血管紧张素受体脑啡肽酶抑制剂对急性心肌梗死患者的早期应用价值及其作用机制探讨

Early application value and mechanism of angiotensin receptor enkephalin inhibitors in patients with acute myocardial infarction

目的探讨血管紧张素受体脑啡肽酶抑制剂对急性心肌梗死(acute myocardial infarction,AMI)患者的早期应用价值及作用机制。方法选取商丘市立医院2022年7月—2023年7月收治的AMI患者122例,随机分为常规组与沙库巴曲缬沙坦(Sacubitril Valsartan Sodium Tablet,Sak)组各61例,两组均接受急诊PCI治疗,常规组术后常规服用抗血小板药物,Sak组在此基础上,术后第3d开始服用Sak,比较两组治疗前后心功能指标、心肌损伤及心肌能量代谢状况、炎症水平及心力衰竭发生率、复住院率、病死率。结果治疗12周,Sak组左室收缩末内径、左室舒张末内径分别为(47.39±8.11)mm、(50.84±6.93)mm,均低于常规组的(54.84±8.49)mm、(58.49±5.39)mm,Sak组左室射血分数、6min步行试验距离分别为(54.39±4.84)%、(349.28±29.11)m,均高于常规组的(50.03±5.37)%、(324.45±41.03)m(P<0.05);Sak组肌钙蛋白I、脑钠肽、心肌能量消耗分别为(0.59±0.32)μg/L、(152.95±98.19)ng/L、(105.82±22.83)Cal/min,均低于常规组的(1.33±0.48)μg/L、(349.60±121.63)ng/L、(119.10±26.82)Cal/min(P<0.05);Sak组超敏C反应蛋白、肿瘤坏死因子-α、降钙素原分别为(13.37±4.39)ng/mL、(45.29±18.71)ng/L、(0.95±0.32)Cal/min,均低于常规组的(17.60±3.20)ng/mL、(59.73±19.74)ng/L、(0.31±0.19)Cal/min(P<0.05);Sak组心力衰竭发生率、复住院率分别为3.28%、4.92%,均低于常规组的16.39%、19.67%(P<0.05);常规组病死率为4.92%,Sak组为1.64%,差异无统计学意义(P>0.05)。结论AMI患者早期应用Sak可有效改善心功能,减轻心肌损伤程度,降低炎症水平,防止出现心力衰竭,改善预后。

Objective To investigate the early application value and mechanism of angiotensin receptor enkephalin inhibitors in patients with acute myocardial infarction.Methods Totally 122 patients with acute myocardial infarction(AMI)admitted to our hospital from July 2022 to July 2023 were randomly divided into routine group and sacubitril valsartan sodium tablet(Sak)group,with 61 patients in each group.Both groups received emergency PCI treatment.The conventional group received antiplatelet drugs routinely after surgery,and the Sak group began to take Sak on the 3rd day after surgery.The cardiac function indexes,myocardial injury and myocardial energy metabolism,inflammation level,incidence of heart failure,re-hospitalization rate,and mortality were compared between the two groups before and after treatment.Results After 12 weeks of treatment,the left ventricular end-systolic diameter and left ventricular end-diastolic diameter in Sak group were(47.39±8.11)mm and(50.84±6.93)mm,respectively,which were lower than those in conventiona1l group(54.84±8.49)mm and(58.49±5.39)mm,respectively.Left ventricular ejeetion fraction and 6min walking distance in Sak group were(54.39±4.84)%and(349.28±29.11)m,respectively,higher than those in conventional group(50.03±5.37)%and(324.45±41.03)m(P<0.05).The energy consumption of troponin I,brain natriuretic peptide and myocardium in Sak group were(0.59±0.32)μg/L,(152.95±98.19)ng/L and(105.82±22.83)Cal/min,respectively.It was lower than(1.33±0.48)μg/L,(349.60±121.63)ng/L,(119.10±26.82)Cal/min in conventional group(P<0.05).Hypersensitive C-reactive protein,tumor necrosis factor-αand procalcitonin in Sak group were(13.37±4.39)ng/mL,(45.29±18.71)ng/L,(0.95±0.32)Cal/min,respectively.It was lower than(17.60±3.20)ng/mL,(59.73±19.74)ng/L and(0.31±0.19)Cal/min in conventional group(P<0.05).The incidence of heart failure and re-hospitalization in Sak group were 3.28%and 4.92%,respectively,which were lower than 16.39%and 19.67%in conventional group(P<0.05).The fatality rate was 4.92%in the conventional group and 1.64%in the Sak group,with no significant diference(P>0.05).Conclusion Early application of Sak in patients with AMI can effectively improve cardiac function,reduce myocardial injury,reduce inflammation,prevent heart failure and improve prognosis.