沙库巴曲缬沙坦对急性前壁ST段抬高型心肌梗死PCI术后心力衰竭患者心功能及B型利钠肽水平的影响

Effects of Sacubitril Valsartan on Cardiac Function and B-Type Natriuretic Peptide Levels in Patients with Heart Failure After PCI for Acute Anterior ST-Segment Elevation Myocardial Infarction

目的:探讨沙库巴曲缬沙坦对急性前壁ST段抬高型心肌梗死经皮冠状动脉介入(PCI)术后心力衰竭患者心功能及N末端B型利钠肽前体(NT-proBNP)水平的影响。方法:将2019年1月-2020年12月在广州医科大学附属第二医院心内科治疗的112例急性前壁ST段抬高型心肌梗死PCI术后心力衰竭患者,随机数表法分为两组,剔除各种原因无法规范服药患者后,观察组50例,对照组48例。对照组使用常规治疗+培哚普利,在此基础上,观察组使用沙库巴曲缬沙坦替代培哚普利,对比两组的临床疗效、心功能[左心室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左心室心肌质量指数(LVMI)]、心肌损伤标志物[心肌肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、NT-proBNP水平]。结果:观察组治疗有效率为94.00%,明显高于对照组的72.92%,差异有统计学意义(P<0.05);观察组治疗后LVEF明显高于对照组,LVEDV、LVMI明显低于对照组,差异有统计学意义(P<0.05);观察组治疗后NT-proBNP、cTnI、CK-MB水平明显低于对照组,差异有统计学意义(P<0.05)。结论:沙库巴曲缬沙坦对急性前壁ST段抬高型心肌梗死PCI术后心力衰竭效果显著,能有效提高LVEF,降低LVEDV、LVMI,改善心功能,并可降低NT-proBNP等心肌损伤标志物水平,促进受损心肌的修复,具有积极的临床意义。

Objective:To investigate the effects of sacubitril valsartan on cardiac function and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels in patients with heart failure after percutaneous coronary intervention(PCI)for acute anterior ST-segment elevation myocardial infarction.Methods:A total of 112 patients with heart failure after PCI for acute anterior ST-segment elevation myocardial infarction who were treated in Department of Cardiology,the Second Affiliated Hospital of Guangzhou Medical University from January 2019 to December 2020 were divided into two groups according to random number table method.There were 50 cases in observation group and 48 cases in control group after those patients who were not able to take standard medicine due to various reasons were excluded.Control group was given conventional treatment+perindopril,and the observation group was treated with conventional treatment+sacubitril valsartan,instead of perindopril.The clinical efficacy,cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular mass index(LVMI)]and myocardial injury markers[cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),NT-proBNP levels]were compared between the two groups.Results:The total effective rate of treatment in the observation group was 94.00%,which was significantly higher than that of control group 72.92%(P<0.05).After treatment,LVEF in the observation group was significantly higher than that in the control group,while LVEDV and LVMI in the observation group were significantly lower than those in the control group,with statistically significant difference(P<0.05).After treatment,the levels of NT-proBNP,c TnI and CK-MB in the observation group were significantly lower than those in the control group,with statistically significant difference(P<0.05).Conclusion:Sacubitril valsartan has significant effect on heart failure after PCI for acute anterior ST-segment elevation myocardial infarction.It can effectively increase LVEF,reduce LVEDV and LVMI,improve cardiac function,reduce myocardial injury markers such as NT-proBNP,and promote the repair of damaged myocardium.It has positive clinical significance.