2019 年第 3 期 第 14 卷

沙库巴曲缬沙坦钠片治疗高原地区高血压慢性心力衰竭患者的临床效果

Clinical effect of sacubitril valsartan sodium tablets on hypertensive patients with chronic heart failure in plateau area

作者：李江曹佳宁丹增洛布刘文娴康云鹏朱佳佳张静盛瑾任燕龙

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科（李江、曹佳宁、刘文娴、康云鹏、朱佳佳、张静、盛瑾、任燕龙）；850000拉萨市人民医院心内科（丹增洛布）

英文单位：

关键词：慢性心力衰竭；高原地区；沙库巴曲缬沙坦钠片；依那普利

英文关键词：

• 摘要：

• 【摘要】目的    评价沙库巴曲缬沙坦钠片治疗高原地区高血压慢性心力衰竭（CHF）患者的临床效果。方法    选取2017年10月至2018年2月在拉萨市人民医院门诊及住院诊治的因高血压导致的CHF患者96例。采用随机数字表法分为观察组（47例）和对照组（49例）。观察组在常规心力衰竭治疗基础上给予沙库巴曲缬沙坦钠片100 mg/次，2次/d口服；对照组则在常规心力衰竭治疗基础上给予马来酸依那普利10 mg/次，2次/d口服，2组均治疗6个月。主要观察指标包括左心室射血分数（LVEF）、6 min步行距离（6MWD），次要观察指标包括心血管不良事件(总死亡、心源性死亡、因心力衰竭再入院等)、收缩压、估算肾小球滤过率（eGFR）、血钾水平等。结果    治疗6个月后，观察组LVEF、6MWD大于对照组［（38±4）%比（36±4）%、（325±70）m比（274±72）m］，差异均有统计学意义（均P＜0.05）。观察组、对照组治疗后收缩压均较治疗前明显下降，差异均有统计学意义（均P＜0.05），但治疗后2组比较差异无统计学意义（P＞0.05）。观察组和对照组eGFR、血钾组内治疗前后比较差异均无统计学意义（均P＞0.05），治疗后2组比较差异亦无统计学意义（P＞0.05）。6个月内观察组因心力衰竭再入院率低于对照组［21.3%（10/47）比42.9%（21/49）］，差异有统计学意义（P<0.05），2组患者总死亡率及心源性死亡率差异无统计学意义［2.1%（1/47）比2.0%（1/49）、2.1%（1/47）比2.0%（1/49）］（P＞0.05）。结论    沙库巴曲缬沙坦钠片较依那普利能改善高原地区高血压CHF患者的左心功能，提高运动耐力及生活质量，减少疾病复发。

• 【Abstract】Objective    To evaluate the clinical effect of sacubitril valsartan sodium tablets on patients with hypertension and chronic heart failure (CHF) in plateau area. Methods    Ninety-six patients with CHF caused by hypertension were enrolled in Lhasa People′s Hospital from October 2017 to February 2018. They were randomly divided into observation group(47 cases) and control group(49 cases). The observation group took sacubitril valsartan sodium tablets 100 mg twice per day and the control group took enalapril maleate 10 mg twice per day on the basis of routine treatment for heart failure for 6 months. Main outcome measurements included left ventricular ejection fraction(LVEF) and 6 minutes walking distance(6MWD). Secondary outcome indicators included total death, cardiogenic death, readmission due to heart failure, systolic blood pressure, estimated glomerular filtration rate(eGFR) and blood potassium level. Results    After 6 months of treatment, LVEF and 6MWD in observation group were significantly higher/longer than those in control group［（38±4）% vs （36±4）%, （325±70）m vs （274±72）m］(both P<0.05). Systolic blood pressure significantly decreased after treatment in both groups(P<0.05), but there was no significant difference between them(P>0.05). There was no significant difference of eGFR and blood potassium between groups before and after treatment(all P>0.05). Readmission rate due to heart failure within 6 months in observation group was significantly lower than that in control group［21.3%(10/47) vs 42.9%(21/49)］(P<0.05). There was no significant difference of total mortality and cardiogenic mortality between groups［2.1%(1/47) vs 2.0%(1/49), 2.1%(1/47) vs 2.0%(1/49)］(P>0.05). Conclusion    Sacubitril valsartan sodium tablets treating hypertensive patients with CHF at high altitude can more effectively improve left ventricular function, exercise tolerance, quality of life, reduce recurrence and readmission than enalapril.