依洛尤单抗联合沙库巴曲缬沙坦治疗急性心肌梗死患者的效果

Effects of Evolocumab combined with Sacubitril/Valsartan in treatment of patients with acute myocardial infarction

目的:观察依洛尤单抗联合沙库巴曲缬沙坦治疗急性心肌梗死(AMI)患者的效果。方法:回顾性分析2020年9月至2023年7月该院收治的62例AMI患者的临床资料,根据治疗方案不同将其分为对照组(n=31)与研究组(n=31)。对照组采用沙库巴曲缬沙坦治疗,研究组在对照组基础上联合依洛尤单抗治疗。比较两组临床疗效,治疗前后心功能指标[左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)]、心肌损伤标志物[心肌肌钙蛋白T(cTnT)、N-末端脑钠肽前体(NT-proBNP)]、血管内皮功能指标[内皮素-1(ET-1)、一氧化氮(NO)、血管紧张素-Ⅱ(Ang-Ⅱ)]、炎性指标[可溶性细胞间黏附分子-1(sICAM-1)、脂蛋白相关磷脂酶A2(Lp-PLA2)]水平,以及不良反应发生率。结果:研究组治疗总有效率为93.55%(29/31),高于对照组的74.19%(23/31),差异有统计学意义(P<0.05);治疗后,两组LVEDD、LVESD水平均低于治疗前,且研究组低于对照组,两组LVEF水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组cTnT、NT-proBNP水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);两组ET-1、Ang-Ⅱ水平均低于治疗前,且研究组低于对照组,两组NO水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组sICAM-1、Lp-PLA2水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:依洛尤单抗联合沙库巴曲缬沙坦治疗AMI患者可提高治疗总有效率,改善心功能指标和血管内皮功能指标水平,降低心肌损伤标志物和炎性指标水平,其效果优于单纯沙库巴曲缬沙坦治疗。

Objective:To observe effects of Evolocumab combined with Sacubitril/Valsartan in treatment of patients with acute myocardial infarction(AMI).Methods:The clinical data of 62 patients with AMI admitted to this hospital from September 2020 to July 2023 were retrospectively analyzed.According to different treatment options,they were divided into control group(n=31)and study group(n=31).The control group was treated with Sacubitril/Valsartan,while the study group was treated with Evolocumab on the basis of that of the control group.The clinical efficacy,the levels of cardiac function indexes[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD)],myocardial injury markers[cardiac troponin T(cTnT),N-terminal pro-brain natriuretic peptide(NT-proBNP)],vascular endothelial function indexes[endothelin-1(ET-1),nitric oxide(NO),angiotensin-II(Ang-II)]and inflammatory indexes[soluble intercellular adhesion molecule-1(sICAM-1),lipoprotein phospholipase(Lp-PLA2)]before and after the treatment,and the incidence of adverse reactions were compared between the two groups.Results:The total effective rate of the study group was 93.55%(29/31),which was higher than 74.19%(23/31)of the control group,and the difference was statistically significant(P<0.05).After the treatment,the levels of LVEDD and LVESD in the two groups were lower than those before the treatment,and those in the study group were lower than those the control group;the LVEF levels of the two groups were higher than those before the treatment,and that in the study group was higher than that in the control group;and the difference was statistically significant(P<0.05).The levels of cTnT and NT-proBNP in the two groups were lower than those before the treatment,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of ET-1 and Ang-II in the two groups were lower than those before the treatment,and those in the study group were lower than those in the control group;the levels of NO in the two groups were higher than those before the treatment,and that in the study group was higher than that in the control group;and the differences were statistically significant(P<0.05).The levels of sICAM-1 and Lp-PLA2 in the two groups were lower than those before the treatment,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions:Evolocumab combined with Sacubitril/Valsartan in the treatment of the AMI patients can improve the total effective rate of treatment,improve the levels of cardiac function indexes and vascular endothelial function indexes,and reduce the levels of myocardial injury markers and inflammatory indexes.Moreover,it is superior to simple Sacubitril/Valsartan treatment.