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沙库巴曲缬沙坦对心衰合并肺动脉高压患者右室–肺动脉耦联的影响研究
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Abstract:
目的：利用超声心动图观察沙库巴曲缬沙坦对心衰合并肺动脉高压患者的右室–肺动脉耦联的影响。方法：回顾性分析2019年10月至2021年6月于青岛大学附属医院心内科住院治疗的154例心衰合并肺动脉高压患者的临床资料，按治疗方式不同分为对照组(n = 61)和观察组(n = 93)。两组患者均给予常规抗心衰治疗(包括利尿剂、β受体阻滞剂、血管扩张剂的应用)，在此基础上，对照组给予缬沙坦(80 mgQd)，观察组给予沙库巴曲缬沙坦(50 mgBid)，之后根据患者情况逐渐滴定至目标剂量。两组均连续治疗6个月。通过电子病历系统收集入选患者的临床基线资料，用药前、用药6个月时超声心动图的参数指标，包括肺动脉收缩压(Pulmonary artery systolic pressure, PASP)、三尖瓣环收缩期位移(Tricuspid annular plane systolic excursion, TAPSE)、三尖瓣环收缩期位移/肺动脉收缩压比值(T/P比值)、右室长径、右室前后径，及左房前后径、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)的变化情况。结果：对照组(ARB组)与观察组(ARNI组)患者的临床基线资料比较均无统计学差异(P > 0.05)。治疗6个月后，ARNI组的右室–肺动脉耦联指标的改善程度均高于ARB组，包括PASP的下降，TAPSE值及T/P比值的升高，差异均有统计学意义(P < 0.05)；且ARNI组在RV长径、RV前后径、LA前后径的减小方面，及左室重构指标(包括LVESD、LVEDD的减小，LVEF的提高)，较治疗前相比，均存在显著统计学差异(P < 0.05)。结论：沙库巴曲缬沙坦可以有效改善心衰合并肺动脉高压患者的右室–肺动脉耦联，且能降低心衰合并肺动脉高压患者的肺动脉收缩压，并对其右心室功能起到一定改善作用。
Objective: Using echocardiography to observe the effects of sacubitril-valsartan on the right ven-tricular arterial coupling in patients with heart failure and pulmonary hypertension. Methods: A total of 154 patients with heart failure and pulmonary hypertension, who were hospitalized in the Department of Cardiovascular Medicine, Affiliated Hospital of Qingdao University from October 2019 to June 2021, were included in this retrospective analysis. According to the different treat-ments, they were divided into the control group (n = 61) and the observation group (n = 93). In ad-dition to conventional treatment, such as diuretics, β-blockers, and vasodilators, the control group was given valsartan by 80 mg daily and the observation group with sacubitril-valsartan by 50 mg twice daily, and gradually titrated to the target recommended or maximum tolerated. Both groups were treated continuously for 6 months. Clinical baseline data and the parameters of echocardiog-raphy before and after treatment were collected through the electronic medical records. The pri-mary effectiveness observation index was pulmonary artery systolic pressure (PASP), tricuspid an-nular plane systolic excursion (TAPSE), TAPSE/PASP (T/P ratio). The secondary observation index was length and anteroposterior diameter of right ventricle. Left atrial anterior-post- erior diameter, Left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) are also recorded and compared. Results: The clinical baseline characteristics were no significant differences between ARNI group and ARB group (P > 0.05). After 6 months of treatment, the improvement degree of right ventricular- pulmonary arteri-al coupling indexes
| [1] | 王华, 李莹莹, 柴坷, 张嵬, 李新立, 董吁钢, 等. 中国住院心力衰竭患者流行病学及治疗现状[J]. 中华心血管病杂志, 2019, 47(11): 865-74. |
| [2] | 何山, 何欣悦, 高仕奇, 张抒扬. 2020年心力衰竭药物治疗进展[J]. 中华心血管病杂志, 2021, 49(4): 305-10. |
| [3] | 熊长明. 《中国肺动脉高压诊断与治疗指南(2021版)》解读——左心疾病所致肺动脉高压[J]. 中国实用内科杂志, 2022, 42(2): 128-130. |
| [4] | Masarone, D., Errigo, V., Melillo, E., Valente, F., Gravino, R., Verrengia, M., Ammendola, E., et al. (2020) Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction. Journal of Clinical Medicine, 9, Article ID: 3159. https://doi.org/10.3390/jcm9103159 |
| [5] | Mcmurray, J.J., Packer, M., Desai, A.S., Gong, J., Lefkowitz, M.P., Rizkala, A.R., et al. (2014) Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. The New England Journal of Medicine, 371, 993-1004.
