沙库巴曲缬沙坦对慢性心力衰竭患者心功能及血管内皮功能的影响

Effect of sacubitril valsartan on cardiac function and vascular endothelial function in patients with chronic heart failure

目的 观察沙库巴曲缬沙坦对慢性心力衰竭(CHF)患者心功能及血管内皮功能的影响。方法 选取2020年4月—2023年4月抚州市东乡区第二人民医院收治的CHF患者92例,按随机数字表法分为缬沙坦组(n=46)与沙库巴曲缬沙坦组(n=46)。缬沙坦组给予缬沙坦胶囊治疗,沙库巴曲缬沙坦组给予沙库巴曲缬沙坦钠片治疗,2组均治疗2个月。比较2组临床疗效,治疗前、治疗2个月后心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、每搏输出量(SV)、心脏指数(CI)]、血管内皮功能指标[内皮素-1(ET-1)、一氧化氮(NO)、一氧化氮合酶(NOS)]、6 min步行距离(6MWD)及明尼苏达心力衰竭生活质量问卷(MLHFQ)评分,不良反应。结果 沙库巴曲缬沙坦组总有效率高于缬沙坦组(93.48%vs.78.26%,χ^(2)=4.389,P=0.036)。治疗2个月后,2组LVEF、SV、CI较治疗前升高,LVEDD较治疗前减小,且沙库巴曲缬沙坦组升高/减小幅度大于缬沙坦组(P<0.01);2组血浆ET-1水平较治疗前下降,血浆NO、NOS水平较治疗前升高,且沙库巴曲缬沙坦组降低/升高幅度大于缬沙坦组(P<0.01);2组6MWD较治疗前延长,身体领域、情绪领域、其他领域评分及MLHFQ总分较治疗前降低,且沙库巴曲缬沙坦组延长/降低幅度大于缬沙坦组(P<0.01)。缬沙坦组与沙库巴曲缬沙坦组不良反应总发生率比较,差异无统计学意义(6.52%vs.10.87%,χ^(2)=0.137,P=0.711)。结论 沙库巴曲缬沙坦治疗CHF可提高临床疗效,可更有效地改善患者的心功能、血管内皮功能,增强患者运动耐量,提高生活质量,且安全性较高。

Objective To observe the effect of sacubitril valsartan on cardiac function and vascular endothelial function in patients with CHF.Methods Ninety-two patients with CHF admitted to the Fuzhou Dongxiang District Second People′s Hospital from April 2020 to April 2023 were selected,and they were divided into the valsartan group(n=46) and the sacubitril valsartan group(n=46) according to the random number table method.The valsartan group was treated with valsartan capsules,and the sacubitril valsartan group was treated with sacubitril valsartan sodium tablets,both groups were treated for 2 months.Clinical efficacy,cardiac function indexes(LVEF,LVEDD,SV,CI),vascular endothelial function indexes(ET-1,NO,NOS),6MWD and MLHFQ score before and after 2 months of treatment,and adverse reactions were compared between the two groups.Results Total effective rate of the sacubitril valsartan group was higher than that of the valsartan group(93.48% vs.78.26%,χ^(2)=4.389,P=0.036).After 2 months of treatment,LVEF,SV and CI in the two groups were higher than those before treatment,while LVEDD was lower than that before treatment,and increase/decrease degree of the indexes in the sacubitril valsartan group were greater than those of the valsartan group(P<0.01);Plasma level of ET-1 in the two groups was lower than that before treatment,plasma levels of NO and NOS were higher than those before treatment,and increase/decrease degree of the indexes in the sacubitril valsartan group were greater than those of the valsartan group(P<0.01);The two groups showed an extended 6MWD compared to that before treatment,and scores of physical domain,emotional domain,other domain and total MLHFQ score were decreased compared to those before treatment,and the increase/decrease degree of the sacubitril valsartan group were greater than those of the valsartan group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the valsartan group and the sacubitril valsartan group(6.52% vs.10.87%,χ^(2)=0.137,P=0.711).Conclusion Sacubitril valsartan can enhance clinical efficacy of patients with CHF,it can improve cardiac function and vascular endothelial function of patients,enhance exercise tolerance and promote quality of life,and with higher safety.