摘要
慢性心力衰竭(CHF)是全球范围内重要的公共健康问题,其高发病率和高病死率严重威胁患者生命健康并增加社会经济负担。沙库巴曲缬沙坦钠片作为一种新型血管紧张素受体脑啡肽酶抑制剂,已被证实可降低CHF患者的心血管死亡率和住院率,然而其在不同患者群体中的具体疗效及对心功能指标的改善作用尚需进一步研究。本研究旨在评估沙库巴曲缬沙坦钠片对CHF患者B型钠尿肽前体(NT-proBNP)水平及心功能指标的影响,为CHF的精准化治疗提供理论依据。本研究为单中心、前瞻性队列研究,纳入2024年1月至2025年1月期间在医院住院的120例CHF患者,随机分为对照组和观察组,各60例。对照组接受标准化CHF常规治疗,包括血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)等药物,观察组在此基础上停用ACEI或ARB,并改用沙库巴曲缬沙坦钠片,治疗周期为12周。主要观察指标为NT-proBNP和左心室射血分数(LVEF);次要观察指标包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、每搏输出量(SV)、心排血量(CO)及六分钟步行距离(6MWD)。两组患者在治疗前的基线特征无显著差异(P>0.05),治疗12周后,与对照组相比,观察组患者的NT-proBNP水平显著降低(2 430.0 vs 3 154.0 pg/mL,P<0.001),LVEF显著升高(47.2%vs 39.2%,P<0.001)。此外,观察组LVEDD(52.9 vs 56.0 mm,P<0.001)、LVESD(38.5 vs 42.2 mm,P<0.001)、SV(74.9 vs 68.2 mL,P<0.001)、CO(5.1 vs 4.8 L/min,P=0.022)及6MWD(418 vs 358 m,P<0.001)等次要指标的改善幅度均显著优于对照组。治疗期间,两组不良事件(如低血压和高血钾)的发生率无显著差异(P>0.05)。沙库巴曲缬沙坦钠片联合常规治疗可显著降低CHF患者的NT-proBNP水平,改善心功能指标(LVEF、LVEDD、LVESD、SV、CO)及运动耐力(6MWD),且具有良好的安全性。
Chronic heart failure(CHF)is a significant global public health issue,characterized by a high incidence and mortality rate that severely threatens patient health and imposes a considerable socioeconomic burden.Sacubitril/valsartan,a novel angiotensin receptor-neprilysin inhibitor(ARNI),has been shown to reduce cardiovascular mortality and hospitalization rates in CHF patients.However,its specific efficacy in different patient populations and its impact on cardiac function parameters require further investigation.This study aims to evaluate the effects of sacubitril/valsartan on N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels and cardiac function parameters in CHF patients,providing theoretical support for the precision treatment of CHF.This single-center,prospective cohort study included 120 CHF patients hospitalized in the department from January 2024 to January 2025.Patients were randomly assigned to the control group or the observation group,with 60 patients in each group.The control group received standardized conventional treatment for CHF,while the observation group received sacubitril/valsartan in addition to conventional treatment for 12 weeks.The primary outcomes were NT-proBNP levels and left ventricular ejection fraction(LVEF).Secondary outcomes included left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),stroke volume(SV),cardiac output(CO),and six-minute walk distance(6MWD).The baseline characteristics of the two groups were comparable(P>0.05).After 12 weeks of treatment,NT-proBNP levels were significantly lower in the observation group compared to the control group(2430.0 vs 3154.0 pg/mL,P<0.001),and LVEF was significantly higher(47.2%vs 39.2%,P<0.001).Additionally,the observation group demonstrated significantly greater improvements in LVEDD(52.9 vs 56.0 mm,P<0.001),LVESD(38.5 vs 42.2 mm,P<0.001),SV(74.9 vs 68.2 mL,P<0.001),CO(5.1 vs 4.8 L/min,P=0.022),and 6MWD(418 vs 358 m,P<0.001)compared to the control group.The incidence of adverse events,such as hypotension and hyperkalemia,did not differ significantly between the two groups(P>0.05).Sacubitril/valsartan combined with conventional treatment significantly reduces NT-proBNP levels,improves cardiac function parameters(LVEF,LVEDD,LVESD,SV,CO),and enhances exercise tolerance(6MWD)in CHF patients,with good safety profiles.
作者
何顺舟
姜靖
张宝库
盛斌
曲迪
HE Shunzhou;JIANG Jing;ZHANG Baoku;SHENG Bin;QU Di(Department of Cardiology,the 971st Hospital of the People's Liberation Army Navy,Qingdao 266071,China)
出处
《药物生物技术》
2025年第5期664-669,共6页
Pharmaceutical Biotechnology
基金
山东省青岛市医药卫生科研指导项目(No.2023-WJZD236)
山东省卫生健康委员科研基金资助项目(No.YGY2023035)。
关键词
慢性心力衰竭
沙库巴曲缬沙坦钠片
B型钠尿肽前体
心功能
六分钟步行距离
左心室射血分数
Chronic heart failure
Sacubitril/valsartan
N-terminal pro-B-type natriuretic peptide
Cardiac function
Six-minute walk distance
Left ventricular ejection fraction
