沙库巴曲缬沙坦钠对缺血性心肌病型冠心病患者血管硬化和心室重构的影响

Effects of sacubitril valsartan sodium on vascular sclerosis and ventricular remodeling in patients with ischemic cardiomyopathical coronary heart disease

目的研究沙库巴曲缬沙坦钠对缺血性心肌病型冠心病患者血管硬化和心室重构的影响。方法采用前瞻性研究的方法,选取2021年1—12月在杭州市第九人民医院治疗的186例冠心病患者,按照随机数字表法分为对照组和观察组各93例,对照组采用常规方法治疗,按指南视情况给予阿司匹林+美托洛尔+硝酸甘油+卡托普利治疗,观察组在对照组的基础上加用沙库巴曲缬沙坦钠治疗,比较两组临床疗效、血管内皮功能及硬度、心功能、心室重构、不良反应等情况。结果观察组治疗总有效率高于对照组[96.77%(90/93)比87.10%(81/93)],差异有统计学意义(P<0.05);治疗后观察组肱动脉内皮依赖性舒张功能高于对照组[(14.46±2.80)%比(13.09±2.74)%],内皮素-1低于对照组[(73.32±9.63)ng/L比(77.47±10.35)ng/L],差异有统计学意义(P<0.05);治疗后观察组左心室射血分数高于对照组[(50.87±3.52)%比(49.72±3.71)%],左心室收缩末期内径、左心室舒张末期内径、室间隔厚度及左心室质量指数低于对照组[(38.26±5.18)mm比(40.05±5.20)mm、(50.49±4.33)mm比(52.08±4.25)mm、(8.95±0.39)mm比(9.08±0.41)mm、(118.49±9.58)g/m^(2)比(121.58±9.62)g/m^(2)],差异有统计学意义(P<0.05);治疗后两组总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平比较差异无统计学意义(P>0.05);两组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治疗冠心病临床疗效好,可改善患者心功能及血管硬化,逆转心室重构,且无显著不良反应发生,有利于疾病恢复。

Objective To study the effects of sacubitril valsartan sodium on vascular sclerosis and ventricular remodeling in patients with ischemic cardiomyopathical coronary heart disease.Methods A prospective research method was adopted.One hundred and eighty-six patients with coronary heart disease who were treated in Hangzhou Ninth People′s Hospital from January to December 2021 were selected and divided into control group and observation group by random digits table method,with 93 cases in each group.The control group adopted routine treatment method of aspirin+metoprolol+nitroglycerin+captopril according to the guideline,while the observation group was additionally treated with sacubitril valsartan sodium on the basis of the control group.The clinical efficacy,vascular endothelial function and hardness,cardiac function,ventricular remodeling and adverse reactions were compared between the two groups.Results The total effective rate of treatment in observation group was significantly higher than that in control group:96.77%(90/93)vs.87.10%(81/93),and there was statistical difference(P<0.05).After treatment,the brachial artery flow-mediated dilation in observation group was significantly higher than that in control group:(14.46±2.80)%vs.(13.09±2.74)%,the level of endothelin-1 was significantly lower than that in control group:(73.32±9.63)ng/L vs.(77.47±10.35)ng/L,and there were statistical differences(P<0.05).After treatment,the left ventricular ejection fraction(LVEF)in observation group was significantly higher than that in control group:(50.87±3.52)%vs.(49.72±3.71)%,the left ventricular end-systolic diameter,left ventricular end-diastolic diameter and ventricular remodeling indicators of interventricular septal thickness and left ventricular mass index were significantly lower than those in control group:(38.26±5.18)mm vs.(40.05±5.20)mm,(50.49±4.33)mm vs.(52.08±4.25)mm,(8.95±0.39)mm vs.(9.08±0.41)mm,(118.49±9.58)g/m^(2) vs.(121.58±9.62)g/m^(2),and there were statistical differences(P<0.05).There were no statistical differences in the levels of total cholesterol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol after treatment between the two groups(P>0.05).There were no statistical differences in the incidences of adverse reactions between the two groups(P>0.05).Conclusions Sacubitril valsartan sodium has a good clinical efficacy in the treatment of coronary heart disease,and it can improve cardiac function and vascular sclerosis and reverse ventricular remodeling.In addition,it has no significant adverse reactions and is conducive to disease recovery.