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| Clinical effect of Sacubitril/Valsartan in the treatment of chronic heart failure patients with different etiology |
| TANG Bi ZHU Lei ZHU Mingli XIE Caixia XU Qingmei KANG Pinfang XUAN Ling ZHANG Heng |
| Department of Cardiovascular, the First Affiliated Hospital of Bengbu Medical College, Anhui Province, Bengbu 233004,China |
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Abstract Objective To observe the clinical effect of Sacubitril/Valsartan in the treatment of patients with chronic heart failure caused by different etiologies. Methods Seventy-four cases with chronic heart failure of left ventricular ejection fraction (LVEF) ≤ 40% who admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to April 2019 were selected as the study objects. According to cardiac function grade, they were divided into Ⅱ grade subgroups (7 cases), Ⅲ grade group (33 cases), Ⅳ grade subgroups (34 cases). According to the etiology, they were divided into coronary heart disease subgroup (42 cases), hypertensive heart disease subgroup (7 cases), dilated cardiomyopathy subgroup (25 cases). All patients were routine anti-heart failure treatment，and angiotensin converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor antagonist (ARB) were replaced by Sacubitril/Valsartan. Qualitative treatment lasted for 3 months. The clinical efficacy of different patients were observed. The indexes of ventricular and cardiac function before and after treatment were compared, and the incidence of cardiovascular end-point events were recorded. Results There was no significant difference in clinical efficacy rate in different etiological subgroups and different cardiac function grades subgroups (P > 0.05). There was no significant difference in ventricular and LVEF of different cardiac function grades subgroups and different etiological subgroups before and after treatment (P > 0.05). Compared with before treatment, left ventricular end-diastolic diameter (LVd) significantly reduced, LVEF increased significantly after treatment in Ⅱ-Ⅳ grade subgroups, and the differences were statistical significance (all P < 0.05); LVd significantly reduced, LVEF increased significantly in after treatment coronary heart disease subgroup, hypertensive heart disease subgroup and dilated cardiomyopathy subgroup, and the differences were statistical significance (all P < 0.05). The incidence of cardiovascular end-point events was 9.45%. Conclusion Sacubitril/Valsartan can significantly improve the cardiac function of patients with chronic heart failure, and the clinical efficacy of patients with heart failure caused by different etiology and cardiac function grade is basically the same.
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[1] 王宙，周琳，刘洋，等.慢性心力衰竭的流行病学研究现状及其防治研究进展[J].中国循证心血管医学杂志，2019， 11（8）：1022-1024.
[2] 申文佳，杨巧芳.慢性心力衰竭患者症状群的研究进展[J].职业与健康，2019，35（14）：2011-2016.
[3] 董昕，王臻，李洁白，等．补阳还五汤对舒张性心力衰竭模型大鼠心脏舒张功能的影响[J]．国际中医中药杂志，2018，40（11）：1055-1058.
[4] Braunwald E. The path to an angiotensin receptor antagonistneprilysin inhibitor in the treatment of heart failure [J]. J Am Coll Cardiol，2015 ，65（10）：1029-1041.
[5] 中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018，46（10）：769-789.
[6] 韩大兴，王芳芳，周宇廷，等.慢性心力衰竭患者血清肌钙蛋白Ⅰ脑钠肽与纽约心脏病协会心功能分级及心脏超声参数相关性分析[J].山西医药杂志，2017，46（9）：1022-1024.
[7] 郑筱萸.中药新药临床研究指导原则[M].北京：中国医药科技出版社，2002：85-86.
[8] 关玲云，张三林.壮心口服液治疗慢性心力衰竭180例临床疗效观察[J].中西医结合心脑血管病杂志，2016，14（15）：1755-1757.
[9] 陈伟伟，高润霖，刘力生，等.《中国心血管病报告2018》概要[J].中国循环杂志，2019，34（3）：209-220.
[10] 董浩，门素珍，马丽娟，等.利钠肽系统与肾素-血管紧张素-醛固酮系统在心力衰竭中交互作用[J].现代生物医学进展，2017，17（13）：2578-2581.
[11] 张金龙，鞠云枫，王育林.慢性心力衰竭患者血栓弹力图及B型利钠肽水平的临床研究[J].实用临床医药杂志，2014，18（21）：161-162.
[12] 张宇辉，张健．PARADIGM-HF 研究设计解读[J]．中国循环杂志，2018，33（2）：200-202．
[13] 陶雯，方五旺.沙库巴曲缬沙坦钠（ARNI）治疗慢性心衰患者25例临床疗效观察[J].中西医结合心血管病电子杂志，2019，7（26）：54-55.
[14] 戴聪，邹凯，曹杰，等.沙库巴曲缬沙坦在心力衰竭患者临床应用中的观察[J].临床心血管病杂志，2019，35（7）：661-664.
[15] McMurray JJ，Packer M，Desai AS，et al. PARADIGM-HF Committees and Investigators. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure：rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial（PARADIGM-HF）[J]. Eur J Heart Fail，2013，15（9）：1062-1073.
[16] Velazquez EJ，Morrow DA，DeVore AD，et al. PIONEER-HF Investigators. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure [J]. N Engl J Med，2019，380（6）：539-548.
[17] Wachter R，Senni M，Belohlavek J，et al. TRANSITION Investigators. Initiation of sacubitril/valsartan in haemodynamically stabilised heart failure patients in hospital or early after discharge：primary results of the randomised TRANSITION study [J]. Eur J Heart Fail，2019， 21（8）：998-1007.
[18] Morrow DA，Velazquez EJ，DeVore AD，et al. Clinical Outcomes in Patients With Acute Decompensated Heart Failure Randomly Assigned to Sacubitril/Valsartan or Enalapril in the PIONEER-HF Trial [J]. Circulation，2019，139（19）：2285-2288.
[19] 周红，黄思兵．沙库巴曲缬沙坦治疗慢性心功能不全的临床效果观察[J]．中国当代医药，2018，25（19）：51-53．
[20] 魏云杰，张密，许海军，等．沙库巴曲缬沙坦治疗高龄射血分数降低心力衰竭患者的临床疗效研究[J]实用心脑肺血管病杂志，2018，26（7）：17-20. |
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