沙库巴曲缬沙坦与环磷腺苷联合治疗老年射血分数降低心力衰竭病人的前瞻性随机对照研究

doi:10.3969/j.issn.1003-9198.2025.05.011

摘要/Abstract

摘要： 目的探索沙库巴曲缬沙坦与环磷腺苷联合治疗对老年射血分数降低的心力衰竭(HFrEF)病人的疗效和安全性。方法本研究为前瞻性、随机对照试验,纳入2021年2月至2023年2月期间南通大学杏林学院附属建湖医院心内科收治的213例老年HFrEF病人,采用随机数表法分为试验组(106例)和对照组(107例)。试验组接受沙库巴曲缬沙坦与环磷腺苷的联合治疗,对照组接受沙库巴曲缬沙坦治疗。2组均治疗14 d,比较2组治疗前后左心室舒张末期直径(LVEDD)、左心室收缩末期直径(LVESD)、LVEF、NYHA心功能分级、血清肌酐(SCr)、估算的肾小球滤过率(eGFR)、6 min步行距离、醛固酮(ALD)和脑钠肽前体(NT-proBNP)水平。随访6个月,记录并比较2组心力衰竭(心衰)再入院、全因死亡以及主要不良心血管事件(MACE)的发生情况。结果治疗前,2组各项指标差异均无统计学意义(P>0.05)。治疗后,2组LVEDD、LVESD、SCr、ALD和NT-proBNP水平均显著下降,LVEF、eGFR、6 min步行距离均显著增加,且试验组上述指标改善效果均优于对照组,差异均有统计学意义(P<0.05);2组NYHA心功能分级均显著改善,且试验组改善更明显(P＜0.05)。随访6个月内,试验组的MACE发生率、心衰再住院率和全因死亡率均显著低于对照组(P＜0.05)。结论沙库巴曲缬沙坦与环磷腺苷联合治疗可以显著改善老年HFrEF病人的心功能和预后,降低全因死亡率、心衰再住院率和MACE发生率,是一种安全有效的治疗方案。

关键词: 心力衰竭, 沙库巴曲缬沙坦, 环磷腺苷, 心功能, 射血分数降低

Abstract: Objective To investigate the safety and effectiveness of the combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate in the elderly patients with heart failure with reduced ejection fraction (HFrEF). Methods A prospective, randomized, controlled study was conducted. A total of 213 elderly patients with HFrEF admitted to Department of Cardiovascular Medicine, Jianhu Hospital Affiliated to Xinglin College of Nantong University from February 2021 to February 2023 were enrolled in this study and divided into experimental group (106 cases) and control group (107 cases)using the random number table method. The experimental group received the combined treatment of sacubitril/valsartan and cyclic adenosine monophosphate, while the control group received sacubitril/valsartan treatment.Both groups were treated for 14 d. The levels of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), aldosterone(ALD) and N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) cardiac function classification and 6-minute walk distance(6MWD) were compared between the two groups before and after treatment. A 6-month follow-up was conducted, and the occurrences of heart failure readmission, all-cause death, and major adverse cardiovascular events (MACE) were recorded and compared between the two groups. Results Before treatment, there were no significant differences in the clinical data between the two groups (P>0.05). After treatment, the levels of LVEDD, LVESD, SCr, ALD and NT-proBNP were significantly decreased, and the levels of LVEF, eGFR and 6MWD were significantly increased in both groups, especially in the experimental group(P<0.05).The NYHA grade were improved in both groups, especially in the experimental group (P<0.05). Compared with the control group, the incidence rates of MACE, heart failure rehospitalization and all-cause mortality were significantly lower in the experimental group (P<0.05) during the follow-up period. Conclusions The combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate can significantly improve the cardiac function and prognosis in the elderly patients with HFrEF, reduce all-cause mortality, heart failure readmission rate and MACE incidence, which is a safe and effective therapeutic option.

Key words: heart failure, sacubitril/valsartan, cyclic adenosine monophosphate, heart function, reduced ejection fraction

中图分类号:

R 541.6

陈步宽, 万镇, 许康士. 沙库巴曲缬沙坦与环磷腺苷联合治疗老年射血分数降低心力衰竭病人的前瞻性随机对照研究[J]. 实用老年医学, 2025, 39(5): 487-491.

