospitalized in Third Affiliated Hospital of Nanchang University from November 2017 to September 2018 were divided into control (25 cases) and treatment (27cases) groups according to different treatments. Two groups of patients were given conventional anti-heart failure treatment. The control group was treated with benazepril hydrochloride 10 mg orally once a day and the dose was doubled every 2 weeks until the target dose was 20 mg orally 1time per day. The treatment group was treated with sacubitril valsartan 50 mg orally twice daily after stop ACEI 36 hours, and the dose was doubled every 2 weeks until the target dose was 200 mg orally 2 times per day. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and 6 min walking distance, the NT-pro BNP levels, LVEF,LVEDD,MLHFQ scores in two groups before and after treatment were compared.RESULTS:After treatment, the clinical efficacy in the control group was 72.00%, which was significantly lower than 92.60% in the treatment group (P＜0.05). After treatment, the 6 min walking distance in two groups were significantly increased.The NT-pro BNP levels, LVEF,LVEDD,and MLHFQ scores were decreased, and the difference was statistically significant in the same group (P＜0.05). The treatment group was significantly improved compared with control group (P＜0.05). CONCLUSION:Sacubitril valsartan has significant curative effect and high safety in the treatment of chronic heart failure.

Key words: sacubitril valsartan sodium, benazepril hydrochloride, chronic heart failure, 6 min walking distance, MLHFQ score, NT-proBNP, echocardiography

中图分类号:

R541

范剑峰，方译，郑春华. 沙库巴曲缬沙坦钠治疗慢性心力衰竭患者的临床疗效分析[J]. 中国临床药理学与治疗学, 2019, 24(7): 810-814.

FAN Jianfeng，FANG Yi，ZHENG Chunhua. Clinical efficacy of sacubitril valsartan in the treatment of chronic heart failure[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(7): 810-814.

参考文献

［1］Yancy CW，Jessup M，Bozkurt B，et al. 2013 ACCF/AHA guideline for the management of heart failure:：Executive summary:：A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines［J］. Circulation, 2013, 128（16）：1810-1852.
［2］Roger VL，Weston SA，Redfield MM，et al. Trends in heart failure incidence and survival in a community-based population［J］.Acc Curr J Rev，2005，13(12)：344-350.
［3］Levy D， Kenchaiah S，Larson MG，et al. Long-term trends in the incidence of and survival with heart failure［J］. N Engl J Med，2002，347(18)：1397-1402.
［4］Yancy CW，Jessup M，Bozkurt B，et al.2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart.Association Task Force on practice guidelines［J］.Circulation，2013，128(16)：1810-1852.
［5］Mcmurray JJ，Adamopoulos S，Anker SD，et al. ESC guidelines for the diagnosis andtreatment of acute and chronic heart failure 2012：The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the european society of cardiology.Developed in collaboration with the Heart Failure Association (HFA) of the ESC［J］. Eur J Heart Fail，2012，14(8)：803-869.
［6］Reed BN，Street SE，Jensen BC，et al. Time and technology will tell：the pathophysiologic basis of neurohormonal modulation in heart failure［J］. Heart Fail Clin, 2014, 10(4): 543-557.
［7］张薇琳，周海英，杨小明.双效血管紧张素受体-脑啡肽酶抑制剂沙库巴曲/缬沙坦钠的研究进展［J］.世界临床药物，2017，38（12）：851-854.
［8］Fala L.Entresto(sacubitril/Valsartan)：First-in-class angiotension receptore neprilysin inhibitor FDA approved for patients with heart failure［J］.Am Health Drug Benefits，2015，8(6)：330-334.
［9］Yancy CW，Jessup M，Bozkurt B，et al．2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America［J］.J Card Fail，2017，23(8) ： 628-651．
［10］Middel B，Bouma J，De Jongste M，et al. Psychometric properties of the Minnesota living with heart failure questionnaire (MLHF-Q) ［J］. Clin Rehabil, 2001, 15(5)： 489-500.
［11］王珍.慢性心力衰竭病因研究进展［J］. 河北医药，2011， 33(14)： 2198-2199.
［12］高路，老年心力衰竭患者心肌能量代谢特点及调节方式［J］.山东医药，2014,54（47）：99-101.
［13］Engeli S，Stinkens R，Heise T，et al. Effect of sacubitril/valsartan on exercise-induced lipid metabolism in patients with obesity and hypertension［J］.Hypertension，2018,71(1)：70-77.
［14］Fu S，Ping P.Synthesis，secretion，function，metabolism and application of natriuretic peptides in heart failure ［J］. J Bio Engineering，2018，12（1）：2-15.
［15］Pandey KN.Emerging roles of natriuretic peptides and their recep-tors in pathophysiology of hypertension and cardiovascular hyperten-sion［J］.J Am Society Hypertension，2008，2（4）：210-226.
［16］王学忠.缬沙坦/沙库巴曲在心力衰竭临床治疗中的应用［J］.中华心血管病杂志，2017，45（6）：538-541.
［17］侯光友，李冰，徐丽华，等.BNP/NT-proBNP在心力衰竭诊断治疗中的应用进展［J］.实用医药杂志，2013，30（12）：1123-1125.
［18］魏子寒.沙库巴曲缬沙坦治疗左心疾病相关性肺动脉高压的临床研究［J］.中国临床药理学与治疗学，2019，24（1），57-62.
［19］赵玉清.沙库巴曲缬沙坦联合胺碘酮治疗合并阵发性房颤的老年性心力衰竭的疗效观察［J］.河北医药,2019，41（3），404-404, 410.
［20］Solomon SD，Rizkala AR. Angiotensin receptor neprilysin inhibition in heart failure with preserved ejection fraction［J］.Scott JACC：Heart Failure，2017，5(7)：471-482.

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沙库巴曲缬沙坦钠治疗慢性心力衰竭患者的临床疗效分析

Clinical efficacy of sacubitril valsartan in the treatment of chronic heart failure

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