沙库巴曲缬沙坦对合并与不合并2型糖尿病射血分数降低心力衰竭患者心室重构及预后的影响

Effect of sacubitril and valsartan on ventricular remodeling and prognosis in patients with heart failure with reduced ejection fraction with or without T2DM

摘要:

目的 探讨沙库巴曲缬沙坦对合并与不合并2型糖尿病（T2DM）射血分数降低心力衰竭患者心室重构及预后的影响。方法 选取2018年2月—2020年2月南通市第二人民医院收治的心力衰竭患者101例作为研究对象，其中57例不合并T2DM作为对照组，44例合并T2DM作为研究组。两组患者均口服沙库巴曲缬沙坦钠片，持续治疗12个月后评价效果，期间随访12个月。对比两组疗效、治疗前后心室重构及心肌损伤情况，统计两组药物安全性及预后情况。结果 两组总有效率比较，差异无统计学意义（P >0.05）。研究组治疗前后左心室射血分数、左室舒张末期内径、左心室收缩末期内径的差值低于对照组（P <0.05）。研究组治疗前后氨基端脑肽钠前体、心肌肌钙蛋白Ⅰ的差值低于对照组（P <0.05）。两组总不良反应发生率、总心脏不良事件发生率比较，差异无统计学意义（P >0.05）。结论 合并T2DM不影响沙库巴曲缬沙坦治疗射血分数降低心力衰竭患者疗效、药物安全及近期预后；但沙库巴曲缬沙坦治疗不合并T2DM射血分数降低心力衰竭患者，对心室重构、心肌损伤改善效果更明显。

Abstract:

Objective To explore the effect of sacubitril and valsartan on ventricular remodeling and prognosis in patients with heart failure with reduced ejection fraction with or without type 2 diabetes mellitus (T2DM).Methods The 101 patients with heart failure admitted to our hospital were divided into two groups according to the presence of T2DM, where 57 patients with heart failure without T2DM were enrolled as the control group and 44 patients with heart failure with T2DM were enrolled as the study group. Both groups of patients took the oral tablets of sacubitril and valsartan for 12 months, and the therapeutic efficacy was evaluated at the end of the treatment. The patients were followed up for another 12 months after the treatment. The therapeutic efficacy, and the ventricular remodeling and the myocardial injury before and after the treatment were compared between the two groups. Besides, the safety of the drug and the prognosis of the two groups of patients were recorded.Results There was no significant difference in the overall effective rate between the two groups (P > 0.05). The differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD) before and after the treatment in the study group were lower than those in the control group (P < 0.05). The differences in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin Ⅰ (cTnⅠ) before and after the treatment in the study group were lower than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions or cardiac adverse events between the two groups (P > 0.05).Conclusions The presence of T2DM does not affect the efficacy and safety of sacubitril and valsartan in the treatment of patients with heart failure with reduced ejection fraction, and the short-term prognosis is also comparable between patients with and without T2DM. However, sacubitril and valsartan exhibits more pronounced effects on improving the ventricular remodeling and the myocardial injury in those without T2DM.