HFrEF合并高血压患者经沙库巴曲缬沙坦钠联合达格列净治疗后血压及心力衰竭指标变化和安全性分析

Changes and safety analysis of blood pressure and heart failure indexes in HFrEF patients with hypertension after treatment with sarcubatrix valsartan sodium and dagelin

目的分析射血分数减低心力衰竭(HFrEF)合并高血压患者经沙库巴曲缬沙坦钠联合达格列净治疗后血压及心力衰竭指标变化和安全性。方法选取2021年1月至2022年6月于河南科技大学临床医学院心血管内科收治的168例HFrEF合并高血压患者为对象,采用信封随机法分为诺欣妥组(n=82)和联合组(n=86)。诺欣妥组患者给予沙库巴曲缬沙坦钠治疗,100 mg,bid;联合组在诺欣妥组基础上每日上午加用达格列净5 mg,qd,两组患者均连续治疗3个月。比较两组患者治疗前后血压、心功能、运动耐力水平,检测两组治疗前后血清氨基末端脑钠尿肽前体(NT-proBNP)、白细胞介素-33(IL-33)等因子的差异并统计两组用药安全性。结果两组治疗前血压、心功能及6 min步行距离(6MWD)比较,无统计学差异(P>0.05)。与治疗前相比,两组治疗后左心室射血分数(LVEF)、6MWD均明显升高,且联合组高于诺欣妥组,差异有统计学意义(P<0.05),两组血压、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)治疗后明显下降,且联合组低于诺欣妥组,差异均有统计学意义(P均<0.05)。两组治疗前血清NT-proBNP、高敏-C反应蛋白(hs-CRP)、IL-33、半乳糖凝集素-3(Gal-3)、可溶性肿瘤因子2抑制剂(sST2)比较,未见统计学差异(P>0.05)。与治疗前相比,两组NT-proBNP、hs-CRP、IL-33、Gal-3、sST2治疗后明显下降,且联合组低于诺欣妥组,差异均有统计学意义(P<0.05)。联合组低血压、高血钾、尿路感染、胃部不适等累计不良反应率为12.79%,与诺欣妥组的9.76%比较,无统计学差异(P>0.05)。结论HFrEF合并高血压患者经沙库巴曲缬沙坦钠联合达格列净治疗可改善心功能,降低Gal-3、sST2等因子的表达,提高运动耐力,且不会增加不良反应。

Objective To analyze the changes and safety of blood pressure and heart failure indicators in patients with heart failure with reduced ejection fraction(HFrEF)and hypertension after treatment with Sacubatrovsartan sodium and Daggligin.Methods 168 patients with HFrEF combined with hypertension admitted to the Department of Cardiovascular Medicine,School of Clinical Medicine,Henan University of Science and Technology,from January 2021 to June 2022 were selected and divided into two groups,the nosyntropic group(n=82)and the combined group(n=86),using the envelope randomization method.Patients in the Noxintol group were treated with sacubitril valsartan sodium 100 mg twice daily,and in the combined group,oral dagliflozin 5 mg was administered once daily in the morning on the basis of the Noxintol group,and patients in both groups were treated continuously for 3 months.Compare the level of blood pressure,cardiac function and exercise endurance before and after treatment,detect the difference of serum amino-terminal brain natriuretic peptide precursor(NT-proBNP),interleukin-33(IL-33)and other factors before and after treatment in the two groups and count the safety of medication in the two groups.Results Comparison of blood pressure,cardiac function and 6-minute walking distance(6MWD)between the two groups before treatment did not show statistical differences(P>0.05).Compared with the pre-treatment,left ventricular ejection fraction(LVEF)and 6MWD of the two groups increased significantly after treatment,and the combined group was higher than that of the Nosinostat group,and the differences were statistically significant(P<0.05),while blood pressure,left ventricular end-diastolic internal diameter(LVEDD)and left ventricular end-systolic internal diameter(LVESD)of the two groups decreased significantly after treatment,and the combined group was lower than that of the Nosinostat group,and the differences were statistically significant(P<0.05).Comparison of serum NT-proBNP,high sensitivity-C-reactive protein(hs-CRP),IL-33,galactose lectin-3(Gal-3),and soluble tumor factor 2 inhibitor(sST2)between the two groups before treatment did not show any statistically significant difference(P>0.05).Compared with pre-treatment,NT-proBNP,hs-CRP,IL-33,Gal-3,and sST2 decreased significantly after treatment in both groups,and the combined group was lower than that of the nociceptor group,and the differences were statistically significant(P<0.05).The cumulative adverse reaction rate of hypotension,hyperkalemia,urinary tract infection and gastric upset in the combined group was 12.79%,which was not statistically different from 9.76%in the nosinostat group(P>0.05).Conclusion In HFrEF patients with hypertension,the treatment of Sakubatrovsartan sodium combined with Daggligin can improve cardiac function,reduce the expression of Gal-3,sST2 and other factors,improve exercise tolerance,and will not increase adverse reactions.