沙库巴曲缬沙坦对高血压左心室肥厚的临床疗效研究

张婷婷; 葛慧娟; 庄晓赛; 任磊; 宁彬

doi:10.16766/j.cnki.issn.1674-4152.003068

沙库巴曲缬沙坦对高血压左心室肥厚的临床疗效研究

doi: 10.16766/j.cnki.issn.1674-4152.003068

阜阳市人民医院心血管内科，安徽阜阳 236000

基金项目:

安徽省卫生健康委科研项目 AHWJ2021b070

蚌埠医学院自然科学类科技项目 2020byzd354

详细信息

通讯作者:
葛慧娟，E-mail：1157840471@qq.com

中图分类号: R541.3 R972.4
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出版历程
- 收稿日期: 2022-11-28
- 网络出版日期: 2023-08-28

Clinical efficacy of sacubitril/valsartan in the treatment of hypertension with left ventricular hypertrophy research

Department of Cardiology, Fuyang People ' s Hospital, Fuyang, Anhui 236000, China

摘要

摘要: 目的探讨沙库巴曲缬沙坦对高血压合并左心室肥厚的逆转作用。方法选取2021年2—8月于阜阳市人民医院心血管内科就诊的门诊及住院的90例高血压左心室肥厚患者，其中男性56例，女性34例，按随机数字表法随机分为3组，分别为沙库巴曲缬沙坦组(A组)、贝那普利组(B组)、缬沙坦组(C组)，每组30例，随访12个月，比较3组室间隔厚度(IVST)、左室舒张末期后壁厚度(LVPWd)、左心室质量指数(LVMI)等左心室肥厚指标、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)等左室重构及功能指标、血压控制达标率等临床疗效、不良反应及并发症发生情况。结果治疗后，3组患者IVST、LVPWd、LVMI等左心室肥厚指标和LVEDD、LVEF等左室重构及功能指标均有明显改善(均P<0.05)，其中A组IVST、LVPWd、LVMI、LVEDD、LVEF指标分别为10.00(10.00, 11.00)mm、10.00(9.25, 10.75)mm、81.38(71.03, 99.34)g/m²、43.00(41.00, 47.75)mm、64.00%(60.00%，67.00%)，较其他2组改善效果显著, 变化幅度差异有统计学意义(P<0.05)。3组血压控制达标率分别为：A组86.67%、B组56.67%、C组53.33%，与B、C组比较，A组血压达标率明显增高，差异有统计学意义(均P<0.05)。3组不良反应及并发症发生率比较，差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦可逆转高血压左心室肥厚，改善心室重构及患者预后，降压效果明显，安全性良好。
- 沙库巴曲缬沙坦 /
- 高血压 /
- 左心室肥厚 /
- 贝那普利 /
- 缬沙坦
Abstract: Objective To explore the role of sacubitril/valsartan in reversing hypertension with left ventricular hypertrophy. Methods Ninety patients with hypertension and left ventricular hypertrophy who visited the Department of Cardiology of Fuyang People's Hospital from February to August 2021 were selected as the research objects, including 56 males and 34 females. They were divided into sacubitril/valsartan (A) group, benazepril (B) group and valsartan (C) group according to random numerical table, with 30 cases in each group, and followed up for 12 months. The degree of left ventricular hypertrophy index interventricular septal thickness (IVST), left ventricular posterior wall thickness in diastole (LVPWd), left ventricular mass index (LVMI), left ventricular remodeling and functional indexes such as left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF), the blood pressure compliance rate, clinical efficacy, occurrence of adverse reactions and complications were compared between the three groups. Results After treatment, the left ventricular hypertrophy index (IVST, LVPWd and LVMI) and the left ventricular remodeling and functional index (LVEDD and LVEF) of the three groups were significantly improved than those before treatment, all the difference was statistically significant (all P<0.05), and the IVST, LVPWd, LVMI, LVEDD, LVEF of the A group were 10.00 (10.00, 11.00) mm, 10.00 (9.25, 10.75) mm, 81.38 (71.03, 99.34) g/m², 43.00 (41.00, 47.75) mm and 64.00%(60.00%, 67.00%), which were better than the other two groups, the difference in amplitude of change was statistically significant (P<0.05). The blood pressure compliance rate were 86.67% of the group A, 56.67% of the group B, and 53.33% of the group C. The blood pressure compliance rate in Group A significantly increased, with a statistically significant difference (all P<0.05). There was no significant difference in the incidence of adverse reactions and complications during treatment among the three groups (P>0.05). Conclusion Sacubitril/valsartan can relieve the degree of left ventricular hypertrophy in the treatment of hypertension complicated with left ventricular hypertrophy, improve ventricular remodeling and patient prognosis, the effect of reducing pressure is obvious, and the safety is good.
- Sacubitril/valsartan /
- Hypertension /
- Left ventricular hypertrophy /
- Benazepril /
- Valsartan

