2022 年第 3 期 第 17 卷

沙库巴曲缬沙坦在改善慢性心力衰竭合并心房颤动患者心脏重构中的作用

The effect of sacubitril valsartan on improving cardiac remodeling in patients with chronic heart failure and atrial fibrillation

作者：毛建斌刘政姜玲杨娅曾欣张峻恺

英文作者：Mao Jianbin Liu Zheng Jiang Ling Yang Ya Zeng Xin Zhang Junkai

单位：中国人民武装警察部队四川省总队医院心血管内科，乐山614000

英文单位：Department of Cardiology Sichuan Provincial Corps Hospital of the Chinese Armed Police Force Leshan 614000 China

关键词：慢性心力衰竭；心房颤动；沙库巴曲缬沙坦；盐酸贝那普利；心脏重构

英文关键词：Chronicheartfailure;Atrialfibrillation;Sacubitrilvalsartan;Benazeprilhydrochloride;Cardiacremodeling

• 摘要：

• 目的 探究沙库巴曲缬沙坦在改善慢性心力衰竭合并心房颤动患者心脏重构中的作用。方法  连续入选2019年12月至2020年12月在中国人民武装警察部队四川省总队医院住院的慢性心力衰竭合并心房颤动患者58例，按照随机数字表法分为沙库巴曲组（30例）与贝那普利组（28例）。在常规抗心力衰竭治疗基础上，贝那普利组给予盐酸贝那普利10 mg/次，1次/d口服治疗，目标剂量为20 mg/次，1次/d。沙库巴曲组给予沙库巴曲缬沙坦50 mg/次，2次/d口服治疗，目标剂量为200 mg/次，2次/d。2组患者均持续治疗24周。比较2组患者临床疗效和治疗前后6 min步行试验距离、N末端B型脑钠肽前体(NT-proBNP)及心脏彩色多普勒超声相关指标。结果 治疗后，沙库巴曲组临床有效率明显高于贝那普利组［90.0%（27/30）比64.3%（18/28）］，差异有统计学意义（P=0.019）。治疗后，沙库巴曲组患者6 min步行试验距离、左心室射血分数明显长于/高于治疗前和贝那普利组，NT-proBNP水平、左心房前后径与右心房左右径明显低于/小于治疗前和贝那普利组，差异均有统计学意义（均P＜0.05）。治疗后，沙库巴曲组患者左心室舒张末期内径明显小于治疗前，差异有统计学意义（P＜0.01），而室间隔舒张末期内径和右心室前后径与治疗前比较差异均无统计学意义（均P＞0.05）。结论  沙库巴曲缬沙坦能有效改善慢性心力衰竭合并心房颤动患者心脏重构，并可能通过着力于心房结构的重塑，减轻慢性心力衰竭与心房颤动的相互影响。

• Objective   To explore the effect of sacubitril valsartan on improving cardiac remodeling in patients with chronic heart failure complicated with atrial fibrillation. Methods   A total of 58 patients with chronic heart failure and atrial fibrillation admitted to Sichuan Provincial Corps Hospital of the Chinese Armed Police Force from December 2019 to December 2020 were selected. They were randomly divided into sacubitril group (30 cases) and benazepril group (28 cases). On the basis of conventional anti-heart failure treatment, the benazepril group was given benazepril hydrochloride 10 mg/time, once a day orally, and the target dose was 20 mg/time, once a day. The sacubitril group was given sacubitril valsartan 50 mg/time, twice a day orally, and the target dose was 200 mg/time, twice a day. Patients in both groups were treated for 24 weeks. The clinical efficacy, 6 min walking test distance, N-terminal pro-brain natriuretic peptide (NT-proBNP) and the related indexes of echocardiography of the two groups were observed. Results  After treatment, the clinical effective rate of sacubitril group was significantly higher than that of benazepril group［90.0%（27/30） vs 64.3%（18/28）］(P=0.019). After treatment, the 6 min walking test distance and left ventricular ejection fraction of sacubitril group were significantly longer/higher than those before treatment and benazepril group, and the NT-proBNP level, left atrial anteroposterior diameter and right atrial transversal diameter were significantly lower/less than those before treatment and benazepril group (all P＜0.05). After treatment, the left ventricular end diastolic diameter in sacubitril group was significantly less than that before treatment (P＜0.01), but there was no significant difference in ventricular septum end diastolic diameter and right ventricular anteroposterior diameter compared with those before treatment (both P＞0.05). Conclusion Sacubitril valsartan can effectively improve cardiac remodeling in patients with chronic heart failure and atrial fibrillation, and may reduce the mutual influence between chronic heart failure and atrial fibrillation by focusing on the remodeling of atrial.