沙库巴曲缬沙坦对不同性别患者急性前壁心肌梗死后心室重塑的临床疗效对比

孙晓寒 陶贵周

【摘要】 目的：對比沙库巴曲缬沙坦对不同性别患者急性前壁心肌梗死后心室重塑的临床疗效。方法：选择2019年1-12月于本院就诊并确诊为急性前壁心肌梗死接受PCI治疗的患者150例为研究对象，其中女性46例，男性104例。所有患者在常规治疗基础上均加用沙库巴曲缬沙坦治疗。对比不同性别患者临床资料、治疗3、6个月后的左室射血分数（LVEF）、左室收缩末期内径（LVSD）、左室舒张末期内径（LVDD）、左房内径（LAD）、N末端脑钠肽前体（NT-proBNP）、6 min步行试验（6MWT）及堪萨斯市心肌病问卷（KCCQ）评分;对比不同性别患者不良反应发生情况。结果：治疗3、6个月，女性患者LVEF、LVSD、LVDD、LAD、NT-proBNP、6MWT、KCCQ评分均优于男性（P<0.05）。治疗3、6个月，男性与女性患者LVSD、LVDD、LAD、NT-proBNP均低于治疗前，LVEF、6MWT与KCCQ评分均高于治疗前（P<0.05）。治疗6个月，男性与女性患者LVEF、LVSD、LVDD、LAD、NT-proBNP均低于治疗3个月，LVEF、6MWT与KCCQ评分均高于治疗3个月（P<0.05）。男性与女性患者不良反应发生率比较，差异无统计学意义（P>0.05）。结论：沙库巴曲缬沙坦可有效逆转急性前壁心肌梗死后患者的心室重塑，且女性治疗效果优于男性，药物的有效性及安全性可靠，值得临床广泛推广应用。

【关键词】 沙库巴曲缬沙坦 女性 心肌梗死 心室重塑

[Abstract] Objective： To compare the clinical effects of Sacubitril Valsartan on ventricular remodeling after acute anterior wall myocardial infarction in patients of different genders. Method： A total of 150 patients admitted to our hospital and diagnosed with acute anterior wall myocardial infarction underwent PCI from January to December 2019 were selected as subjects， including 46 females and 104 males. On the basis of conventional treatment， all patients were treated with Sacubitril Valsartan. Clinical data， left ventricular ejection fraction （LVEF）， left ventricular end-systolic diameter （LVSD）， left ventricular end-diastolic diameter （LVDD）， left atrial diameter （LAD）， N-terminal brain natriuretic peptide precursor （NT-proBNP）， 6 min walking test （6MWT） and Kansas City cardiomyopathy questionnaire （KCCQ） score at 3 and 6 months after treatment of different gender patients were compared; the incidence of adverse reactions in patients of different genders was compared. Result： After 3 and 6 months of treatment， the LVEF， LVSD， LVDD， LAD， NT-proBNP， 6MWT and KCCQ scores in female patients were better than those in male patients （P<0.05）. After 3 and 6 months of treatment， LVSD， LVDD， LAD and NT-proBNP in both male and female patients were lower than those before treatment， and LVEF， 6MWT and KCCQ scores were higher than those before treatment （P<0.05）. After 6 months of treatment， LVEF， LVSD， LVDD， LAD and NT-proBNP in both male and female patients were lower than those after 3 months of treatment， and LVEF， 6MWT and KCCQ scores were higher than those after 3 months of treatment （P<0.05）. There was no statistical significance in the incidence of adverse reactions between male and female patients （P>0.05）. Conclusion： Sacubitril Valsartan can effectively reverse ventricular remodeling in patients with acute anterior wall myocardial infarction， and the treatment effect of female is better than that of male. The effectiveness and safety of the drug are reliable， and it is worthy of clinical widespread application.

[Key words] Sacubitril Valsartan Female Acute myocardial infarction Ventricular remodeling

First-author’s address： The First Affiliated Hospital of Jinzhou Medical University， Jinzhou 121000， China

doi：10.3969/j.issn.1674-4985.2021.25.033

随着冠心病发病率的逐年上升，急性心肌梗死（AMI）后心室重塑所致的心力衰竭成为越来越多患者及家庭的身心障碍及经济负担[1]。AMI发病后，早期于24～72 h内，心室出现细胞坏死及心肌顿抑;到了晚期，心肌细胞逐渐肥大、凋亡和弥漫性纤维化，左室壁肥厚，从而引发心室重塑，心腔严重恶化并出现不可逆的病理改变。有研究表明，40～79岁的心力衰竭患者中，男性与女性的患病率大不相同，男性的患病率是2.7%，而女性则高达14.4%[2]。……