CHEN Bukuan, WAN Zhen, XU Kangshi. Prospective randomized controlled study of the combination therapy of sacubitril/valsartan and cyclic adenosine monophosphate in elderly patients with heart failure with reduced ejection fraction[J]. Practical Geriatrics, 2025, 39(5): 487-491.

参考文献

[1] LEE V Y J, HOUSTON L, PERKOVIC A, et al. The effect of weight loss through lifestyle interventions in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomised controlled trials[J]. Heart Lung Circ, 2024, 33(2):197-208.
[2] MINANA G, DE LA ESPRIELLA R, PALAU P, et al.Early glomerular filtration rate decline is associated with hemoglobin rise following dapagliflozin initiation in heart failure with reduced ejection fraction[J]. Rev Esp Cardiol: Engl Ed, 2023, 76(10):783-792.
[3] SANCHEZ MEJIA A A, PIGNATELLI R H, RAINUSSO N,et al. Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients[J]. Int J Cardiovasc Imaging, 2023, 39(4):747-755.
[4] 姜浩,李浅予,朱思敏,等. 沙库巴曲缬沙坦钠治疗射血分数轻度下降的慢性心力衰竭患者的临床研究[J]. 宁夏医科大学学报,2023,45(3):299-302.
[5] 袁强. 环磷腺苷治疗对心力衰竭患者血浆脑钠肽的影响[J]. 华中科技大学学报(医学版),2011,40(2):229-230,235.
[6] 中华医学会心血管病学分会,中国医师协会心血管内科医师分会,中国医师协会心力衰竭专业委员会,等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志,2024,52(3):235-275.
[7] 赵泓渊,杨丹,杨茂琼,等. 慢性心力衰竭患者氧化应激及血清GDF11、HO-1水平与心功能指标的相关性分析[J]. 中国现代医学杂志,2024,34(1):1-6.
[8] 王斌,胡丹,王芳芳. 血清尿酸及脑钠肽水平与射血分数保留心衰房颤患者房颤结构重构关系[J]. 实用医学杂志,2023,39(20):2633-2637.
[9] AKASAKA H, SUGIMOTO K, SHINTANI A, et al. Effects of ipragliflozin on left ventricular diastolic function in patients with type 2 diabetes and heart failure with preserved ejection fraction: the EXCEED randomized controlled multicenter study[J]. Geriatr Gerontol Int, 2022, 22(4):298-304.
[10] 巩德成,冯少彬,宁宇,等. 心衰合剂联合阿托伐他汀钙对射血分数保留心力衰竭患者临床疗效观察及对无创血流动力学参数的影响[J]. 中国老年学杂志,2020,40(24):5168-5170.
[11] 张保华,白永怿,刘宏斌. 射血分数保留心衰患者发生肾功能不全的相关因素分析[J]. 解放军医学院学报,2023,44(6):600-606.
[12] 王建丽,周琳,肖小玲,等. 沙库巴曲缬沙坦联合达格列净对射血分数减低型心衰不伴糖尿病患者的疗效[J]. 西安交通大学学报(医学版),2023,44(3):415-420.
[13] 赵旭东,高贝贝,邓丽,等. 沙库巴曲缬沙坦对老年射血分数降低的心衰患者心脏功能及心理状态的影响[J]. 中国药学杂志,2023,58(14):1339-1342.
[14] KAMISAKA K, KAMIYA K, IWATSU K,et al.Impact of weight loss in patients with heart failure with preserved ejection fraction: results from the FLAGSHIP study[J]. ESC Heart Fail, 2021, 8(6):5293-5303.
[15] AKAMINE K, KONDO H, YONEZU K, et al.Suppression of acute heart failure rehospitalization by biventricular pacing in wide QRS and mid-range ejection fraction[J]. ESC Heart Fail, 2021, 8(6):4705-4709.
[16] 罗方林,吴国祥,吴艳晴. 沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗慢性心力衰竭(LVEF≤40％)的疗效及其对心率变异性、CysC、miR-451a、BNP水平的影响[J]. 药物评价研究,2021,44(9):1950-1955.
[17] 何易,钟慧,薛痕,等. 沙库巴曲缬沙坦在慢性肾脏病患者中的应用[J]. 中华肾脏病杂志,2024,40(1):67-73.