马来酸依那普利联合沙库巴曲缬沙坦对老年冠心病伴慢性心力衰竭患者心功能及炎性因子的影响

Effect of enalapril maleate plus sacubitril/valsartan on cardiac function and inflammatory factors in elderly patients with coronary heart disease complicated by chronic heart failure

目的探讨马来酸依那普利联合沙库巴曲缬沙坦治疗对老年冠心病伴慢性心力衰竭患者心功能、炎性因子水平及安全性等的影响。方法将90例老年冠心病伴慢性心力衰竭患者随机分为两组,各45例。对照组患者采用马来酸依那普利治疗,观察组患者采用马来酸依那普利联合沙库巴曲缬沙坦治疗,观察6个月。比较两组患者的临床疗效、不良反应发生率,以及治疗前后血清可溶性细胞间黏附分子-1(sICAM-1)水平、可溶性血管细胞黏附分子-1(sVCAM-1)水平、心功能[氨基末端B型利钠肽原(NT-proBNP)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、血压[收缩压(SBP)、舒张压(DBP)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)]水平。结果观察组患者临床疗效总有效率高于对照组(P<0.05)。治疗后,两组患者血清sICAM-1、sVCAM-1水平均较治疗前明显降低,且观察组低于对照组(P<0.01)。治疗后,两组患者NT-proBNP、LVEDD、SBP、DBP均较治疗前下降,LVEF较治疗前上升,且观察组优于对照组(P<0.05或0.01)。治疗后,两组患者TNF-α、IL-6和hs-CRP水平均较治疗前降低,且观察组低于对照组(P<0.01)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论马来酸依那普利联合沙库巴曲缬沙坦治疗老年冠心病伴慢性心力衰竭疗效显著,可改善患者心功能,降低血清sICAM-1、sVCAM-1水平,减轻炎症反应,安全性高,值得临床进一步推广。

Objective To explore the effect of enalapril maleate plus sacubitril/valsartan on cardiac function,inflammatory factor levels,and safety in elderly patients with coronary heart disease complicated by chronic heart failure.Methods Ninety elderly patients with coronary heart disease and chronic heart failure were randomly divided into two groups with 45 ones in each.Controls were treated with enalapril maleate,observation group with enalapril maleate combined with sacubitril valsartan,and observed for 6 months.Clinical efficacy,incidence of adverse reactions,and levels of soluble intercellular adhesion molecule-1(sICAM-1),soluble vascular cell adhesion molecule-1(sVCAM-1),cardiac function(N-terminal B-type natriuretic peptide precursor[NT-proBNP],left ventricular ejection fraction[LVEF],left ventricular end diastolic diameter[LVEDD]),blood pressure(systolic blood pressure[SBP],diastolic blood pressure[DBP]),inflammatory factors(tumor necrosis factor-α[TNF-α],interleukin-6[IL-6],high-sensitivity C-reactive protein[hs-CRP])before and after treatment were compared between two groups.Results The total clinical effective rate was higher in observation than control group(P<0.05).After treatment,serum sICAM-1 and sVCAM-1 levels in both groups significantly lowered compared with pre-treatment and those were lower in observation group than controls(P<0.01).After treatment,the NT-proBNP,LVEDD,SBP,and DBP values lowered and LVEF elevated in both groups compared with pre-treatment,and observation group was better than controls(P<0.05 or 0.01).After treatment,the TNF-α,IL-6,and hs-CRP levels in both groups lowered compared with pre-treatment and those were lower in observation group than controls(P<0.01).There was no statistically significant intergroup difference in the incidence of adverse reactions(P>0.05).Conclusion Enalapril maleate combined with sacubitril/valsartan has a definite effect on elderly patients with coronary heart disease complicated by chronic heart failure,can improve cardiac functions,reduce serum sICAM-1 and sVCAM-1 levels,alleviate inflammatory reactions,has high safety,and deserves further promotion clinically.