沙库巴曲缬沙坦钠对慢性心力衰竭患者心室重塑与炎症因子的作用

Effects of Sacubitril Valsartan Sodium on Ventricular Remodeling and Inflammatory Response Factors in Patients with Chronic Heart Failure

目的 探讨沙库巴曲缬沙坦钠对慢性心力衰竭(CHF)患者心室重塑、炎症因子的作用。方法 选取鞍山市中心医院2017年6月至2020年6月收治的CHF患者作为研究对象,根据用药方案从中选取应用盐酸贝那普利片治疗的149例患者纳入贝那普利组,另选取应用沙库巴曲缬沙坦钠治疗的149例患者纳入沙库巴曲缬沙坦钠组。观察两组患者治疗前后心功能指标:左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、心排血量(CO);心室重塑指标:舒张期室间隔厚度(IVST)、舒张期左室后壁厚度(LVPWT)、左室质量指数(LVMI);血清炎症因子:白细胞介素-33(IL-33)、肿瘤坏死因子-α(TNF-α)、细胞黏附分子-1(ICAM-1)水平;心肌损伤指标:N端脑钠肽前体(NT-pro BNP)、肌钙蛋白Ⅰ(c TnⅠ);活动耐力指标:6 min步行试验(6MWT)变化情况。统计两组治疗期间不良反应发生情况。结果 治疗前两组患者各项心肌损伤与活动耐力指标、心功能指标、心室重塑指标、炎症因子比较,差异无统计学意义(P>0.05);治疗后,两组患者NT-pro BNP、c TnⅠ低于治疗前,6MWT长于治疗前,且沙库巴曲缬沙坦钠组NT-pro BNP、c TnⅠ低于贝那普利组,6MWT长于贝那普利组,差异有统计学意义(P<0.05);治疗后,两组患者LVESV、LVEDV低于治疗前,LVEF、CO高于治疗前,且沙库巴曲缬沙坦钠组LVESV、LVEDV低于贝那普利组,LVEF、CO高于贝那普利组,差异有统计学意义(P<0.05);治疗后,两组患者IVST、LVPWT、LVMI低于治疗前,且沙库巴曲缬沙坦钠组低于贝那普利组,差异有统计学意义(P<0.05);治疗后,两组患者ICAM-1、TNF-α、IL-33低于治疗前,且沙库巴曲缬沙坦钠组低于贝那普利组,差异有统计学意义(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 沙库巴曲缬沙坦钠能够改善CHF患者的心室重塑、减轻心肌损伤、抑制炎症反应,从而增强活动耐力,且用药安全。

Objective To investigate the effects of sacubitril valsartan sodium on ventricular remodeling and inflammatory response factors in patients with heart failure. Methods A retrospective analysis was conducted on patients with treated in our hospital from June 2017 to June 2020. According to the medication regimen, 149 patients treated with Benazepril Hydrochloride Tablets(Dio)(generic name: Benazepril Hydrochloride) were selected into the Benazepril group, and 149 patients treated with Entresto were divided into Entresto group;the cardiac function including left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume(LVEDV), left ventricular ejection fraction(LVEF), cardiac output(CO);ventricular remodeling indexes including diastolic interventricular septal thickness(IVST), diastolic left ventricular posterior wall thickness(LVPWT), left ventricular mass index(LVMI);serum inflammatory response factors including interleukin-33(IL-33), tumor necrosis factor-α(TNF-α), cell adhesion molecule-1(ICAM-1) levels;myocardial injury indexes including N-terminal brain natriuretic peptide precursor(NT-pro BNP), serum troponin I(cTnI) before and after treatment were compared between the two groups;the change of 6-minute walk test(6MWT) was observed;the incidence of ADR in the two groups during treatment was counted to evaluate the safety of medication. Results Before treatment, there was no statistical difference in myocardial injury, activity endurance index,cardiac function index, ventricular remodeling index and inflammatory response factor between two groups(P>0.05). After treatment, the two groups improved with respect to NT-proBNP,cTnI, 6MWT, LVESV, LVEDV, LVEF, CO, IVST, LVPWT, LVMI,ICAM-1, TNF-α and IL-33(all P<0.05), with more notable improvement observed in Entresto group than the Benazepril group(all P<0.05). After treatment, no distinctive difference was witnessed in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Entresto is a boon for patients with CHF in terms of improving ventricular remodeling, reducing myocardial injury and inhibiting inflammatory response, thereby enhancing the activity endurance of patients, with higher safety.