沙库巴曲缬沙坦对射血分数降低型心力衰竭患者心功能及心室重构的影响

Effect of sacubitril valsartan on cardiac function and ventricular remodeling in patients with heart failure with reduced ejection fraction

目的 观察沙库巴曲缬沙坦对射血分数降低型心力衰竭(HFrEF)患者心功能及心室重构的影响。方法 选取2022年3月—2023年3月中国贵航集团三○二医院收治的HFrEF患者80例,按照随机数字表法分为常规治疗组与联合治疗组,各40例。常规治疗组给予常规药物治疗,联合治疗组基于常规治疗组用药加用沙库巴曲缬沙坦钠片,2组治疗时间均为12周。比较2组临床疗效,治疗前后心功能指标[E峰减速时间(DT)、二尖瓣口舒张早期峰值血流速度/舒张晚期峰值血流速度(E/A)、左室质量指数(LVMI)]、心肌损伤标志物(心肌肌钙蛋白I、肌酸激酶同工酶、心脏型脂肪酸结合蛋白)、心室重构指标(金属蛋白酶抑制剂-1、Ⅰ型前胶原羧基端肽、基质金属蛋白酶-9、Ⅰ型C端胶原前肽)、氧化应激指标[总抗氧化能力(TAC)、过氧化脂质(LPO)],主要不良心血管事件(MACE)发生情况及治疗后前后明尼苏达心力衰竭生活质量问卷(MLHFQ)评分。结果 联合治疗组治疗总有效率高于常规治疗组(97.50%vs. 80.00%,χ^(2)=4.507,P=0.034)。治疗12周后,2组DT缩短,E/A增大,LVMI降低,且联合治疗组改善幅度大于常规治疗组(P均<0.01);2组心肌损伤标志物、心室重构指标及LPO水平降低,TAC水平升高,且联合治疗组降低/升高幅度大于常规治疗组(P<0.05或P<0.01)。联合治疗组MACE总发生率低于常规治疗组(2.50%vs. 20.00%,χ^(2)=4.507,P=0.034)。治疗12周后,2组MLHFQ评分降低,且联合治疗组低于常规治疗组(P<0.01)。结论 在常规药物治疗基础上加用沙库巴曲缬沙坦治疗HFrEF可获得满意效果,可显著改善患者心功能,抑制心室重构,增强机体抗氧化能力,减轻心肌损伤,且可降低患者MACE发生率,提高其生活质量。

Objective To observe the effect of sacubitril valsartan on cardiac function and ventricular remodeling in patients with HFrEF.Methods A total of 80 patients with HFrEF admitted to 302 Hospital of Aviation Industry Corporation of China from March 2022 to March 2023 were selected,and they were divided into the convention group and the combination group according to the randomized numerical table method,with 40 cases in each group.The conventional group was given conventional drugs treatment,and the combination group was plused sacubitril valsartan sodium tablets based on the drugs used in the conventional group,and the treatment time of the two groups was 12 weeks.Clinical efficacy,cardiac function indexes(DT,E/A,LVMI),myocardial injury markers(cardiac troponin I,creatine kinase isoenzyme,cardiac fatty acid binding protein,matrix metalloproteinase-9,typeⅠC-terminal collagen prepeptide),ventricular remodeling indexes(metalloproteinases inhibitor-1,typeⅠpre-collagen carboxy-terminal endogenous protein),oxidative stress markers(TAC,LPO)before and after treatment,occurrence of MACE,and MLHFQ score before and after treatment were compared between the two groups.Results The total efficiency rate in the combination group was higher than that in the conventional group(97.50%vs.80.00%,χ^(2)=4.507,P=0.034).After 12 weeks of treatment,DT in the two groups was shorter,E/A was larger,and LVMI was lower compared with before treatment,and the indexes in the combination group were better than those in the conventional group(P<0.01);Myocardial injury markers,ventricular remodeling indexes and LPO level in the two groups were lower than before treatment,and TAC level was higher than before treatment,and indexes in the combination group were better than those in the conventional group(P<0.05 or P<0.01).Total incidence of MACE in the combination group was lower than that in the conventional group(2.50%vs.20.00%,χ^(2)=4.507,P=0.034).After 12 weeks of treatment,MLHFQ score decreased in the two groups,and MLHFQ score in the combination group was lower than that in the conventional group(P<0.01).Conclusion On the basis of conventional drugs treatment,the addition of sacubitril valsartan can obtain ideal results for HFrEF patients,it can significantly improve the patients′cardiac function,inhibit ventricular remodeling,enhance the body′s antioxidant capacity,reduce myocardial injury,it can reduce the incidence of MACE in patients and improve their quality of life.