| 陆 益,胡 伟,尹桂芝,廖鹏翡,沈芳芳,董 健.诺欣妥对难治性心力衰竭患者心室重构及预后的影响研究[J].,2019,19(13):2498-2501 |
| 诺欣妥对难治性心力衰竭患者心室重构及预后的影响研究 |
| A Study on the Effect of Sacubitril /Valsartan on the Ventricular Remodeling and Prognosis of Patients with Refractory Heart Failure |
| 投稿时间：2018-11-23 修订日期：2018-12-18 |
| DOI：10.13241/j.cnki.pmb.2019.13.022 |
| 中文关键词: 难治性心力衰竭 诺欣妥 心室重构 预后 |
| 英文关键词: Refractory heart failure Sacubitril/valsartan Cardiac remodeling Prognosis |
| 基金项目:上海市医学重点专科项目(A类资助：ZK2015A10)；上海市卫生和计划生育委员会重点项目(201640029) |
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| 中文摘要: |
| 摘要 目的：探讨诺欣妥对难治性心力衰竭患者心室重构及预后的影响。方法：选择2017年9月~2017年12月复旦大学附属闵行医院心内科收治入院的难治性心衰患者150例并将其随机分为两组，每组各75例。所有患者均给予指南导向药物治疗(GDMT)，治疗组在此基础上给予诺欣妥，起始剂量50 mg/次，2次/d，每隔2-4周倍增一次，直至剂量达到维持剂量200 mg/次，2次/d。所有患者均连续治疗4周。比较两组患者治疗前后左心室结构及功能改变、血清神经内分泌激素及脑钠肽(NT-proBNP)水平的变化、治疗期间的不良反应及随访期间的预后转归。结果：治疗后，治疗组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)均较治疗前显著降低，左室射血分数(LVEF)较治疗前显著升高，且均明显优于对照组(P<0.05)。治疗后，两组患者血清肾素(RA)、血管紧张素(AngⅡ)及NT-proBNP水平均较治疗前明显降低，且治疗组以上指标均显著低于对照组(P<0.05)。两组不良反应的发生率比较差异无统计学意义(P>0.05)。治疗组心衰再住院率、心源性死亡率显著低于对照组(P<0.05)。结论：诺欣妥用于治疗难治性心衰可有效改善患者心功能，逆转心脏重构，降低住院率及病死率，且不增加不良反应。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the effect of sacubitril/valsartan on ventricular remodeling and prognosis of patients with refractory heart failure. Methods: 150 patients with refractory heart failure who were treated in the department of Cardiology, Minhang Hospital, Fudan University from September 2017 to December 2017 were divided into two groups. The control group(n=75) was given guidelines guide drug treatment (GDMT), and the treatment group(n=75) was given sacubitril/valsartan on the basis of control group, with a starting dose of 50 mg/time and 2 times/d, doubling every 2-4 weeks until the dose reached the maintenance dose of 200 mg/ time and 2 times/d. All patients were treated for 4 weeks. The changes of left ventricular structure and function, serum neurohormones and NT-pro BNP levels were analyzed before and after treatment, between two groups. At the same time, the incidence of adverse effects during treatment and the prognosis during follow-up were observed and compared. Results: After treatment, the left ventricular end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD) of treatment group were significantly lower than those before treatment, the left ventricular ejection fraction (LVEF) was significantly higher than before treatment, and these indicators in the treatment group were superior to those of the control group(P<0.05). After treatment, the levels of serum renin activity (RA), renin nervous element (Ang Ⅱ) and NT-pro BNP of both groups were all significantly lower than those before treatment, which were also lower in the treatment group than those of the control group(P<0.05). No significant difference was found in the incidence of complications between two groups(P>0.05). The rehospitalization rate and cardiogenic mortality rate of treatment group were significantly lower than those in control group(P<0.05). Conclusion: Sacubitril/valsartan can effectively improve the cardiac function, reverse the cardiac remodeling and reduce the hospitalization rate and mortality rate without increasing adverse reactions in the treatment of refractory heart failure. |
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