沙库巴曲缬沙坦对射血分数降低的心力衰竭Ⅳ级患者生化指标和左心室结构的干预作用

Effects of Sacubitril/Valsartan on biochemical indicators and on left ventricular structure in NYHA Ⅳ heart failure with reduced ejection fraction patients

目的观察沙库巴曲缬沙坦对射血分数减低的心衰(HFrEF)Ⅳ级患者N端前脑钠肽(NT-proBNP)、高敏C反应蛋白(hs-CRP)、可溶性ST2(sST2)及左心室结构的干预作用。方法选取射血分数降低的心力衰竭Ⅳ级患者62例,随机分为对照组30例和观察组32例。对照组患者行常规药物治疗,观察组患者在常规治疗方案中,将血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)替换为沙库巴曲缬沙坦。采用荧光素增强免疫化学发光法、胶乳增强免疫比浊法和酶联免疫吸附法(ELISA)测定NT-proBNP、hs-CRP和sST2,改良Simpson法检测左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPW)、左心室射血分数(LVEF);两组患者均连续治疗观察随访6个月。结果观察组临床疗效优于对照组[8例(26.7%)比20例(61.3%),P<0.05]。观察组治疗后较对照组LVEF提高(46.7±9.2)%(P<0.05),LVEDD缩小(52.6±6.7)mm(P<0.05)。两组治疗后NT-proBNP、hs-CRP、sST2均较治疗前下降(P<0.05),观察组优于对照组(P<0.05)。观察组患者年重复住院次数、累计住院天数少于对照组(P<0.05),托拉塞米维持剂量少于对照组(P<0.05)。结论沙库巴曲缬沙坦治疗射血分数降低的心力衰竭Ⅳ级患者安全有效,能降低hs-CRP、sST2水平,改善射血分数降低的心力衰竭Ⅳ级患者的心室重构。

Objective To investigate the effects of Sacubitril/Valsartan on amino-terminal pro-brain natriuretic peptide(NT-proBNP), high sensitivity C-reactive protein(hs-CRP), soluble suppression of tumorigenicity 2(sST2)levels and on left ventricular(LV)structure in NYHA Ⅳ heart failure with reduced ejection fraction(HFrEF)patients. Methods A total of 67 HFrEF patients with NYHA Ⅳ were randomly divided into the control group(n=30)receiving conventional medical treatment, and the observation group(n=32)receiving Sacubitril/Valsartan instead of ACEI(or ARB if ACEI induced cough)in conventional medical treatment.NT-proBNP levels were determined by fluorescer-enhanced chemiluminescence.hs-CRP levels were detected by latex-enhanced immunoturbidimetric assay.sST2 levels were determined by enzyme-linked immunosorbent assay(ELISA). The modified Simpson method was used to detect left ventricular end-diastolic diameter(LVEDD), LV posterior wall(LVPW)and LV ejection fraction(LVEF). Two groups of patients were treated and followed-up for 6 months. Results Clinical efficacy was better in the observation group than in the control group(effective rate, 20 cases or 61.3% vs.8 cases or 26.7%, P<0.05). As compared with the control group, the observation group of patients had an increased LVEF[(46.7±9.2)% vs.(41.8±8.0)%, P<0.05]and a decreased LVEDD[(52.6±6.7)mm vs.(58.8±7.5)mm, P<0.05]. After vs.before treatment, NT-proBNP, hs-CRP and sST2 levels were decreased in both control and observation groups[(1 427±219)μg/L vs.(2 615±273)μg/L,(1.14±1.02)mg/L vs.(1.55±1.38)mg/L,(0.30±0.12)μg/L vs.(0.41±0.10)μg/L, all P<0.05], and the decrements were much more in the observation group than in the control group(P<0.05). The annual accumulated frequence and duration of hospitalization were less in the observation group than in the control group[(0.8±0.6)times vs.(1.8±1.0)times,(10.2±5.8)d vs.(16.5±7.2)d, P<0.05]. The maintenance dose of tolasemide was lower in the observation group than in the control group[(15.2±8.4)mg vs.(20.6±10.8)mg, P<0.05]. Conclusions Sacubitril/valsartan therapy is safe and effective and it can reduce hs-CRP and sST2 levels and improve the ventricular remodeling in HFrEF patients of HYHA Ⅳ.