沙库巴曲缬沙坦对缺血性心肌病所致心力衰竭患者心脏各参数、血管扩张功能和主要不良心血管事件的影响

Effect of Sacubitril Valsartan on Cardiac Parameters,Vasodilation Function and Major Adverse Cardiovascular Events in Patients with Heart Failure Caused by Ischemic Cardiomyopathy

目的:观察沙库巴曲缬沙坦对缺血性心肌病(ICM)所致心力衰竭(HF)患者心脏各参数、血管扩张功能和主要不良心血管事件(MACE)的影响。方法:选取2020年1月—2021年12月在江西中医药大学附属医院心血管科收治的ICM所致HF的120例住院患者作为研究对象,采用随机数字表法分为常规组与研究组,每组60例。常规组给予依那普利(起始剂量为2.5 mg/次,2次/d),研究组给予沙库巴曲缬沙坦(起始剂量25 mg/次,2次/d),两组均治疗1个月。比较治疗前后两组左心房内径(LAD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、血管扩张功能(FMD)、颈动脉内中膜厚度(CIMT)、C反应蛋白(CRP)、半乳糖凝集素3(Gal-3)、N末端脑钠肽前体(BNP)、白细胞介素(IL)-33、肿瘤坏死因子(TNF)-α。于治疗前后使用Barthel指数(BI)及明尼苏达州心衰生活质量问卷(MLHF-Q)评估两组日常生活能力及生活质量。记录两组随访1个月内再入院率及不良心血管事件。结果:研究组总有效率为90.00%,高于常规组的75.00%,差异有统计学意义(P<0.05)。治疗后,研究组LAD、LVEDD、LVESD均降低,LVEF升高(P<0.05);治疗后,常规组LVEDD、LVESD均降低,LVEF升高(P<0.05),LAD与治疗前比较差异无统计学意义(P>0.05)。治疗后,研究组治疗后心脏各参数均优于常规组(P<0.05)。治疗后,两组FMD均升高,研究组CIMT降低(P<0.05),但常规组治疗前后CIMT差异无统计学意义(P>0.05)。治疗后,研究组FMD、CIMT均优于常规组(P<0.05)。治疗后,两组CRP、Gal-3、BNP、IL-33、TNF-α均降低,且研究组均优于常规组(P<0.05)。治疗后两组BI均升高、MLHF-Q评分均降低,研究组均优于常规组(P<0.05)。研究组MACE发生率及再入院率均低于常规组(P<0.05)。结论:对于ICM所致HF的患者,在常规抗心衰药物治疗基础上使用沙库巴曲缬沙坦可较好地提高临床疗效,改善患者心脏功能和生活质量,下调了LAD、LVEDD、LVESD、CIMT、CRP、Gal-3、BNP和MLHF-Q水平,上调了LVEF、FMD、BI,显著降低了患者的再入院率及MACE事件发生率。

Objective:To observe the effect of Sacubitril Valsartan on cardiac parameters,vasodilation function and major adverse cardiovascular events(MACE)in patients with heart failure(HF)caused by ischemic cardiomyopathy(ICM).Method:A total of 120 patients with HF caused by ICM who were admitted to Cardiology Department of Affiliated Hospital of Jiangxi University of Chinese Medicine from January 2020 to December 2021 were selected as the research subjects.They were divided into the conventional group and the study group by random number table method with 60 patients in each group.The conventional group was treated with Enalapril(initial dose of 2.5 mg/time,twice/day),while the study group was treated with Sacubitril Valsartan(initial dose of 25 mg/time,twice/day).Both groups were treated for 1 month.Left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),flow mediated dilation (FMD), carotid intima-media thickness (CIMT), C reactive protein (CRP), galectin 3 (Gal-3), N-terminal pro-brain natriuretic peptide (BNP), interleukin (IL)-33 and tumor necrosis factor (TNF)-α levels were compared before and after treatment. Barthel index (BI) and the Minnesota living with heart failure questionnaire (MLHF-Q) were used to evaluate activities of daily living and quality of life in both groups before and after treatment. The readmission rates and the incidence rates of adverse reactions in the two groups during 1 month of follow-up were recorded. Result: The total effective rate of the study group was 90.00%, which was higher than 75.00% of the conventional group, and the difference was statistically significant (P<0.05). After treatment, LAD, LVEDD and LVESD were decreased, while LVEF was increased in the study group (P<0.05). After treatment, LVEDD and LVESD were decreased and LVEF was increased in the conventional group (P<0.05), and LAD was not significantly different from that before treatment (P>0.05). After treatment, all cardiac parameters in the study group were better than those in the conventional group (P<0.05). After treatment, FMD increased in both groups and CIMT decreased in the study group (P<0.05), but there was no significant difference in CIMT before and after treatment in the conventional group (P>0.05). After treatment, FMD and CIMT in the study group were better than those in the conventional group (P<0.05). After treatment, CRP, Gal-3, BNP, IL-33 and TNF-α were decreased in both groups, and those in the study group were better than those in the conventional group (P<0.05). After treatment, BI increased and MLHF-Q score decreased in both groups, and those in the study group were better than those in the conventional group (P<0.05). The incidence of MACE and readmission rate in the study group were lower than those in the conventional group (P<0.05). Conclusion: For patients with HF caused by ICM, applying Sacubitril Valsartan treatment on the basis of conventional anti-heart failure drug treatment can enhance clinical efficacy, improve the patients' cardiac function and quality of life, reduce LAD, LVEDD, LVESD, CIMT, CRP, Gal-3, BNP and MLHF-Q score, increase LVEF, FMD and BI, and significantly reduce the readmission rate and the incidence of MACE.