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NEJM：沙库巴曲缬沙坦对低射血分数为45%以上心力衰竭患者的影响

2019-10-24 MedSci MedSci原创

沙库巴曲缬沙坦低射血分数心力衰竭
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研究认为，沙库巴曲缬沙坦不能降低射血分数为45%或更高心力衰竭患者因心力衰竭和心血管疾病导致的死亡和住院风险

在心力衰竭和射血分数降低的患者中，血管紧张素受体-脑啡肽酶抑制剂沙库巴曲缬沙坦可降低因心力衰竭或心血管原因死亡住院的风险，但其对保留射血分数的心力衰竭患者的作用尚不清楚。

4822名纽约心脏病协会（NYHA）II级至IV级心力衰竭、射血分数为45%或更高、钠尿肽水平升高和结构性心脏病患者参与研究，接受沙库巴曲缬沙坦（靶剂量，97 mg 沙库巴曲和103 mg 曲缬沙坦，每日两次）或曲缬沙坦（靶剂量，160 mg每天两次）。研究的主要结果是心衰和心血管疾病死亡的住院总人数。次要结果包括NYHA分级改变、肾功能恶化、堪萨斯城心肌病调查表[KCCQ]临床总结评分和安全性。

526例接受沙库巴曲缬沙坦的患者中，发生894例主要事件，而557例缬沙坦治疗的患者中，发生1009例主要事件（RR：0.87）。在沙库巴曲缬沙坦组中，心血管原因死亡的发生率为8.5%，缬沙坦组为8.9%（HR：0.95）；心力衰竭总住院人数分别为690和797人（RR：0.85）。沙库巴曲缬沙坦组15.0%的患者和缬沙坦组中12.6%的患者（OR：1.45）改善了NYHA心功能分级，肾功能恶化率分别为1.4%和2.7%（HR：0.50）。在沙库巴曲缬沙坦组中，KCCQ临床总结评分在8个月的平均变化为1.0点。沙库巴曲缬沙坦组的患者低血压和血管性水肿的发生率较高，高钾血症发生率较低。

研究认为，沙库巴曲缬沙坦不能降低射血分数为45%或更高心力衰竭患者因心力衰竭和心血管疾病导致的死亡和住院风险。

原始出处：

Scott D. Solomon et al. Angiotensin-Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction. N Engl J Med， October 24， 2019.

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    2019-11-16 仁医06

    #低射血分数#

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1719541, encodeId=0fba1e195412f, content=<a href='/topic/show?id=827826198e0' target=_blank style='color:#2F92EE;'>#低射血分数#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26198, encryptionId=827826198e0, topicName=低射血分数)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Nov 16 18:57:00 CST 2019, time=2019-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374652, encodeId=58333e46528f, content=学习了，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Thu Oct 31 22:10:50 CST 2019, time=2019-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367680, encodeId=7b92136e68052, content=<a href='/topic/show?id=9334e9305c7' target=_blank style='color:#2F92EE;'>#缬沙坦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79305, encryptionId=9334e9305c7, topicName=缬沙坦)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f73a255, createdName=medscijoin, createdTime=Sat Oct 26 09:57:00 CST 2019, time=2019-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1616560, encodeId=8db7161656000, content=<a href='/topic/show?id=afc4644e0f0' target=_blank style='color:#2F92EE;'>#沙库巴曲缬沙坦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64470, encryptionId=afc4644e0f0, topicName=沙库巴曲缬沙坦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=205e19772291, createdName=12498bd5m22暂无昵称, createdTime=Sat Oct 26 09:57:00 CST 2019, time=2019-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034998, encodeId=cb111034998b3, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Oct 24 21:57:00 CST 2019, time=2019-10-24, status=1, ipAttribution=)]
    2019-10-31 qingfengqishi5

    学习了，学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1719541, encodeId=0fba1e195412f, content=<a href='/topic/show?id=827826198e0' target=_blank style='color:#2F92EE;'>#低射血分数#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26198, encryptionId=827826198e0, topicName=低射血分数)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Sat Nov 16 18:57:00 CST 2019, time=2019-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=374652, encodeId=58333e46528f, content=学习了，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzTetibytbqFDmFITWHyBWbxU7S9MYibgPSqvu0sYteH0N6zXqbU0Kf3Mbdb7yWM1Kud3zPgYBibE2SZ/0, createdBy=da7696924, createdName=qingfengqishi5, createdTime=Thu Oct 31 22:10:50 CST 2019, time=2019-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367680, encodeId=7b92136e68052, content=<a href='/topic/show?id=9334e9305c7' target=_blank style='color:#2F92EE;'>#缬沙坦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79305, encryptionId=9334e9305c7, topicName=缬沙坦)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f73a255, createdName=medscijoin, createdTime=Sat Oct 26 09:57:00 CST 2019, time=2019-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1616560, encodeId=8db7161656000, content=<a href='/topic/show?id=afc4644e0f0' target=_blank style='color:#2F92EE;'>#沙库巴曲缬沙坦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64470, encryptionId=afc4644e0f0, topicName=沙库巴曲缬沙坦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=205e19772291, createdName=12498bd5m22暂无昵称, createdTime=Sat Oct 26 09:57:00 CST 2019, time=2019-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034998, encodeId=cb111034998b3, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Oct 24 21:57:00 CST 2019, time=2019-10-24, status=1, ipAttribution=)]
    2019-10-26 medscijoin

    #缬沙坦#

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    2019-10-26 12498bd5m22暂无昵称

    #沙库巴曲缬沙坦#

    0

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    2019-10-24 旺医

    顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息

    0

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