摘要
目的:探讨沙库巴曲缬沙坦对冠心病患者心功能变化及主要心血管不良事件(MACE)风险的影响。方法:选取2023年1月~2024年2月期间于某院初诊的278例冠心病患者,采用随机数字表法按2∶1的比例分为对照组(n=100)和研究组(n=178)。两组患者均接受常规治疗,对照组患者在常规治疗基础上加用马来酸依那普利片,研究组患者在常规治疗基础上加用沙库巴曲缬沙坦钠片。两组患者均持续治疗并随访1年。比较两组患者治疗前、治疗3个月和6个月后血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)、心输出量(CO)]、心脏结构与功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)],并分析随访1年期间MACE发生率的差异。应用Logistic回归分析及向前逐步法进行变量筛选,以确定沙库巴曲缬沙坦是否为初诊冠心病患者发生MACE的独立影响因素。结果:治疗3个月、6个月后,两组患者SBP、DBP、LVEDD和LVESD均降低,且研究组低于对照组(P<0.05);LVEF均升高,且研究组高于对照组(P<0.05)。随访期间,研究组患者MACE发生率(8.4%)低于对照组(18.0%,χ^(2)=5.609,P=0.018)。校正性别、年龄、高血压、糖尿病等因素后,Logistic回归分析提示应用沙库巴曲缬沙坦是初诊冠心病患者发生MACE的独立保护因素(OR=0.414,95%CI 0.198~0.866,P=0.019)。结论:沙库巴曲缬沙坦可显著改善初诊冠心病患者的心功能,并为预防MACE提供独立保护。
Objective:To investigate the effects of sacubitril/valsartan on changes in cardiac function and the risk of major adverse cardiovascular events(MACE)in patients with coronary heart disease.Methods:A total of 278 patients with newly diagnosed coronary heart disease at a hospital between January 2023 and February 2024 were selected and assigned to the control group(n=100)and study group(n=178)in a 2:1 ratio using random number table method.Both groups received conventional therapy.In addition to conventional therapy,the control group was treated with enalapril maleate tablets,while the study group was treated with sacubitril valsartan sodium tablets.Both groups received continued treatment and were followed up for 1 year.The hemodynamic parameters[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),cardiac output(CO)],cardiac structure and function indices[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)]before treatment and after 3 and 6 months of treatment were compared between the two groups.The difference in MACE incidence over the 1-year follow-up was also analyzed.Logistic regression analysis with forward stepwise selection was performed to determine whether sacubitril/valsartan was an independent influencing factor for the occurrence of MACE in patients with newly diagnosed coronary heart disease.Results:After 3 and 6 months of treatment,SBP,DBP,LVEDD and LVESD decreased in both groups,with the study group showing lower values than the control group(P<0.05).LVEF increased in both groups,with the study group showing higher values than the control group(P<0.05).During follow-up,the MACE incidence in the study group(8.4%)was lower than that in the control group(18.0%,χ^(2)=5.609,P=0.018).After adjusting for factors such as gender,age,hypertension and diabetes mellitus,Logistic regression analysis indicated that the use of sacubitril/valsartan was an independent protective factor against MACE in patients with newly diagnosed coronary heart disease(OR=0.414,95%CI 0.198~0.866,P=0.019).Conclusion:Sacubitril/valsartan can significantly improve cardiac function and provide independent protection against MACE in patients with newly diagnosed coronary heart disease.
作者
彭晓燕
栾一
杨吉操
PENG Xiao-yan;LUAN Yi;YANG Ji-cao(Nanyang Second People's Hospital,Nanyang 473000,China)
出处
《中国合理用药探索》
2025年第12期53-60,共8页
Chinese Journal of Rational Drug Use
关键词
冠心病
沙库巴曲缬沙坦
血流动力学
心肌功能
主要心血管不良事件
coronary heart disease
sacubitril/valsartan
hemodynamic
myocardial function
major adverse cardiovascular events
