沙库巴曲缬沙坦钠治疗蒽环类药物所致心肌损害临床疗效观察

Clinical efficacy of sacubitril valsartan sodium in treatment of myocardial damage induced by anthracycline

目的:观察沙库巴曲缬沙坦钠治疗蒽环类药物所致心肌损害的临床疗效。方法:选取应用包含阿奇霉素化疗方案治疗后有心肌损害表现的患者70例作为研究对象,随机分为观察组和对照组,每组35例。对照组进行纠正电解质紊乱、去除诱因等常规治疗。观察组在对照组的基础上给予沙库巴曲缬沙坦钠片口服,持续治疗12周。比较两组患者治疗总有效率,治疗前后堪萨斯城心肌病患者生活质量量表(KCCQ)评分、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、心肌校正的背向散射积分均值(IBS%)、背向散射积分周期变异率(CVIB%)和后间隔基底段收缩期峰值应变率SR峰值,以及血清抗心肌肌钙蛋白I自身抗体(cTnIAAb)、可溶性信号素4D(sSema4D)和miR-34a-5p水平。结果:观察组总有效率高于对照组(P<0.05)。治疗后,观察组KCCQ评分较对照组高(P<0.05);两组SR峰值、IBS%、CVIB%与治疗前比较有统计学差异,且观察组与对照组比较有统计学差异(均P<0.05);两组患者血清cTnIAAb、sSema4D、miR-34a-5p水平较治疗前降低,观察组低于对照组(均P<0.05),且与超声检测结果存在一定相关性。结论:沙库巴曲缬沙坦钠治疗可有效改善蒽环类药物所致心肌损害患者的心功能,其内在机制可能与降低血清cTnIAAb和sSema4D、抑制miR-34a-5p表达、预防左心室重构相关。

Objective:To investigate the clinical efficacy of sacubitril valsartan sodium in the treatment of myocardial damage induced by anthracycline.Methods:70 patients with myocardial damage after treatment with azithromycin chemotherapy were randomly divided into observation group and control group,35 cases in each group.The control group received routine treatment such as correcting electrolyte disorder and removing inducement.On the basis of the control group,the observation group was given oral administration of sacubitril valsartan sodium for 12 weeks.The total effective rate,KCCQ score,LVEF,LVEDD,IBS%,CVIB%and SR peak of posterior septal basal,as well as serum levels of cTnIAAb,sSema4D and miR-34a-5p before and after treatment were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).After treatment,the KCCQ score of the observation group was higher than that of the control group(P<0.05);the SR peak,IBS%and CVIB%of the two groups were statistically different from those before treatment,and there were statistical differences between the two groups(all P<0.05);the levels of serum cTnIAAb,sSema4D and miR-34a-5p of the two groups were lower than those before treatment,and the observation group was lower than the control group(all P<0.05),and there was a certain degree of correlation with the results of ultrasound detection.Conclusion:Sacubitril valsartan sodium can effectively improve the cardiac function of patients with myocardial damage induced by anthracycline,and its internal mechanism may be related to reducing serum cTnIAAb and sSema4D,inhibiting the expression of miR-34a-5p,and preventing left ventricular remodeling.