沙库巴曲缬沙坦联合美托洛尔治疗冠心病并慢性心力衰竭的临床疗效

Clinical efficacy of sacubitril valsartan combined with metoprolol in the treatment of coronary heart disease complicated with chronic heart failure

目的 观察沙库巴曲缬沙坦联合美托洛尔治疗冠心病并慢性心力衰竭(CHF)的临床疗效。方法 选取2022年1—12月长沙市第四医院收治的冠心病并CHF患者80例,经双盲法分为美托洛尔组与联合治疗组,各40例。美托洛尔组予以美托洛尔,联合治疗组在美托洛尔组基础上予以沙库巴曲缬沙坦,2组均连续用药1个月。比较2组用药前后心功能指标、血管内皮功能指标及其他实验室指标,不良反应。结果 用药1个月后,美托洛尔组与联合治疗组左室射血分数(LVEF)、每搏输出量(SV)较用药前升高,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)较用药前缩小,且联合治疗组LVEF、SV高于美托洛尔组,LVEDD、LVESD小于美托洛尔组(P<0.01);美托洛尔组与联合治疗组血清内皮素(ET)、可溶性生长刺激表达基因2蛋白(sST2)、N末端脑钠肽前体(NT-proBNP)、血管紧张素Ⅱ(AngⅡ)水平较用药前降低,血清一氧化氮合酶(NOS)、一氧化氮(NO)、降钙素基因相关肽(CGRP)水平较用药前升高,且联合治疗组血清ET、sST2、NT-proBNP、AngⅡ水平低于美托洛尔组,血清NOS、NO、CGRP水平高于美托洛尔组(P<0.01)。美托洛尔组与联合治疗组不良反应总发生率比较,差异无统计学意义(5.00%vs. 7.50%,P=1.000)。结论 冠心病并CHF患者采用沙库巴曲缬沙坦联合美托洛尔治疗的疗效确切,可有效改善心功能与血管内皮功能,逆转心室重构,药物安全性较高。

Objective To observe the clinical efficacy of sacubitril valsartan combined with metoprolol in the treatment of coronary heart disease complicated with CHF.Methods Eighty patients with coronary heart disease complicated with CHF admitted to the Fourth Hospital of Changsha from January to December 2022 were selected and divided into the metoprolol group and the combined treatment group by double-blind method,40 cases in each group.The metoprolol group was given metoprolol,and the combined treatment group was given sacubitril valsartan on the basis of the metoprolol group,and both groups were treated continuously for 1 month.The indexes of cardiac function,vascular endothelial function and the laboratory indexes before and after medication and adverse reactions were compared between the two groups.Results After 1 month of medication,LVEF and SV in the metoprolol group and combined treatment group were lower than those before medication,LVEDD and LVESD were less than those before medication,and the LVEF and SV in the combined treatment group were higher than those in the metoprolol group,and the LVEDD and LVESD were less than those in the metoprolol group(P<0.01);Levels of serum ET,sST2,NT-proBNP and AngⅡin the metoprolol group and the combined treatment group were lower than those before medication,while levels of serum NOS,NO and CGRP were higher than those before medication,and levels of serum ET,sST2,NT-proBNP and AngⅡin the combined treatment group were lower than those in the metoprolol group,levels of serum NOS,NO and CGRP were higher than those in the metoprolol group(P<0.01).There was no statistically significant difference in the total incidence of adverse reactions between the metoprolol group and the combined treatment group(5.00%vs.7.50%,P=1.000).Conclusion The combination of sacubitril valsartan and metoprolol have a definite therapeutic effect on treating patients with chronic heart disease complicated with CHF,it can effectively improve cardiac function and vascular endothelial function,reverse ventricular remodeling,and has higher drug safety.