沙库巴曲缬沙坦对老年高血压并发HFpEF病人CRP及左心室重构影响

EFFECTS OF SACUBITRIL/VALSARTAN ON C-REACTIVE PROTEIN AND LEFT VENTRICULAR REMODELING INDICES IN ELDERLY HYPERTENSION WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

目的观察老年高血压并射血分数保留心力衰竭(HFpEF)病人应用沙库巴曲缬沙坦(ARNI)治疗后C反应蛋白(CRP)及左心室重构指标的变化。方法选择年龄≥65岁高血压并HFpEF病人,根据用药方案分为ARNI组(110例,口服ARNI治疗,每次100 mg,每日2次)、对照组(120例,口服贝那普利每次10 mg或缬沙坦每次80 mg,每日1次),比较两组治疗前、治疗12个月后CRP、左心房容积指数(LAVI)、左心室质量指数(LVMI)、左心室舒张早期二尖瓣血流峰值速度/舒张早期二尖瓣环峰值速度(E/e’)、左心室射血分数(LVEF)指标,评估ARNI对老年高血压并HFpEF病人炎症指标、心室重构及心功能影响。结果与治疗前比较,治疗后ARNI组CRP、LAVI、LVMI、E/e’水平下降,对照组CRP、E/e’水平下降,差异有显著性(Z=-8.360~-2.565,P<0.05)。与对照组比较,治疗后ARNI组CRP、LAVI、LVMI、E/e’明显下降,差异有统计学意义(Z=-7.150~-2.071,P<0.05);治疗后两组LVEF比较差异无统计学意义(P>0.05)。随访12个月,因心力衰竭再入院病人ARNI组为8例(7.3%),对照组为16例(13.3%),两组比较差异有显著性(χ^(2)=2.256,P<0.05)。结论ARNI可降低老年高血压相关HFpEF过程中的炎症因子水平,有效逆转心肌重塑及心室重构,改善心脏功能及预后。

Objective To investigate the changes of C-reactive protein(CRP)and left ventricular remodeling indices in elderly patients with hypertension with heart failure with preserved ejection fraction(HFpEF)after treatment with sacubitril/valsartan,an angiotensin receptor/neprilysin inhibitor(ARNI).Methods Patients aged≥65 years with hypertension with HFpEF were divided into ARNI group(110 cases,oral ARNI 100 mg,twice daily)and control group(120 cases,benazepril 10 mg or valsartan 80 mg,once daily).The two groups were compared in the following indicators before treatment and after 12 months of treatment to analyze the effects of ANRI on the inflammatory indicator,ventricular remodeling,and cardiac function in elderly patients with hypertension with HFpEF:CRP,left atrial volume index(LAVI),left ventricular mass index(LVMI),left ventricular early diastolic mitral inflow velocity/early diastolic mitral annular velocity(E/e’),and left ventricular ejection fraction(LVEF).Results After treatment,CRP,LAVI,LVMI,and E/e’in the ARNI group were significantly decreased,and CRP and E/e’in the control group were significantly decreased(Z=-8.360 to-2.565,P<0.05).Compared with those of the control group,CRP,LAVI,LVMI,and E/e’in the ARNI group were decreased significantly after treatment(Z=-7.150 to-2.071,P<0.05).There was no significant difference in LVEF between the two groups after treatment(P>0.05).After 12 months of follow-up,8(7.3%)patients in the ARNI group and 16(13.3%)patients in the control group were re-hospitalized due to heart fai-lure,with a significant difference(χ^(2)=2.256,P<0.05).Conclusion ARNI can reduce inflammatory levels,effectively reverse myocardial and ventricular remodeling,and improve cardiac function and prognosis in the process of HFpEF related to elderly hypertension.