https://doi.org/10.1056/NEJMoa1409077 |
| [6] | Mcdonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., B？hm, M., et al. (2021) 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. European Heart Journal, 42, 3599-726.
https://doi.org/10.1093/eurheartj/ehab368 |
| [7] | 王华, 梁延春. 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): 760-789. |
| [8] | Opitz, C., Rosenkranz, S., Ghofrani, H.A., Grünig, E., Klose, H., Olschew-ski, H., et al. (2016) ESC-Guidelines 2015: Pulmonary Hypertension: Diagnosis and Treatment. Deutsche medizinische Wochenschrift, 141, 1764-1769.
https://doi.org/10.1055/s-0042-117784 |
| [9] | Yener？a？, M., Arslan, U., Dereli, S., ？oksevim, M., Do？du？, M. and Kaya, A. (2021) Effects of Angiotensin Receptor Neprilysin Inhibition on Pulmonary Arterial Stiffness in Heart Failure with Reduced Ejection Fraction. The International Journal of Cardiovascular Imaging, 37, 165-173. https://doi.org/10.1007/s10554-020-01973-8 |
| [10] | Zelt, J.G.E., Chaudhary, K.R., Cadete, V.J., Mielniczuk, L.M. and Stewart, D.J. (2019) Medical Therapy for Heart Failure Associated with Pulmonary Hypertension. Circulation Re-search, 124, 1551-1567.
https://doi.org/10.1161/CIRCRESAHA.118.313650 |
| [11] | Bellofiore, A. and Chesler, N.C. (2013) Methods for Measuring Right Ventricular Function and Hemodynamic Coupling with the Pulmonary Vasculature. Annals of Biomed-ical Engineering, 41, 1384-1398.
https://doi.org/10.1007/s10439-013-0752-3 |
| [12] | Guazzi, M. (2018) Use of Tapse/Pasp Ratio in Pulmonary Arterial Hypertension: An Easy Shortcut in a Congested Road. International Journal of Cardiology, 266, 242-244. https://doi.org/10.1016/j.ijcard.2018.04.053 |
| [13] | 陈红娟, 郑璇, 颜梦欢, 周红梅, 金博文, 邓晓娴, 等. 右室-肺动脉耦合联合右心房压力对肺动脉高压患者的风险评估研究[J]. 中国实用内科杂志, 2020, 40(50): 50-53. |
| [14] | Tello, K., Axmann, J., Ghofrani, H.A., Naeije, R., Narcin, N., Rieth, A., et al. (2018) Relevance of the Tapse/Pasp Ratio in Pulmonary Arterial Hypertension. International Journal of Cardiology, 266, 229-235.
https://doi.org/10.1016/j.ijcard.2018.01.053 |
| [15] | Correale, M., Mallardi, A., Mazzeo, P., Tricarico, L., Diella, C., Romano, V., et al. (2020) Sacubitril/Valsartan Improves Right Ventricular Function in a Real-Life Population of Patients with Chronic Heart Failure: The Daunia Heart Failure Registry. IJC Heart & Vasculature, 27, Article ID: 100486. https://doi.org/10.1016/j.ijcha.2020.100486 |
| [16] | 冀梦雪. 沙库巴曲缬沙坦对左心相关性心功能不全合并肺动脉高压患者的临床疗效观察[D]: [硕士学位论文]. 新乡: 新乡医学院, 2021. |
| [17] | Clements, R.T., Vang, A., Fer-nandez-Nicolas, A., Kue, N.R., Mancini, T.J., Morrison, A.R., et al. (2019) Treatment of Pulmonary Hypertension with Angiotensin Ii Receptor Blocker and Neprilysin Inhibitor Sacubitril/Valsartan. Circulation: Heart Failure, 12, Article ID: e005819. https://doi.org/10.1161/CIRCHEARTFAILURE.119.005819 |
| [18] | Liu, S., Wang, Y., Lu, S., Hu, J., Zeng, X., Liu, W., et al. (2021) Sacubitril/Valsartan Treatment Relieved the Progression of Established Pulmonary Hy-pertension in Rat Model and Its Mechanism. Life Sciences, 266, Article ID: 118877. |
| [19] | 刘丽芬, 郭婷婷, 付悦, 王芮琦. 沙库巴曲缬沙坦治疗慢性心力衰竭合并肺动脉高压的临床疗效分析[J]. 中国药物与临床, 2021, 21(14): 2487-2488. https://doi.org/10.1016/j.lfs.2020.118877 |
| [20] | 冯盼盼, 郭伟, 程功, 贾硕, 关蕾, 张骥. 沙库巴曲缬沙坦对射血分数中间值的心力衰竭及射血分数保留的心力衰竭患者肺动脉收缩压的影响研究[J]. 实用心脑肺血管病杂志, 2021, 29(6): 93-98. |
