沙库巴曲缬沙坦辅助治疗心房颤动合并射血分数保留心力衰竭的临床效果及可能机制研究

Clinical Effect and Potential Mechanism of Sacubatrol Valsartan in Adjuvant Treatment of Atrial Fibrillation Combined with Heart Failure with Preserved Ejection Fraction

目的分析沙库巴曲缬沙坦辅助治疗心房颤动合并射血分数保留心力衰竭(HFpEF)的临床效果及可能作用机制。方法选取2022年1—8月收治的心房颤动合并HFpEF 100例为研究对象,随机分为观察组和对照组,每组50例。2组均给予基础治疗,同时对照组予以瑞舒伐他汀治疗,观察组予以沙库巴曲缬沙坦联合瑞舒伐他汀治疗。治疗6个月后比较2组临床疗效及不良反应。比较2组治疗前及治疗3、6个月后心功能指标、心室结构指标、心肌损伤指标、Toll样受体4(TLR4)/核转录因子-κB(NF-κB)信号通路相关因子mRNA表达水平及心房颤动发作持续时间、心室搏动频率。结果观察组总有效率90.00%(45/50)高于对照组74.00%(37/50)(P<0.05)。治疗3、6个月后,2组左心室射血分数、每搏输出量、心排血量均较治疗前升高,左心房内径、右心室内径、左心室舒张末期内径均较治疗前降低,且观察组升高或降低幅度更大(P<0.05)。治疗3、6个月后,2组血清心肌肌钙蛋白I、肌酸激酶、心肌型肌酸激酶同工酶、N末端脑钠肽前体水平以及TLR4、NF-κB、肿瘤坏死因子-α、白细胞介素-6 mRNA表达水平均较治疗前降低,且观察组降低幅度更大(P<0.05)。治疗3、6个月后,2组心房颤动发作持续时间均较治疗前缩短,心室搏动频率均较治疗前降低,且观察组变化幅度更大(P<0.05)。观察组上述指标治疗前与治疗3、6个月后差值均大于对照组(P<0.05)。2组不良反应总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治疗心房颤动合并HFpEF效果显著,可改善心功能、抑制心室重构、减轻心肌损伤,且具有一定安全性,其可能通过调节TLR4/NF-κB信号通路而发挥作用。

Objective To analyze the clinical effect and potential mechanism of Sacubatrol Valsartan in the treatment of atrial fibrillation(AF)combined with heart failure with preserved ejection fraction(HFpEF).Methods A total of 100 patients with AF combined with HFpEF treated from January to August 2022 were selected as the study subjects,and then randomly divided into observation group(n=50)and control group(n=50).Both groups were given basic treatment.The control group was treated with Rosuvastatin,and the observation group was treated with Sacubactril Valsartan combined with Rosuvastatin.After 6 months of treatment,the clinical efficacy and adverse reactions of the two groups were compared.The cardiac function index,ventricular structure index,myocardial injury index,and mRNA expression levels of Toll-like receptor 4(TLR4)/nuclear transcription factor-κB(NF-κB)signaling pathway-related factors as well as duration of atrial fibrillation attacks and frequency of ventricular beat were compared between the two groups before treatment and at 3 and 6 months after treatment.Results The total effective rate of observation group was 90.00%(45/50),which was higher than that of control group[74.00%(37/50)](P<0.05).At 3 and 6 months after treatment,left ventricular ejection fraction,stroke output and cardiac output in the two groups were higher than those before treatment,while left atrial diameter,right ventricular diameter and left ventricular end-diastolic diameter were lower than those before treatment;the increase or decrease was greater in the observation group(P<0.05).At 3 and 6 months after treatment,the levels of serum cardiac troponin I,creatine kinase,myocardial creatine kinase isoenzyme,N-terminal brain natritic peptide precursor and mRNA expression levels of TLR4,NF-κB,tumor necrosis factor-αand interleukin-6 in the two groups were decreased compared with those before treatment,and the reduction was greater in the observation group(P<0.05).At 3 and 6 months after treatment,the duration of atrial fibrillation attacks in both groups was shortened compared with that before treatment,and the frequency of ventricular beats was reduced compared with that before treatment;changes were greater in the observation group(P<0.05).The difference of the above indexes in the observation group before treatment and at 3 and 6 months after treatment was greater than that in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Sackubactril Valsartan has significant effect in the treatment of AF combined with HFpEF,which can improve cardiac function,inhibit ventricular remodeling,and alleviate myocardial injury with certain safety.It may play a role by regulating TLR4/NF-κB signaling pathway.