摘要
目的:本研究分析比较沙库巴曲缬沙坦(sacubitril valsartan,ARNI)对比ACEI/ARB治疗急性心肌梗死合并射血分数保留型心力衰竭(post myocardial infarction heart failure with preserved ejection fraction,P-MI-HFpEF)患者预后的差异。方法:本研究为回顾性研究,连续纳入从2020年8月至2021年8月,于濉溪县医院住院的P-MI-HFpEF患者共231例。根据出院服用药物情况分为ARNI组和ACEI/ARB组。对两组的一般资料、实验室检验检查、合并症及出院带药情况进行比较。利用Kaplan-Meier分析与Cox回归模型分析两组与主要不良事件(major adverse events,MAE)的关系。结果:在P-MI-HFpEF患者中,与ACEI/ARB相比,ARNI组患者的年龄更小、血钾水平偏高、有高血压病史患者人数偏少。ARNI使用与更多的LVEF提高,LVEDD缩小、NT-proBNP减低和MAE(包括因心力衰竭住院和死亡)的发生率减少相关。即使调整了年龄、吸烟、性别、BMI、心肌梗死类型、收缩压、舒张压、心率、血肌酐、cTnI、NT-proBNP、心房颤动病史、高血压病史、卒中史、糖尿病史、β受体阻滞剂、PCI治疗后,ARNI使用者发生MAE风险较ACEI/ARB仍显著下降(HR=0.52,95%CI:0.28~0.97,P=0.041)。结论:在P-MI-HpEF患者中,ARNI相较于ACEI/ARB使用者,可以更好的改善患者的心功能,减少近期主要不良事件的发生。
Objective:In this study,we analyzed and compared the difference between sackubactril valsartan(ARNI)and ACEI or ARB in the treatment of post myocardial infarction heart failure with preserved ejection fraction(P-MI-HFpEF).Methods:This study was a retrospective study,and 231 patients suffered from P-MI-HFpEF who were admitted to the Suixi Hospital from August 2020 to August 2021 were included.They were divided into ARNI group and ACEI/ARB group according to discharge medication.General information,laboratory tests,comorbidities and medications taken at discharge were compared between the two groups.Kaplan-Meier analysis and Cox model were used to analyze the relationship between the two groups and major adverse events(MAE).Results:In patients with acute myocardial infarction combined with preserved ejection fraction heart failure,patients in the ARNI group were younger,had higher blood potassium levels,and fewer patients suffered hypertension compared with ACEI/ARB.ARNI users were associated with increased LVEF,decreased LVEDD,decreased NT-proBNP,and decreased incidence of MAE in patients with P-MI-HFpEF.Even after adjusting for age,smoking,sex,BMI,infarct type,systolic blood pressure,diastolic blood pressure,heart rate,creatinine,cTnI,NT-proBNP,history of atrial fibrillation,history of hypertension,history of stroke,history of diabetes mellitus,beta-blockers and PCI,ARNI users had a significantly lower risk of having an adverse outcome compared with ACEI/ARB(HR=0.52,95%CI:0.28-0.97,P=0.041).Conclusions:Compared with ACEI/ARB users,ARNI can better improve patients'cardiac function,reduce the occurrence of MAE,and bring better benefits to patients in patients with P-MI-HFpEF.
作者
陈利
赵一奇
葛宏想
薛杰
CHEN Li;ZHAO Yiqi;GE Hongxiang;XUE Jie(Department of General Practice,Suixi County Hospital of Huaibei City,Suixi 235100,China)
出处
《心肺血管病杂志》
CAS
2023年第5期400-405,共6页
Journal of Cardiovascular and Pulmonary Diseases
关键词
沙库巴曲缬沙坦
血管紧张素转化酶抑制剂β受体拮抗剂
急性心肌梗死
射血分数保留型心力衰竭
Sackubactril valsartan
Angiotensin-converting enzyme inhibitors/Angiotensin receptor blockers
Acute myocardial infarction
Heart failure with preserved ejection fraction