沙库巴曲缬沙坦治疗对早期急性失代偿心力衰竭患者血小板活化状态、炎症因子、心肌损伤因子的影响

Treatment of early acute decompensated heart failure with sacubattril valsartan and its effects on platelet activation,inflammatory factors and myocardial damage factors

目的研究沙库巴曲缬沙坦(SV)治疗早期急性失代偿心力衰竭(ADHF)及对血小板活化状态、炎症因子、心肌损伤因子的影响。方法前瞻性选择2020年1月至2022年12月于武汉市中医医院接受治疗的ADHF患者86例,依据随机数字表法将其分为SV组(n=43)、对照组(n=43)。对照组行常规治疗+培哚普利治疗,SV组行常规治疗+SV治疗。观察两组治疗后的临床疗效,比较两组治疗前、治疗3个月后的心功能指标[左心室射血分数(LVEF)、左室收缩末期内径(LVESD)及左室舒张末期内径(LVEDD)]、血清血小板活化状态指标[血小板溶酶体膜糖蛋白(CD63)、α-颗粒膜蛋白(CD62P)]、炎症因子[肿瘤坏死因子-α(TNF-α)、高敏C-反应蛋白(hs-CRP)、白细胞介素-33(IL-33)]水平、心肌损伤因子[微管链接蛋白(Nexilin)、可溶性凋亡相关因子配体(sFasL)、半乳糖凝集素3(Gal-3)]水平,观察两组治疗过程中的不良反应发生情况。结果SV组治疗的总有效率为83.72%,高于对照组(62.79%),差异有统计学意义(P<0.05)。治疗3个月后,SV组LVEF为(48.63±5.06)%,高于对照组[(43.97±4.61)%],LVESD、LVEDD及血清CD63、CD62P、TNF-α、hs-CRP、IL-33、Nexilin、sFasL、Gal-3水平分别为(46.76±4.93)mm、(52.49±5.46)mm、(4.87±0.52)%、(4.63±0.49)%、(14.87±1.69)pg/mL、(5.02±0.52)mg/L、(112.60±13.64)ng/L、(0.73±0.08)μg/L、(0.14±0.01)ng/L、(22.75±2.43)ng/L,均低于对照组[(51.53±5.36)mm、(57.40±5.96)mm、(6.21±0.64)%、(5.97±0.62)%、(18.95±2.02)pg/mL、(6.84±0.71)mg/L、(143.08±16.84)ng/L、(0.95±0.10)μg/L、(0.19±0.02)ng/L、(30.68±3.31)ng/L],差异均有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(13.95%vs.11.63%)(P>0.05)。结论SV治疗可提高ADHF患者的临床疗效,抑制血小板活化,缓解炎症反应,避免心肌损伤,改善患者心功能,安全性高。

Objective To study the effects of sakubatrotril valsartan(SV)on early acute decompensated heart failure(ADHF)and platelet activation status,inflammatory factors and myocardial damage factors.Methods A total of 86 patients with ADHF treated in Wuhan Traditional Chinese Medicine Hospital from January 2020 to December 2022 were prospectively selected and divided into SV group(n=43)and control group(n=43)according to the random number table method.The control group was treated with conventional therapy+perindopril,and the SV group was treated with conventional therapy+SV.The clinical efficacy of two treatment groups was observed.The cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD)and left ventricular end-diastolic diameter(LVEDD)],serum platelet activation status indicators[platelet membrance glycoprotein(CD63),α-granular membrane protein(CD62P)],inflammatory factors[tumor necrosis factor-α(TNF-α),high-sensitive C-reactive protein(hs-CRP),interleukin-33(IL-33)]levels,myocardial damage factors[Nexilin,soluble factor associated suicide ligand(sFasL)and Galactoagglutinin 3(Gal-3)]levels were observed before and after 3 months of treatment.The occurrence of adverse reactions during the two treatment processes was observed.Results The total effective rate of the SV group was 83.72%,which was higher than that of the control group(62.79%),the difference was statistically significant(P<0.05).After 3 months of treatment,LVEF in SV group was(48.63±5.06)%,which was higher than that of the control group[(43.97±4.61)%],the levels of LVESD,LVEDD and serum CD63,CD62P,TNF-α,hs-CRP,IL-33,Nexilin,sFasL and Gal-3 were(46.76±4.93)mm,(52.49±5.46)mm,(4.87±0.52)%,(4.63±0.49)%,(14.87±1.69)pg/mL,(5.02±0.52)mg/L,(112.60±13.64)ng/L,(0.73±0.08)μg/L,(0.14±0.01)ng/L,(22.75±2.43)ng/L,which were lower than those in the control group[(51.53±5.36)mm,(57.40±5.96)mm,(6.21±0.64)%,(5.97±0.62)%,(18.95±2.02)pg/mL,(6.84±0.71)mg/L,(143.08±16.84)ng/L,(0.95±0.10)μg/L,(0.19±0.02)ng/L,(30.68±3.31)ng/L],the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(13.95%vs.11.63%)(P>0.05).Conclusion SV treatment of ADHF can inhibit platelet activation and relieve inflammation,avoid myocardial damage,improve cardiac function,improve efficacy and high safety.