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表 1 3组高血压左心室肥厚患者一般临床资料比较

Table 1. Comparison of general clinical data among the three groups of hypertensive patients with left ventricular hypertrophy

组别	例数	性别[例(%)]		年龄[M(P₂₅, P₇₅), 岁]	病程[M(P₂₅, P₇₅), 年]	BMI[M(P₂₅, P₇₅)]
组别	例数	男性	女性	年龄[M(P₂₅, P₇₅), 岁]	病程[M(P₂₅, P₇₅), 年]	BMI[M(P₂₅, P₇₅)]
A组	30	19(63.33)	11(36.67)	55.00(47.00, 66.75)	9.00(4.25, 14.50)	25.75(23.32, 28.77)
B组	30	18(60.00)	12(40.00)	63.50(54.00, 70.50)	10.00(5.00, 10.00)	26.70(24.15, 29.25)
C组	30	19(63.33)	11(36.67)	61.00(56.00, 73.00)	7.50(5.00, 10.00)	25.45(23.02, 28.32)
统计量		0.095^a		4.455^b	0.822^b	1.694^b
P值		0.954		0.108	0.663	0.429

组别	例数	治疗前SBP [M(P₂₅, P₇₅), mmHg]	治疗前DBP [M(P₂₅, P₇₅), mmHg]	高脂血症 [例(%)]	糖尿病 [例(%)]	冠心病 [例(%)]
A组	30	162.50(152.00, 167.00)	90.00(82, 00, 96.75)	7(23.33)	3(10.00)	4(13.33)
B组	30	156.00(148.00, 159.50)	88.00(79.25, 96.75)	6(20.00)	4(13.33)	5(16.67)
C组	30	154.00(146.00, 164.00)	91.00(77.00, 100.00)	5(16.67)	3(10.00)	4(13.33)
统计量		5.581^b	0.106^b	0.417^a	0.225^a	0.180^a
P值		0.061	0.948	0.812	0.894	0.914
注：^a为χ²值，^b为H值。1 mmHg=0.133 kPa。

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表 2 3组治疗前后血压变化及血压达标率比较

Table 2. Comparison of blood pressure changes before and after treatment and the rate of blood pressure reaching standard among the three groups

组别	例数	SBP[M(P₂₅, P₇₅), mmHg]		V值	P值	DBP[M(P₂₅, P₇₅), mmHg]		V值	P值	血压达标率(%)
组别	例数	治疗前	治疗后	V值	P值	治疗前	治疗后	V值	P值	血压达标率(%)
A组	30	162.50(152.00, 167.00)	120.00(116.20, 126.00)	465.000	< 0.001	90.00(82.00, 96.75)	61.5(60.00, 65.75)	465.000	< 0.001	86.67(26/30)
B组	30	156.00(148.00, 159.5)	128.00(122.00, 136.00)	465.000	< 0.001	88.00(79.25, 96.75)	70.50(65.25, 79.75)	400.500	< 0.001	56.67(17/30)^a
C组	30	154.00(146.00, 164.00)	125.00(117.80, 133.80)	465.000	< 0.001	91.00(77.00, 100.00)	70.00(65.00, 81.50)	403.000	< 0.001	53.33(16/30)^a
注：3组血压达标率比较，χ²=8.956，P=0.011；3组间血压达标率两两比较，校正检验水准为0.017，与A组比较，^aP<0.017。

