沙库巴曲缬沙坦对慢性心力衰竭患者血管内皮功能及心功能的影响

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

目的探讨沙库巴曲缬沙坦对慢性心力衰竭(CHF)患者血管内皮功能及心功能影响。方法选取2021年9月至2022年9月西安市人民医院(西安市第四医院)收治的188例CHF患者作为研究对象,按随机数表法分为研究组和对照组各94例。两组患者均常规给予抗心衰治疗,对照组给予缬沙坦治疗,研究组给予沙库巴曲缬沙坦治疗,两组患者均治疗6个月。比较两组患者治疗前后的肱动脉血流介导血管舒张功能(FMD)、一氧化氮(NO)和内皮素-1(ET-1)水平;左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、每搏输出量(SV)、心输出量(CO)、N末端脑钠肽前体(NT-proBNP)水平及NYHA心功能分级。结果两组患者治疗前的FMD、NO和ET-1水平比较差异均无统计学意义(P>0.05);治疗后,研究组患者的NO、FMD值分别为(115.21±6.52)μmol/L、(11.79±3.24)%,明显高于对照组的(83.09±5.15)μmol/L、(10.05±3.17)%,ET-1水平为(41.08±6.02)ng/L,明显低于对照组的(50.42±7.41)ng/L,差异均有统计学意义(P<0.05);治疗前,两组患者的LVEDD、LVEF、SV、CO和NT-proBNP水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的LVEDD、NT-proBNP水平均低于治疗前,且研究组患者治疗后的LVEDD、NT-proBNP水平分别为(64.77±9.23)mm、(863.51±178.52)ng/L,明显低于对照组的(68.17±10.84)mm、(1367.84±220.72)ng/L,但治疗后两组患者的LVEF、SV、CO均高于治疗前,且研究组患者治疗后的LVEF、SV和CO分别为(63.28±7.01)%、(83.41±17.83)mL、(6.96±1.47)L/min,明显高于对照组的(56.30±6.54)%、(76.91±14.67)mL、(6.44±0.98)L/min,差异均有统计学意义(P<0.05);治疗后,研究组患者的NYHA心功能分级为Ⅰ级例数占比明显高于对照组,Ⅱ级和Ⅲ级例数占比明显低于对照组,差异均有统计学意义(P<0.05)。结论采用沙库巴曲缬沙坦治疗CHF可有效改善患者的血管内皮和心功能。

Objective To investigate the effects of sacubitril and valsartan on vascular endothelial function and cardiac function in patients with chronic heart failure(CHF).Methods A total of 188 patients with CHF admitted to Xi'an People's Hospital(Xi'an Fourth Hospital)from September 2021 to September 2022 were selected as the study subjects.They were randomly divided into a study group and a control group,with 94 patients in each group,using a random number table method.Based on routine anti-heart failure treatment,patients in the control group received valsartan treatment,and those in the study group received sacubitril and valsartan treatment,both for 6 months.The brachial artery blood flow-mediated vasodilation function(FMD)before and after treatment,nitric oxide(NO),and endothelin-1(ET-1)were compared between the two groups of patients before and after treatment,as well as left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),stroke output(SV),cardiac output(CO),N-terminal proBNP levels,and NYHA cardiac function grading.Results There was no statistically significant difference in the levels of FMD,NO,and ET-1 between the two groups of patients before treatment(P>0.05).After treatment,the NO and FMD values of the study group were(115.21±6.52)μmol/L,(11.79±3.24)%,significantly higher than the control group's(83.09±5.15)μmol/L,(10.05±3.17)%;ET-1 level was(41.08±6.02)ng/L,significantly lower than the control group's(50.42±7.41)ng/L;the differences were statistically significant(P<0.05).Before treatment,there was no statistically significant difference in the levels of LVEDD,LVEF,SV,CO,and NT-proBNP between the two groups of patients(P>0.05).After treatment,the average LVEDD and NT-proBNP levels in both groups of patients were lower than those before treatment,and the LVEDD and NT-proBNP levels in the study group were(64.77±9.23)mm and(863.51±178.52)ng/L,respectively,significantly lower than(68.17±10.84)mm and(1367.84±220.72)ng/L in the control group(P<0.05).However,after treatment,the LVEF,SV,and CO levels in both groups were significantly higher than those before treatment,and the LVEF,SV,and CO scores in the study group after treatment were(63.28±7.01)%,(83.41±17.83)mL,and(6.96±1.47)L/min,significantly higher than the control group's(56.30±6.54)%,(76.91±14.67)mL,and(6.44±0.98)L/min(P<0.05).After treatment,the proportion of NYHA heart function grading of patients in the study group as Grade Ⅰ was significantly higher than that in the control group,and the proportion of Grade Ⅱ and Ⅲ cases was significantly lower than that in the control group,with statistically significant differences(P<0.05).Conclusion The use of sacubitril and valsartan in the treatment of CHF can effectively improve the vascular endothelium and cardiac function of patients.