沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗慢性心力衰竭的效果及对心功能指标的影响

Effect of Sakubatril Valsartan Sodium Combined with Meglumine Adenosine Cyclophosphate in the Treatment of Chronic Heart Failure and Its Influence on Cardiac Function Indicators

目的:探讨沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗慢性心力衰竭的效果及对心功能指标的影响。方法:选取2018年1月-2021年1月淄博市中心医院收治的100例慢性心力衰竭患者,应用随机数字表法将其分为单一用药组和联合用药组,各50例。单一用药组接受环磷腺苷葡胺治疗,联合用药组接受沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗。比较两组心功能指标、神经内分泌因子指标、单核细胞TLR4/NF-κB信号通路相关指标及血管内皮功能指标。结果:治疗前,两组左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及心脏指数(CI)比较,差异均无统计学意义(P>0.05);治疗后,两组CI及LVEF均高于治疗前,联合用药组均高于单一用药组;LVESD、LVEDD、IVST及LVPWT均低于治疗前,联合用药组均低于单一用药组,差异均有统计学意义(P<0.05)。治疗前,两组N末端脑钠肽前体(NT-proBNP)、肾素活性(PRA)及抗利尿激素(ADH)水平比较,差异均无统计学意义(P>0.05);治疗后,两组NT-proBNP、ADH及PRA水平均低于治疗前,联合用药组NT-proBNP、ADH水平均低于单一用药组,差异均有统计学意义(P<0.05)。治疗后,两组PRA水平比较,差异无统计学意义(P>0.05)。治疗前,两组的TLR4 mRNA、NF-κB mRNA、白介素-6(IL-6)mRNA、肿瘤坏死因子-α(TNF-α)mRNA水平比较,差异均无统计学意义(P>0.05);治疗后,两组TLR4 mRNA、NF-κB mRNA、IL-6 mRNA、TNF-αmRNA均低于治疗前,且联合用药组均低于单一用药组,差异均有统计学意义(P<0.05)。治疗前,两组肱动脉血流介导血管舒张功能(FMD)、血清内皮素-1(ET-1)及一氧化氮(NO)比较,差异均无统计学意义(P>0.05);治疗后,两组FMD及NO水平均高于治疗前,联合用药组均高于单一用药组,ET-1水平均低于治疗前,联合用药组低于单一用药组,差异均有统计学意义(P<0.05)。结论:沙库巴曲缬沙坦钠联合环磷腺苷葡胺治疗慢性心力衰竭,可改善患者的心功能及血管内皮功能,抑制单核细胞TLR4/NF-κB信号通路及神经内分泌因子分泌,效果显著。

Objective:To investigate the effect of Sakubatril Valsartan Sodium combined with Meglumine Adenosine Cyclophosphate in the treatment of chronic heart failure and its influence on cardiac function indexes.Method:A total of 100 patients with chronic heart failure admitted to Zibo Central Hospital from January 2018 to January 2021 were selected,they were divided into single drug group and combined drug group by applying the random number table method,with 50 cases in each group.The single drug group received Meglumine Adenosine Cyclophosphate and the combined drug group received Sakubatril Valsartan Sodium combined with Meglumine Adenosine Cyclophosphate.The cardiac function indexes,neuroendocrine factor indexes,monocyte TLR4/NF-κB signaling pathway-related indexes and vascular endothelial function indexes were compared between the two groups.Result:Before treatment,there were no significant differences in left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT)and cardiac index(CI)between the two groups(P>0.05);after treatment,CI and LVEF in both groups were higher than those before treatment,and those in combined drug group were higher than those in single drug group;LVESD,LVEDD,IVST and LVPWT were lower than those before treatment,those in combined drug group were lower than those in single drug group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in the levels of N-terminal brain natriuretic peptide precursor(NT-proBNP),plasma renin assay(PRA)and antidiuretic hormone(ADH)between the two groups(P>0.05);after treatment,the levels of NT-proBNP,ADH and PRA in both groups were lower than those before treatment,the levels of NT-proBNP and ADH in combined drug group were lower than those in single drug group,the differences were statistically significant(P<0.05).After treatment,there was no significant difference in PRA level between the two groups(P>0.05).Before treatment,there were no significant differences in TLR4 mRNA,NF-κB mRNA,interleukin-6(IL-6)mRNA and tumour necrosis factor-α(TNF-ɑ)mRNA levels between the two groups(P>0.05);after treatment,TLR4 mRNA,NF-κB mRNA,IL-6 mRNA and TNF-αmRNA in both groups were lower than those before treatment,those in combined drug group were lower than those in the single drug group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in brachial artery flow mediated dilation(FMD),serum endothelin-1(ET-1)and nitric oxide(NO)between the two groups(P>0.05);after treatment,FMD and NO levels in both groups were higher than those before treatment,those in combined drug group were higher than those in single drug group,ET-1 level were lower than those before treatment,that in combined drug group was lower than that in single drug group,the differences were statistically significant(P<0.05).Conclusion:The treatment of chronic heart failure with Sakubatril Valsartan Sodium combined with Meglumine Adenosine Cyclophosphate can improve the cardiac function and vascular endothelial function of patients,and inhibit the TLR4/NF-κB signaling pathway and neuroendocrine factor secretion of monocytes with significant effect.