沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗慢性心力衰竭(LVEF≤40%)的疗效及其对心率变异性、CysC、miR-451a、BNP水平的影响

Efficacy of sacubitril valsartan sodium combined with meglumine adenosine cyclophosphate in treatment of chronic heart failure(LVEF≤40%)and its effects on heart rate variability,CysC,miR-451a,and BNP levels

目的探讨沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗左心室射血分数(LVEF)≤40%慢性心力衰竭(CHF)的临床疗效。方法选取2020年1月—2020年12月福建医科大学附属南平市第一医院治疗的127例LVEF≤40%的慢性心力衰竭患者作为研究对象,根据治疗方法将患者分为对照组(n=63)和观察组(n=64)。对照组患者静脉滴注注射用环磷腺苷葡胺,60 mg/次,1次/d。观察组在对照组的基础上口服沙库巴曲缬沙坦钠片,50 mg/次,2次/d。两组均治疗15 d后观察疗效。比较两组治疗前后的心率变异性[全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)]、心脏功能指标[LVEF、6 min步行距离(6MWD)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)]及血清胱抑素(CysC)、miR-451a、脑钠肽(BNP)水平。统计主要不良心脏事件(MACE)发生率。结果治疗后,观察组治疗总有效率87.50%,显著高于对照组的71.43%(P<0.05)。治疗后,两组SDANN、SDNN、PNN50均显著升高(P<0.05),且观察组SDANN、SDNN、PNN50高于对照组(P<0.05)。治疗后,两组LVEF和6MWD均显著升高,LVESV和LVEDV显著降低(P<0.05);且观察组心功能指标显著优于对照组(P<0.05)。治疗后,两组血清CysC、BNP水平均显著降低,miR-451a表达显著升高(P<0.05);治疗后,观察组血清CysC、BNP水平及miR-451a表达情况显著优于对照组(P<0.05)。治疗后随访3个月,两组MACE发生率比较,差异无统计学意义。结论环磷腺苷葡胺与沙库巴曲缬沙坦钠片联合治疗LVEF≤40%慢性心力衰竭患者疗效确切,能有效控制心率变异性,改善心功能,抑制心室重构,延缓心力衰竭进展,具有一定的临床推广价值。

Objective To investigate the effect of sacubitril valsartan sodium combined with meglumine adenosine cyclophosphate in treatment of LVEF≤40%chronic heart failure.Methods A total of 127 chronic heart failure patients with LVEF≤40%were selected from the First Hospital of Nanping Affiliated to Fujian Medical University from January 2020 to December 2020.The patients were divided into control group(n=63)and observation group(n=64)according to the treatment method.Patients in the control group were iv administered with Meglumine Adenosine Cyclophosphate for Injection,60 mg/time,once daily.Patients in the observation group were po administered with Sacubitril Valsartan Sodium Tablets on the basis of control group,50 mg/time,twice daily.Both groups were treated for 15 days and the efficacy was observed.Heart rate variability(SDNN,SDANN,PNN50)and cardiac function indexes(LVEF,6 MWD,LVESV,and LVEDV),serum CysC,miR-451 a,BNP levels before and after treatment were compared.The incidence of major adverse cardiac events(MACE)was calculated.Results After treatment,the total effective rate of observation group was 87.50%,which was significantly higher than 71.43%of control group(P<0.05).After treatment,SDANN,SDNN,and PNN50 in two groups were significantly increased(P<0.05),and SDANN,SDNN and PNN50 in observation group were higher than those in control group(P<0.05).After treatment,LVEF and 6 MWD in two groups were significantly increased,while LVESV and LVEDV were significantly decreased(P<0.05).And the cardiac function index of the observation group was significantly better than that of the control group(P<0.05).After treatment,the serum levels of CysC and BNP in two groups were significantly decreased,and the expression of miR-451 a was significantly increased(P<0.05).After treatment,the levels of serum CysC,BNP and the expression of miR-451 a in the observation group were significantly better than those in the control group(P<0.05).After 3 months of follow-up,there was no significant difference in the incidence of MACE between two groups.Conclusion The combined treatment of sacubitril valsartan sodium combined with meglumine adenosine cyclophosphate in patients with LVEF≤40%chronic heart failure has an effective effect,which can effectively control heart rate variability,improve cardiac function,inhibit ventricular remodeling and delay the progression of heart failure,and has certain clinical value.