2022 年第 1 期 第 17 卷

沙库巴曲缬沙坦治疗缺血性心肌病与扩张型心肌病所致心力衰竭的效果比较

Comparison of the effects of sacubitril valsartan on heart failure caused by ischemic cardiomyopathy and dilated cardiomyopathy

作者：王彬宇1王妍2郭冰立1李雪玉1赖娜1汪朝晖2

英文作者：Wang Binyu1 Wang Yan2 Guo Bingli1 Li Xueyu1 Lai Na1 Wang Chaohui2

单位：1华中科技大学同济医学院附属梨园医院心血管临床医学中心，武汉430000；2华中科技大学同济医学院附属协和医院心内科，武汉430000

英文单位：1Cardiovascular Clinical Center Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology Wuhan 430000 China; 2Department of Cardiology Union Hospital Tongji Medical College of Huazhong University of Science and Technology Wuhan 430000 China

关键词：缺血性心肌病；扩张型心肌病；沙库巴曲缬沙坦；心力衰竭

英文关键词：Ischemiccardiomyopathy；Dilatedcardiomyopathy；Sacubitrilvalsartan；Heartfailureeartfailure.

• 摘要：

• 目的  比较沙库巴曲缬沙坦治疗缺血性心肌病（ICM）心力衰竭和扩张型心肌病（DCM）心力衰竭的临床效果。方法 选取2018年1月至2020年7月就诊于华中科技大学同济医学院附属协和医院的63例ICM心力衰竭患者（ICM组）和78例DCM心力衰竭患者（DCM组）为研究对象。所有患者予沙库巴曲缬沙坦钠片口服治疗，连续治疗12个月。统计2组沙库巴曲缬沙坦最终用药剂量。比较2组治疗前和治疗后6、12个月呼吸困难症状评分、6 min步行试验（6MWT）评分、超声心动图指标以及实验室指标水平。结果 2组患者沙库巴曲缬沙坦最终用药剂量比较差异无统计学意义（P＞0.05）。治疗6、12个月，2组呼吸困难症状评分和6MWT评分均呈降低趋势，且治疗12个月时DCM组均低于ICM组（均P＜0.05）。治疗前，2组左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）比较差异均无统计学意义（均P＞0.05），DCM组左心室后壁厚度（LVPWT）、室间隔厚度（IVST）均大于ICM组（均P＜0.05）。治疗6、12个月，2组LVEF均逐渐升高，且DCM组高于ICM组，LVESD、LVEDD、LVPWT、IVST均逐渐降低，且治疗12个月时DCM组LVESD、LVEDD均低于ICM组［（3.2±0.5）cm比（3.7±0.5）cm、（5.5±0.5）cm比（5.9±0.5）cm］（均P＜0.05）。治疗6、12个月，2组N末端B型脑钠肽前体（NT-proBNP）、血肌酐、血尿素氮水平均低于治疗前，估算肾小球滤过率水平均高于治疗前，且DCM组NT-proBNP水平均低于ICM组（均P＜0.05）。2组临床疗效比较差异无统计学意义（P＞0.05）。结论  沙库巴曲缬沙坦可用于改善ICM心力衰竭和DCM心力衰竭患者的预后，在改善DCM心力衰竭患者心功能、抑制心室重构方面效果更好。

• Objective   To compare the effects of sacubitril valsartan on ischemic cardiomyopathy (ICM) heart failure and dilated cardiomyopathy (DCM) heart failure. Methods  From January 2018 to July 2020, 63 patients with ICM heart failure (ICM group) and 78 patients with DCM heart failure (DCM group) admitted to Union Hospital, Tongji Medical College of Huazhong University of Science and Technology were enrolled. All patients were given sacubitril valsartan sodium tablets orally for 12 months. The final dose of sacubitril valsartan in the two groups was counted. The dyspnea symptom score, 6 min walk test (6MWT) score, echocardiographic indexes, and laboratory index levels before treatment and 6, 12 months after treatment were compared between the two groups. Results  There was no significant difference in the final dose of sacubitril valsartan between the two groups (P>0.05). The dyspnea symptom score and 6MWT score 6 and 12 months after treatment in the two groups showed a decreasing trend, and those in DCM group were lower than those in ICM group 12 months after treatment (all P<0.05). Before treatment, there were no significant differences in left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) between the two groups（all P>0.05）, while left ventricular posterior wall thickness (LVPWT) and interventricular septum thickness (IVST) in DCM group were greater than those in ICM group (both P<0.05). After 6 and 12 months of treatment, LVEF in both groups gradually increased, and that in DCM group was higher than that in ICM group; LVESD, LVEDD, LVPWT and IVST in both groups gradually decreased, and LVESD and LVEDD in DCM group 12 months after treatment were lower than those in ICM group［(3.2±0.5)cm vs (3.7±0.5)cm, (5.5±0.5)cm vs (5.9±0.5)cm］(all P<0.05). After 6 and 12 months of treatment, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), serum creatinine and blood urea nitrogen in both groups were lower than those before treatment, estimated glomerular filtration rate level in both groups was higher than that before treatment, and the level of NT-proBNP in DCM group was lower than those in ICM group （all P<0.05）. There was no significant difference in clinical efficacy between the two groups (P>0.05). Conclusions  Sacubitril valsartan can be used to improve the prognosis of patients with ICM heart failure and DCM heart failure. It has advantages in improving cardiac function and inhibiting ventricular remodeling in patients with DCM h