沙库巴曲缬沙坦治疗慢性心力衰竭患者预后的影响因素分析

Influencing factors for prognosis in patients with chronic heart failure after sacubitril/valsartan treatment

目的分析沙库巴曲缬沙坦治疗慢性心力衰竭患者预后的影响因素。方法选择2018年12月至2021年2月建德市中西医结合医院心内科收治的接受沙库巴曲缬沙坦治疗的慢性心力衰竭患者282例,根据第6个月患者LVEF增长量分为改善组(LVEF从<40%升高到>50%)237例及未改善组45例(LVEF持续<40%或稳定在40%~49%)。分析2组一般资料以及可溶性生长刺激表达基因2蛋白(sST2)、白细胞介素1β(IL-1β)、N末端B型钠尿肽前体(NT-proBNP)水平。采用多因素logistic回归分析影响接受沙库巴曲缬沙坦治疗患者预后的因素。结果改善组sST2、IL-1β、NT-proBNP水平明显低于未改善组,差异有统计学意义[(54.21±4.12)ng/Lvs(61.78±5.15)ng/L,(41.39±8.21)μg/Lvs(58.21±11.98)μg/L,(5564.14±1267.34)ng/Lvs(6473.61±2097.97)ng/L,P<0.01]。多因素logistic回归分析显示,sST2、NT-proBNP以及IL-1β是影响预后的因素(HR=1.336,95%CI:1.165~1.533,P=0.000;HR=1.001,95%CI:1.000~1.001,P=0.029;HR=1.294,95%CI:1.185~1.413,P=0.000)。结论sST2、IL-1β、NT-proBNP均为预测接受沙库巴曲缬沙坦治疗慢性心力衰竭患者预后的因素。

Objective To analyze the influencing factors for the prognosis in patients with chronic heart failure(CHF)after sacubitril/valsartan treatment.Methods A total of 282 CHF patients treated with sacubitril/valsartan in our department from December 2018 to February 2021 were recruited in this study.According to LVEF growth in the 6th month after treatment,they were divided into improved group(LVEF increased from 40%to>50%,n=237)and non-improved group(LVEF continued to be 40%,n=45).The general data and sST2,IL-1βand NT-proBNP levels were compared and analyzed.Multivariate logistic regression analysis was used to analyze the factors affecting the prognosis of the patients after sacubitril/valsartan treatment.Results The sST2,IL-1βand NT-proBNP levels were significantly lower in the improved group than the non-improved group(54.21±4.12 ng/L vs 61.78±5.15 ng/L,41.39±8.21μg/L vs 58.21±11.98μg/L,5564.14±1267.34 ng/L vs 6473.61±2097.97 ng/L,P<0.01).Multivariate logistic regression analysis showed that sST2,NT-proBNP and IL-1βwere the prognostic factors(HR=1.336,95%CI:1.165-1.533,P=0.000;HR=1.001,95%CI:1.000-1.001,P=0.029;HR=1.294,95%CI:1.185-1.413,P=0.000).Conclusion The sST2,IL-1β,and NT-proBNP levels are all prognostic factors for CHF patients treated with sacubitril/valsartan.