沙库巴曲缬沙坦治疗慢性心力衰竭肺动脉高压的疗效分析
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摘要
目的探讨沙库巴曲缬沙坦治疗慢性心衰肺动脉高压的临床效果。方法将56例慢性心衰肺动脉高压患者随机为对照组和观察组,各28例,常规抗心衰治疗基础上,对照组给予缬沙坦,观察组给予沙库巴曲缬沙坦。加量至目标推荐剂量。对比治疗90 d后的效果。结果治疗后,观察组总有效率显著高于对照组(96. 43%vs 71.43%,P<0.05);两组患者血清中N末端脑钠肽前体(NT-proBNP)下降,左室舒张末期直径(LVEDd)、右室舒张末期直径(RVEDd)、肺动脉收缩压(PASP)下降,6 min步行距离(6WMD)、左室射血分数(LVEF)提高,差异均有统计学意义(P<0.05);观察组上述指标的差异均高于对照组(P<0.05)。结论沙库巴曲缬沙坦能有效降低左心衰患者的肺动脉收缩压,临床效果较缬沙坦更佳。
Objective To observe the efficacy of sacubitril/valsartan in patients with chronic heart failure and pulmonary hypertension.Methods A total of 56 patients with chronic heart failure and pulmonary hypertension were randomly divided into the control group(n=28 cases)and the observation group(n=28 cases),control group was treatd with valsartan and observation group was treatd with sacubitril/valsartan on the basis of toutine anti-heart failure treatment, both drugs were dosed to the target recommended. Compared the effects after 90 days of treatment.Results The total efective rate was 96.43% and 71.43% in the control and observation group,which showed a higher rate in the observation group with statistical diference(P<0.05).Compared with before treatment,The plasma level N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end-diastolic diameter(LVEDd),right ventricular end-diastolic diameter(RVEDd),pulmonary artery systolic blood pressure(PASP) decreased,6-minute walking distance and left ventricular ejection fraction(LVEF) increased,and the differences were statistically significant(P<0.05).Whereas the differences of the above indicators in the observation group were more significant than the control group, and the differences were statistically significant(P<0.05).Conclusion Sacubitril/valsartan was more effective in reducing the pulmonary artery systolic blood pressure in patients with left heart failure and reduced ejection fraction.
Objective To observe the efficacy of sacubitril/valsartan in patients with chronic heart failure and pulmonary hypertension.Methods A total of 56 patients with chronic heart failure and pulmonary hypertension were randomly divided into the control group(n=28 cases)and the observation group(n=28 cases),control group was treatd with valsartan and observation group was treatd with sacubitril/valsartan on the basis of toutine anti-heart failure treatment, both drugs were dosed to the target recommended. Compared the effects after 90 days of treatment.Results The total efective rate was 96.43% and 71.43% in the control and observation group,which showed a higher rate in the observation group with statistical diference(P<0.05).Compared with before treatment,The plasma level N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end-diastolic diameter(LVEDd),right ventricular end-diastolic diameter(RVEDd),pulmonary artery systolic blood pressure(PASP) decreased,6-minute walking distance and left ventricular ejection fraction(LVEF) increased,and the differences were statistically significant(P<0.05).Whereas the differences of the above indicators in the observation group were more significant than the control group, and the differences were statistically significant(P<0.05).Conclusion Sacubitril/valsartan was more effective in reducing the pulmonary artery systolic blood pressure in patients with left heart failure and reduced ejection fraction.
引文
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[8] Maslov MY,Foianini S,Orlov MV,et al.A Novel Paradigm for Sacubitril/Valsartan:Beta-Endorphin Elevation as a Contributor to Exercise Tolerance Improvement in Rats With Preexisting Heart Failure Induced by Pressure Overload[J].J Card Fail,2018,24(11):773-782.
[9] Appadurai V,Thoreau J,Malpas T,et al.Sacubitril/Valsartan in Adult Congenital Heart Disease Patients With Chronic Heart Failure - A Single Centre Case Series and Call for an International Registry[J].Heart Lung Circ,2018:s1443-9506.
[10] 魏子寒,李栋博,元峥,等.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.
[11] Dupuis J,Guazzi M.Pathophysiology and Clinical Relevance of Pulmonary Remodelling in Pulmonary Hypertension due to Left Heart Diseases[J].Canadian Journal of Cardiology,2015,31(4):416-429.
[12] Mochel JP,Teng CH,Peyrou M,et al.Sacubitril/valsartan (LCZ696) significantly reduces aldosterone and increases cGMP circulating levels in a canine model of RAAS activation[J].European Journal of Pharmaceutical Sciences,2019,128:103-111.
[13] Trivedi RK,Polhemus DJ,Li Z,et al.Combined Angiotensin Receptor-Neprilysin Inhibitors Improve Cardiac and Vascular Function Via Increased NO Bioavailability in Heart Failure[J].J Am Heart Assoc,2018,7(5):e008268.
[2] Vanderpool RR,Naeije R.Progress in Pulmonary Hypertension with Left Heart Failure Beyond New Definitions and Acronyms[J].Am J Respir Crit care med,2015,192(10):1152-1154.
[3] McMurray JJV,Packer M,Desai AS,et al.Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure[J].New England Journal of Medicine,2014,371(11):993-1004.
[4] Yancy CW,Jessup M,Masoudi FA,et al.2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure:An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure[J].Journal of the American College of Cardiology,2016,68(13):1476-1488.
[5] Sakao S,Tatsumi K,Voelkel NF.Reversible or Irreversible Remodeling in Pulmonary Arterial Hypertension[J].American Journal of Respiratory Cell and Molecular Biology,2010,43(6):629-634.
[6] Bartelds B,Borgdorff MA,Smit-van OA,et al.Differential responses of the right ventricle to abnormal loading conditions in mice:pressure vs.volume load[J].Eur J Heart Fail,2011,13(12):1275-1282.
[7] Kobalava Z,Kotovskaya Y,Averkov O,et al.Pharmacodynamic and Pharmacokinetic Profiles of Sacubitril/Valsartan (LCZ696) in Patients with Heart Failure and Reduced Ejection Fraction[J].Cardiovascular Therapeutics,2016,34(4):191-198.
[8] Maslov MY,Foianini S,Orlov MV,et al.A Novel Paradigm for Sacubitril/Valsartan:Beta-Endorphin Elevation as a Contributor to Exercise Tolerance Improvement in Rats With Preexisting Heart Failure Induced by Pressure Overload[J].J Card Fail,2018,24(11):773-782.
[9] Appadurai V,Thoreau J,Malpas T,et al.Sacubitril/Valsartan in Adult Congenital Heart Disease Patients With Chronic Heart Failure - A Single Centre Case Series and Call for an International Registry[J].Heart Lung Circ,2018:s1443-9506.
[10] 魏子寒,李栋博,元峥,等.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.
[11] Dupuis J,Guazzi M.Pathophysiology and Clinical Relevance of Pulmonary Remodelling in Pulmonary Hypertension due to Left Heart Diseases[J].Canadian Journal of Cardiology,2015,31(4):416-429.
[12] Mochel JP,Teng CH,Peyrou M,et al.Sacubitril/valsartan (LCZ696) significantly reduces aldosterone and increases cGMP circulating levels in a canine model of RAAS activation[J].European Journal of Pharmaceutical Sciences,2019,128:103-111.
[13] Trivedi RK,Polhemus DJ,Li Z,et al.Combined Angiotensin Receptor-Neprilysin Inhibitors Improve Cardiac and Vascular Function Via Increased NO Bioavailability in Heart Failure[J].J Am Heart Assoc,2018,7(5):e008268.