沙库巴曲缬沙坦改善射血分数降低心力衰竭患者心功能及与脉搏波传导速度的关系

张志敏; 赵连友; 付勤德; 杜峥; 李梦琦; 苟丽莎; 王巍; 周圣华

doi:10.12125/j.chj.202005100

沙库巴曲缬沙坦改善射血分数降低心力衰竭患者心功能及与脉搏波传导速度的关系

Sacubitril valsartan improves heart functions in heart failure patients with reduced ejection fraction

摘要

摘要:
目的观察沙库巴曲缬沙坦对射血分数降低心力衰竭（heart failure with reduced ejection fraction，HFrEF）患者心功能及脉搏波传导速度(pulse wave velocity, PWV)的影响，以及探讨两者间潜在关系。
方法选取2017年1月至2019年10月于新疆军区总医院心内科住院诊治的慢性心力衰竭患者80例为观察对象，随机分为对照组及试药组，每组40例。对照组给予常规治疗，试药组将常规治疗方案中ACEI/ARB替换为沙库巴曲缬沙坦，比较两组治疗前后心功能、心室重构相关指标及PWV值变化。
结果治疗前，两组患者基线资料差异无统计学意义。对照组及试药组治疗后左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）较治疗前显著降低（均P<0.05），左室射血分数（LVEF）、6分钟步行距离（6MWD）较治疗前显著升高（均P<0.05）；治疗后试药组LVEF、6MWD显著高于对照组（P<0.05）。对照组及试药组治疗后舒张期室间隔厚度（IVST）、舒张期左室后壁厚度（LVPWT）、左室质量指数（LVMI）显著降低（均P<0.05）；治疗后试药组LVMI显著低于对照组（P<0.05）。对照组治疗后氨基末端脑钠尿肽前体（NT-proBNP）、可溶性肿瘤因子2抑制剂（sST2）较治疗前显著降低（P<0.05），一氧化氮（NO）水平显著升高（P<0.05）；治疗后试药组NT-proBNP、sST2较治疗前显著降低（均P<0.01），NO水平显著升高（P<0.01）。治疗后，对照组PWV较治疗前显著降低（P<0.05），试药组PWV较治疗前显著降低（P<0.01），且显著低于对照组（P<0.05）。
结论沙库巴曲缬沙坦更为有效抑制HFrEF患者心肌纤维化，逆转心室重构，改善心功能，从而提高心衰患者活动耐量；且沙库巴曲缬沙坦两药可协同改善动脉顺应性，减轻心脏后负荷，进一步延缓心衰发展进程。

Abstract:
AIM To observe the effect of sacubitril valsartan on heart functions and pulse wave velocity (PWV) in heart failure patients with reduced ejection fraction and to explore the relationship the between heart functions and PWV.
METHODS Eighty patients with chronic heart failure who were hospitalized in the Department of Cardiology, Xinjiang Military Region General Hospital from January 2017 to October 2019 were selected for this study and they were randomly divided into control group and treatment group, with 40 in each group. Control group was given conventional treatment and in treatment group, sacurabitril valsartan replaced ACEI/ARB in the conventional treatment regimen. Comparison between the two groups was made in the changes in cardiac functions, ventricular remodeling related indexes and PWV values before and after treatment.
RESULTS There was no statistically difference in baseline data between the two groups. After treatment, LVEDV and LVESV in both control group and treatment group were lower than those before treatment (P<0.05) and LVEF and 6MWD were higher and longer than those before treatment (P<0.05). LVEF and 6MWD in treatment group after treatment were better improved than those in control group (P<0.05). IVST, LVPWT and LVMI in both groups were reduced after treatment (P<0.05) and LVMI in treatment group after treatment was lower than that in control group (P<0.05). After treatment, NT-proBNP and sST2 in control group were lower than those before treatment (P<0.05) and NO levels were increased (P<0.05). After treatment, NT-proBNP and sST2 in treatment group were significantly lower than those before treatment (P<0.01) and NO levels increased more significantly (P<0.01). PWV in control group was lower than that before treatment (P<0.05) and PWV in treatment group was significantly lower than that before treatment (P<0.01), and lower than that in control group (P<0.05).
CONCLUSION Sacubitril valsartan is more effective in reducing myocardial fibrosis in heart failure patients with ejection fraction, reversing ventricular remodeling and improving cardiac functions, and thus enhancing the activity tolerance of patients with heart failure. Sacubitril valsartan synergistically improves arterial compliance, reduces heart afterload and further delays the development of heart failure.

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