作者：张义，韩东建，刘志煜，姜庆娇，王富行，刘苗苗，庄沅松，沈德良

单位：

450052河南省郑州市，郑州大学第一附属医院心血管内科 通信作者：沈德良，E-mail：dlshen@zzu.edu.cn

Units：

Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Corresponding author: SHEN Deliang, E-mail: dlshen@zzu.edu.cn

关键词：

扩张型心肌病; 心力衰竭; 沙库巴曲缬沙坦; 血管紧张素受体-脑啡肽酶抑制剂; 治疗结果; 药物相关性副作用和不良反应;

Keywords：

Dilated cardiomyopathy; Heart failure; Sacubitril/valsartan; Angiotensin receptor-neprilysin inhibitor;Treatment outcome; Drug-related side effects and adverse reactions

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.127

Funds：

河南省高层次人才特殊支持“中原千人计划”中原领军人才项目（ZYQR201912022）；河南省卫生计生科技创新型人才计划

摘要：

目的 比较不同起始剂量沙库巴曲缬沙坦治疗扩张型心肌病（DCM）心力衰竭的短期疗效及安全性。方法 回顾性选取2019年1月至2021年6月郑州大学第一附属医院心血管内科收治的DCM心力衰竭患者88例。根据沙库巴曲缬沙坦起始剂量不同将其分为A组（25 mg/次、2次/d,n=43）和B组（50 mg/次、2次/d,n=45），患者均治疗4周。比较两组治疗前后血清N末端脑钠肽前体（NT-proBNP）水平、超声心动图指标和治疗后左心室逆重构（LVRR）发生率及不良反应发生率。结果 治疗后，两组NT-proBNP、左心室舒张末期内径（LVEDD）、左心房内径（LAD）较本组治疗前降低（P<0.05）；但两组间比较，差异无统计学意义（P>0.05）。治疗后，两组左心室射血分数（LVEF）、每搏输出量（SV）较本组治疗前升高，且B组高于A组（P<0.05）。治疗后，B组肺动脉压较治疗前降低（P<0.05）；但两组间比较，差异无统计学意义（P>0.05）。两组LVRR、低血压、肾功能下降、高钾血症发生率比较，差异无统计学意义（P>0.05）。结论 以沙库巴曲缬沙坦50 mg/次、2次/d为起始剂量治疗DCM心力衰竭患者可以更好地逆转患者左心室重构，改善患者心功能，并可早期降低肺动脉压，而未增加不良反应。

Abstract：

【Abstract】 Objective To investigate the short-term efficacy and safety of different initial doses of sacubitril/valsartanin the treatment of dilated cardiomyopathy (DCM) and heart failure. Methods A total of 88 DCM and heart failure patientsin the Department of Cardiology in the First Affiliated Hospital of Zhengzhou University from January 2019 to June 2021 wereretrospectively selected. Patients were categorized into group A (25 mg/time, twice a day,n=43) and group B (50 mg/time, twice aday,n=45) based on initial doses of sacubitril/valsartan. All patients were treated for 4 weeks. The level of N-terminal-pro-brainnatriuretic peptide (NT-proBNP) , echocardiographic indexes before and after treatment, the incidence of left ventricular reverseremodeling (LVRR) after treatment and adverse reactions were compared between the two groups. Results After treatment,NT-proBNP, left ventricular end diastolic diameter (LVEDD) and left atrial diameter (LAD) of the two groups were lower thanthose before treatment, respectively (P < 0.05) , but there was no significant difference between the two groups (P > 0.05) . Aftertreatment, left ventricular ejection fraction (LVEF) and stroke volume (SV) of the two groups were higher than those beforetreatment, respectively, and LVEF and SV in group B were higher than those in group A (P < 0.05) . After treatment, pulmonaryarterial pressure of group B was lower than that before treatment (P < 0.05) , but there was no significant difference between thetwo groups (P > 0.05) . There was no significant difference in the incidence of LVRR, hypotension, renal function deterioration, andhyperkalemia between the two groups (P > 0.05) .Conclusion The use of sacubitril/valsartan with a initial dose of 50 mg/time,twice a day in the treatment of patients with DCM and heart failure can better reverse left ventricular remodeling, improve cardiacfunction, reduce pulmonary artery pressure at early stage without increasing adverse effects.

ReferenceList：