| Objective:To observe both the clinical symptoms and changes of related indicators and measure the serum level of chromogranin A(CGA)of patients with chronic heart failure(CHF)before and after treatment with sacubitril/valsartan and valsartan,and compare the clinical efficacy of sacubitril/valsartan and valsartan.With a view to providing practical experience and clinical reference for the clinical application of sacubatril valsartan.Methods:We enrolled 62 CHF patients,who were hospitalized in our cardiology department of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from June 2019 to October 2019,and collected the basic clinical data of those patients,and patients’ cardiac function was based on NYHA classification standard.The patients were randomly divided into the experimental group and the control group according to their medical order,each group included 31 cases.And all the patients from the two groups were treated with routine anti-heart failure treatments.In the meantime,the patients from experimental group were given sacubitril/valsartan(Entresto,100mg,Beijing Novartis Pharmaceutical Co.LTD,J20171054)treatment,starting with 50 mg,orally twice daily,and if the patients didn’t experience serious adverse reactions such as hypotension,renal impairment,angioedema,and hyperkalemia after 2 weeks treatment,the dose would be increased to 100 mg and gradually increased until the target oral dose was 200 mg.Patients in the control group were given orally valsartan(Dewen,80mg,Beijing Novartis Pharmaceutical Co.LTD,H20040217),80mg once a day,then gradually increase to the target oral dose of 320mg.During the treatment,the patients should be given the maximum oral dose that they can tolerate and the systolic blood pressure of them should be equal to or greater than 95mmHg.After treatment and follow-up for 3 months,we collected the general data clinical symptoms and signs of the two groups of patients.In addition,patient’s blood pressure(BP),heart rate(HR),6 min walk distance(6MWD),left ventricular ejection fraction(LVEF),left ventricular end diastolic volume(LVEDV),and the plasm level of NT-proBNP,should be detected before and after treatment,and enzyme-linked immunosorbent assay was used to determine the CGA level.Results:(1)There were no significant differences in the conventional biochemical indicators such as age,gender and blood lipid between the two groups(P>0.05).There was no significant difference in BP,HR,and 6MWD between the two groups before and after treatment(P>0.05).After treatment,the comparison within the same group was improved compared with before treatment(P<0.05).(2)In different levels of cardiac function,the levels of NT-proBNP,CGA,and LVEF of the two groups of patients were significantly different(P<0.05).The levels of NT-proBNP and CGA in the cardiac function class Ⅳ group were significantly higher than those in the cardiac function class Ⅲ group and cardiac function Ⅱ group(P<0.05),and LVEF level in the cardiac function class Ⅳ group was significantly lower than that in the group Ⅲ and group Ⅱ(P<0.05).(3)NT-proBNP levels of the two groups of patients were negatively correlated with LVEF(correlation coefficient r=-0.865,P<0.01),and positively correlated with LVEDV(r=0.888,P<0.01);CGA levels were negatively correlated with LVEF(r=-0.814,P<0.01),and positively correlated with LVEDV(r=0.873,P<0.01);NT-proBNP also has a strong correlation with CGA,which is a positive correlation(r=0.919,P<0.01).(4)Before treatment,the levels of NT-proBNP,CGA,LVEF and LVEDV were not significantly different between the two groups of subjects(P>0.05).Compared with before treatment,the levels of NT-proBNP,CGA and LVEDV decreased significantly after treatment,and the levels of LVEF increased significantly(P<0.01).After treatment,the levels of NT-proBNP,CGA and LVEDV in the experimental group were significantly lower than those in the control group,and LVEF level was significantly higher than that in the control group(P<0.05).(5)After treatment,7 cases(23%)were markedly effective,22 cases(71%)were effective,2 cases(6%)were ineffective,and the total effective rate was 94%in the experimental group;2 cases(6%)were markedly effective,and 24 were effective(77%),5 cases were invalid(16%),the total effective rate was 84%in the control group,the total effective rate of the experimental group was significantly higher than that of the control group(P<0.05).(6)One case of symptomatic hypotension occurred in the experimental group,and no hypotension occurred in the control group.4 patients in the experimental group were hospitalized for recurrent heart failure,whereas 5 patients in the control group were hospitalized for recurrent heart failure.No adverse reactions such as angioedema,impaired renal dysfunction,and hyperkalemia occurred in the two groups of patients during treatment,and neither group of patients experienced death due to cardiovascular disease.There was no significant difference in heart failure rehospitalization rate and hypotension between the two groups(P>0.05).Conclusions:Sacubitril/valsartan and valsartan are both safe and effective in clinical application,but compared with valsartan,sacubitril/valsartan can better improve the patient’s heart function,reduce the expression level of serum CGA,and the clinical treatment effect of it is more significant. |
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