沙库巴曲缬沙坦对射血分数降低心功能不全患者金属基质蛋白酶及左室重构影响

Influence of Sacubitril/Valsartan on matrix metalloproteinase and left ventricular remodeling in heart failure with reduced ejection fraction patients

目的 探讨沙库巴曲缬沙坦对射血分数降低心功能不全(HFrEF)患者金属基质蛋白酶(MMP)水平及左室重构的影响。方法 选取自2020年2月至2021年2月收治的66例HFrEF患者为研究对象,随机分为缬沙坦组(n=31)与沙库巴曲缬沙坦组(n=35)。两组患者分别于治疗前及随访6个月后采血检测N末端B型利钠肽原(NT-proBNP)、MMP-1、MMP-2和MMP-9水平,同时,行超声心动图检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室舒张末容积(LVEDV)和左室收缩末容积(LVESV)。结果 两组患者在随访初始、随访6个月时,缬沙坦用药剂量比较,差异无统计学意义(P>0.05)。随访6个月,缬沙坦组的MMP-9水平较治疗前明显降低,差异有统计学意义(P<0.05)。随访6个月,沙库巴曲缬沙坦组NT-proBNP、MMP-1、MMP-2、MMP-9水平均较治疗前降低,且低于缬沙坦组,差异有统计学意义(P<0.05)。随访6个月时,缬沙坦组患者LVEF、LVEDD、LVEDV和LVESV与治疗前比较,差异无统计学意义(P>0.05)。随访6个月时,沙库巴曲缬沙坦组LVEF较治疗前明显升高,且高于缬沙坦组;沙库巴曲缬沙坦组LVEDD、LVEDV和LVESV较治疗前明显降低,且低于缬沙坦组,差异有统计学意义(P<0.05)。结论 沙库巴曲缬沙坦可有效改善HFrEF患者左心室重构和左室收缩功能,其部分机制与抑制血浆中MMP-1、MMP-2和MMP-9表达水平有关。

Objective To investigate the influence of Sacubitril/Valsartan on the level of matrix metalloproteinase(MMP)and left ventricular remodeling in heart failure with reduced ejection fraction(HFrEF)patients.Methods A total of 66 patients with HFrEF admitted from February 2020 to February 2021 were selected and randomly divided into Valsartan group(n=31)and Sacubitril/Valsartan group(n=35).N-terminal pro-B-type natriuretic peptide(NT-proBNP),MMP-1,MMP-2 and MMP-9 were measured before the treatment and at 6-month follow-up.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were measured by echocardiography before the treatment and at 6-month follow-up.Results There was no significant difference in the dosage of Valsartan between the two groups at the initial follow-up and 6-month follow-up(P>0.05).At the 6-month follow-up,the level of MMP-9 in the Valsartan group was significantly lower than that before the treatment,and the difference was statistically significant(P<0.05).At the 6-month follow-up,the levels of NT-proBNP,MMP-1,MMP-2 and MMP-9 in the Sacubitril/Valsartan group were lower than those before the treatment,and lower than those in the Valsartan group,with statistical significance(P<0.05).At the 6-month follow-up,there were no significant differences in LVEF,LVEDD,LVEDV and LVESV in the Valsartan group compared with those before the treatment(P>0.05).At the 6-month follow-up,LVEF in the Sacubitril/Valsartan group was significantly higher than that before the treatment,and higher than that in the Valsartan group,while LVEDD,LVEDV and LVESV in the Sacubitril/Valsartan group were significantly lower than those before the treatment,and lower than those in the Valsartan group,and the differences were statistically significant(P<0.05).Conclusions Sacubitril/Valsartan can effectively improve left ventricular remodeling and left ventricular systolic function in HFrEF patients,and part of the mechanism is related to the inhibition of plasma MMP-1,MMP-2 and MMP-9 levels.