益心颗粒联合沙库巴曲缬沙坦钠治疗慢性心力衰竭的效果及对血管内皮功能的影响

Effect of Yixin Granules Combined with Sacubitril Valsartan Sodium in the Treatment of Chronic Heart Failure and Its Influence on Vascular Endothelial Function

目的:探究益心颗粒联合沙库巴曲缬沙坦钠治疗慢性心力衰竭(CHF)的效果。方法:选择2022年2月—2023年2月在临沂市中心医院心血管内科治疗的CHF患者160例,应用随机数字表法将其分为对照组(予以沙库巴曲缬沙坦钠治疗)及观察组(在对照组基础上联合益心颗粒治疗),各80例。对比两组心功能[左室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、治疗总有效率、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)]、神经内分泌水平[醛固酮(ALD)、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)]、心肌相关因子水平[可溶性生长刺激表达基因2蛋白(sST2)、心型脂肪酸结合蛋白(hFABP)、脂蛋白相关磷脂酶A2(Lp-PLA2)]。结果:治疗前,两组心功能指标比较,差异均无统计学意义(P>0.05);治疗后,两组LVEF均升高,LVESD、LVEDD均减小,观察组LVEF高于对照组,LVESD、LVEDD均小于对照组,差异均有统计学意义(P<0.05)。对照组治疗总有效率低于观察组,差异有统计学意义(P<0.05)。治疗前,两组血管内皮功能指标比较,差异均无统计学意义(P>0.05);治疗后,两组NO均升高,ET-1均降低,观察组NO高于对照组,ET-1低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组神经内分泌水平比较,差异均无统计学意义(P>0.05);治疗后,两组ALD、PRA、AngⅡ水平均降低,观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组心肌相关因子水平比较,差异均无统计学意义(P>0.05);治疗后,两组sST2、hFABP、Lp-PLA2水平均降低,观察组均低于对照组,差异均有统计学意义(P<0.05)。结论:CHF患者采用益心颗粒联合沙库巴曲缬沙坦钠治疗,可改善心功能、血管内皮功能,效果显著,其作用机制可能与下调ALD、PRA、AngⅡ、sST2、hFABP、Lp-PLA2水平有关。

Objective:To investigate the effect of Yixin Granules combined with Sacubitril Valsartan Sodium in the treatment of chronic heart failure(CHF).Method:A total of 160 CHF patients who were treated in the Department of Cardiovascular Medicine,Linyi Central Hospital from February 2022 to February 2023 were selected.They were randomly divided into a control group(treated with Sacubitril Valsartan Sodium)and an observation group(treated with Yixin Granules in addition to the control group)using a random number table method,with 80 patients in each group.Cardiac function[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)],total effective rate of treatment,vascular endothelial function[nitric oxide(NO),endothelin-1(ET-1)],neuroendocrine levels[aldosterone(ALD),plasma renin activity(PRA),angiotensinⅡ(AngⅡ)]and the levels of myocardial related factors[soluble growth stimulating gene 2 protein(sST2),heart type fatty acid binding protein(hFABP)and lipoprotein associated phospholipase A2(Lp-PLA2)]of the two groups were compared.Result:Before treatment,there were no significant differences in cardiac function indexes between the two groups(P>0.05).After treatment,LVEF in both groups increased,LVESD and LVEDD decreased,LVEF in observation group was higher than that in control group,LVESD and LVEDD were lower than those in control group,the differences were statistically significant(P<0.05).The treatment total effective rate of control group was lower than that of observation group,the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in vascular endothelial function indexes between the two Medical Innovation of China Vol.21,No.9 March,2024 groups(P>0.05).After treatment,NO increased and ET-1 decreased in both groups,NO in observation group was higher than that in control group,and ET-1 was lower than that in control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in neuroendocrine levels between the two groups(P>0.05).After treatment,the levels of ALD,PRA and AngⅡin both groups decreased,and those in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in myocardial related factors levels between the two groups(P>0.05).After treatment,the levels of sST2,hFABP and Lp-PLA2 in both groups decreased,and those in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Treatment of CHF patients with Yixin Granules combined with Sacubitril Valsartan Sodium can improve cardiac function and vascular endothelial function,and the effect is remarkable.Its mechanism may be related to down-regulating the levels of ALD,PRA,AngⅡ,sST2,hFABP and Lp-PLA2.