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表 3 3组治疗前后左心室肥厚指标变化比较[M(P₂₅, P₇₅)，n_i=30]

Table 3. Comparison of left ventricular hypertrophy indicators before and after treatment in the three groups [M(P₂₅, P₇₅), n_i=30]

组别	时间	IVST(mm)	LVPWd(mm)	LVMI(g/m²)	LVEDD(mm)	LVEF(%)
A组	治疗前	13.00(12.00, 14.00)	12.00(11.25, 13.00)	132.7(116.10, 143.50)	46.50(44.25, 50.75)	58.00(53.00，64.00)
	治疗后	10.00(10.00, 11.00)	10.00(9.25, 10.75)	81.38(71.03, 99.34)	43.00(41.00, 47.75)	64.00(60.00，67.00)
	V值	435.000	465.000	465.000	437.000	< 0.001
	P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
B组	治疗前	12.50(12.00, 14.00)	12.00(11.00, 12.00)	121.41(102.08, 129.06)	45.00(43.25, 47.75)	60.00(56.00，65.00)
	治疗后	12.00(11.00, 13.00)	10.00(10.00, 11.00)	97.13(86.43, 114.90)	44.50(42.25, 46.00)	63.00(59.00，66.00)
	V值	406.000	406.000	465.000	348.500	53.500
	P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
C组	治疗前	13.00(12.00, 14.00)	12.00(11.00, 12.00)	125.36(111.83, 134.46)	45.00(43.00, 50.00)	62.00(58.00，66.00)
	治疗后	12.00(11.00, 13.00)	11.00(10.00, 11.75)	100.99(88.82, 114.75)	44.50(42.00, 49.00)1	63.00(59.00，68.00)
	V值	465.000	351.000	464.000	364.500	62.000
	P值	< 0.001	0.001	< 0.001	0.003	0.001
	H值^a	2.529	3.714	< 0.001	1.115	4.374
	P值^a	0.282	0.156	0.251	0.573	0.112
注：^a为治疗前3组间比较的H值和P值。

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表 4 各组治疗前后相关指标变化幅度比较[M(P₂₅, P₇₅), %]

Table 4. Comparison of the change amplitude of relevant indexes before and after treatment in each group[M(P₂₅, P₇₅), %]

组别	例数	SBP降幅	DBP降幅	IVST降幅	LVPWd降幅	LVMI降幅	LVEDD降幅	LVEF增幅
A组	30	32.50(28.11, 37.08)	35.68(16.74, 53.31)	27.27(20.00, 33.33)	22.22(20.00, 29.32)	52.76(43.69, 65.59)	6.68(4.71, 9.25)	9.92(4.69, 13.09)
B组	30	21.31(13.91, 26.51)	21.78(9.30, 38.17)	8.71(7.69, 10.09)	10.00(9.09, 10.00)	18.05(16.54, 24.08)	2.35(2.07, 3.32)	3.36(2.74, 5.09)
C组	30	24.80(17.03, 32.79)	22.71(9.90, 37.78)	9.09(8.33, 14.05)	9.55(8.52, 14.32)	17.89(14.91, 26.68)	2.33(1.98, 2.62)	1.87(1.38, 3.43)
H值^a		16.273	6.213	29.696	30.964	44.007	26.735	22.46
P值^a		< 0.001	0.045	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
Z值^b		1 873.500	1 648.000	2 053.000	2 023.000	2 113.000	1 974.000	2 004.500
P值^b		< 0.001	0.014	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：^a为3组间整体比较的H值和P值；^b为3组间趋势性比较的Z值和P值。

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