沙库巴曲缬沙坦联合螺内酯治疗老年慢性心力衰竭的临床效果及其对患者心室重塑的短期影响

The clinical effect and short-term effect of sacubitril valsartan combined with spironolactone on ventricular remodeling in elderly patients with chronic heart failure

目的探讨沙库巴曲缬沙坦联合螺内酯治疗老年慢性心力衰竭的临床效果及其对患者心室重塑的短期影响。方法选取2018年2月至2019年2月阜阳市第二人民医院收治的86例老年慢性心力衰竭患者为研究对象,采用随机数字表法将入选患者分为观察组和对照组,每组各43例。在常规治疗基础上,分别给予对照组和观察组患者缬沙坦联合螺内酯、沙库巴曲缬沙坦联合螺内酯治疗,两组患者均治疗3个月。比较两组患者治疗前后左室射血分数(left ventricular ejection fraction,LVEF)、左室收缩末期容积(left ventricular end systolic volume,LVESV)、左室舒张末期容积(left ventricular end diastolic volume,LVEDV)、室间隔厚度(interventricular septum thickness,IVST)、血清N末端B型利钠肽原(N-terminal pro-Btype natriuretic peptide,NT-proBNP)、转化生长因子-β(transforming growth factor-β,TGF-β)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、基质金属蛋白酶抑制剂-1(tissue inhibitors of metalloproteinases-1,TIMP-1)水平、临床疗效和安全性。结果两组患者治疗后3个月LVEF和TIMP-1水平均显著高于本组治疗前(均P<0.05),LVESV、LVEDV、IVST、血清NT-proBNP、TGF-β、MMP-9水平均显著低于本组治疗前(均P<0.05)。观察组患者治疗后3个月LVEF、TIMP-1水平均显著高于对照组(P<0.05),LVESV、LVEDV、IVST、血清NT-proBNP、TGF-β、MMP-9水平均显著低于对照组(均P<0.05)。观察组患者治疗总有效率显著高于对照组(P<0.05)。两组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联合螺内酯能显著改善老年慢性心力衰竭患者的心室重塑,临床疗效优于缬沙坦联合螺内酯,安全可靠。

Objective To investigate the clinical effect and short-term effect of sacubitril valsartan combined with spironolactone on ventricular remodeling in elderly patients with chronic heart failure(CHF).Method Eighty-six elderly patients with CHF admitted to NO.2 People's Hospital of Fuyang City from February 2018 to February 2019 were randomly divided into observation group and control group according to random number table method,with 43 cases in each group.On the basis of routine treatment,patients in control group and observation group were given valsartan combined with spironolactone,sacubitril valsartan combined with spironolactone for 3 months.The left ventricular ejection fraction(LVEF),left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),interventricular septum thickness(IVST),serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),transforming growth factor-β(TGF-β),matrix metalloproteinase-9(MMP-9),tissue inhibitors of metalloproteinases-1(TIMP-1)before and after treatment and efficiency and safety were compared between the two groups.Result The LVEF and TIMP-1 levels of the two groups were significantly higher than those before treatment(all P<0.05),while the LVESV,LVEDV,IVST,serum NT-proBNP,TGF-βand MMP-9 levels were significantly lower than those before treatment(all P<0.05).The LVEF and TIMP-1 levels in observation group 3 months after treatment were significantly higher than those in control group(all P<0.05),the LVESV,LVEDV,IVST,serum NT-proBNP,TGF-βand MMP-9 levels were significantly lower than those in control group(all P<0.05).The total effective rate of observation group was significantly higher than that of control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Sacubitril valsartan combined with spironolactone can significantly improve the ventricular remodeling of elderly patients with CHF.Its clinical efficacy is better than that of combination of valsartan and spironolactone,and it is safe,reliable and worthy of clinical application.