摘要
目的 观察沙库巴曲缬沙坦钠联合常规对症治疗射血分数保留心力衰竭(HFpEF)的临床疗效,并探讨其对患者心功能、心率变异、炎性因子、血管内皮功能和再住院率的影响。方法 选取2021年1月至2022年12月许昌医院收治的108例HFpEF患者作为研究对象,按随机数表法分为联合组和对照组各54例。对照组患者行常规的利尿药物、β受体阻滞剂、血管紧张素转换酶抑制剂等对症支持治疗,联合组患者则在对照组治疗的基础上联合沙库巴曲缬沙坦钠治疗。治疗8周后,比较两组患者的临床疗效,以及治疗前后的心功能指标[左心室射的血分数(LVEF)、左心室的收缩末期内径(LVESD)、左心室的舒张末期内径(LVEDD)]、心率变异性指标[24 h窦性心律R-R间期标准差(SDNN)、24 h相邻正常R-R间期差值>50 ms百分比(RNN50)]、炎性因子[血清白细胞介素(IL)-1β、IL-8]、血管内皮功能[一氧化氮(NO)、内皮素-1 (ET-1)]水平,同时比较两组患者治疗期间的不良反应发生率和治疗结束后随访3个月的再住院率。结果 治疗8周后,联合组患者的治疗总有效率为92.59%,明显高于对照组的70.37%,差异有统计学意义(P<0.05);治疗8周后,联合组患者的LVEF、RNN50、SDNN分别为(61.11±5.03)%、(12.01±2.24)%、(112.20±12.23) ms,明显高于对照组的(58.85±4.72)%、(10.31±1.89)%、(103.34±10.18) ms,而LVESD、LVEDD分别为(40.37±4.12) mm、(47.71±4.55) mm,明显低于对照组的(45.17±4.38) mm、(50.52±4.67) mm,差异均有统计学意义(P<0.05);治疗8周后,联合组患者的血清IL-1β、IL-8、ET-1水平分别为(9.94±1.25) ng/L、(53.53±5.04) ng/L、(82.26±7.05) ng/L,明显低于对照组的(15.76±2.21) ng/L、(76.67±7.11) ng/L、(88.18±8.24) ng/L,血清NO水平为(89.65±7.53)μmol/L,明显高于对照组的(70.52±6.61)μmol/L,差异均有统计学意义(P<0.05);治疗期间,联合组患者的并发症总发生率为12.96%,略高于对照组的9.26%,但差异无统计学意义(P>0.05);治疗结束后随访3个月,联合组患者因心衰再住院率为3.70%,明显低于对照组的16.67%,差异有统计学意义(P<0.05)。结论 沙库巴曲缬沙坦钠联合常规对症治疗HFpEF可进一步改善患者的心功能、心率变异及血管内皮功能,减轻炎性状态,降低再住院率,其临床疗效确切且具有较高的安全性。
Objective To observe the clinical efficacy of sacubatrol valsartan sodium combined with conven-tional symptomatic treatment in patients with heart failure with preserved ejection fraction(HFpEF),and to investigate its effects on cardiac function,heart rate variability,inflammatory factors,vascular endothelial function,and re-hospital-ization rate.Methods A total of 108 patients with HFpEF treated in Xuchang Hospital from January 2021 to December 2022 were selected as research objects.They were divided into a combination group and a control group by random num-ber table method,with 54 patients in each group.The patients in the control group received conventional diuretic drugs,β-blockers,angiotensin-converting enzyme inhibitors and other symptomatic supportive treatment.The patients in the combination group were treated with sacubatrol valsartan sodium on the basis of the control group.After 8 weeks of treatment,the clinical efficacy was compared between the two groups,as well as cardiac function indexes[left ventricu-lar ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD)],heart rate variability indexes[standard deviation of RR interval with 24 h(SDNN),percentage of 24 h adja-cent normal R-R interval difference>50 ms(RNN50)],inflammatory factors[serum interleukin(IL)-1β,IL-8],vascular endothelial function[nitric oxide(NO),endothelin-1(ET-1)]before and after treatment.At the same time,the incidence of adverse reactions during treatment and the rehospitalization rate after 3 months of treatment were compared between the two groups.Results After 8 weeks of treatment,the total effective rate in the combination group was 92.59%,which was significantly higher than 70.37%in the control group(P<0.05).After 8 weeks of treatment,the LVEF,RNN50,and SDNN in the combination group were(61.11±5.03)%,(12.01±2.24)%,and(112.20±12.23)ms,respectively,which were significantly higher than(58.85±4.72)%,(10.31±1.89)%,(103.34±10.18)ms in the control group,while the LVESD and LVEDD in the combination group were(40.37±4.12)mm and(47.71±4.55)mm,respectively,significantly lower than(45.17±4.38)mm and(50.52±4.67)mm in the control group(P<0.05).After 8 weeks of treatment,the serum levels of IL-1β,IL-8,and ET-1 in the combination group were(9.94±1.25)ng/L,(53.53±5.04)ng/L,and(82.26±7.05)ng/L,respectively,which were significantly lower than(15.76±2.21)ng/L,(76.67±7.11)ng/L,(88.18±8.24)ng/L in the control group,while the se-rum NO level was(89.65±7.53)μmol/L,significantly higher than(70.52±6.61)μmol/L in the control group(P<0.05).Dur-ing the treatment period,the overall complication rate in the combination group was 12.96%,which was slightly higher than 9.26%in the control group,but the difference was not statistically significant(P>0.05).After 3 months of follow-up,the rehospitalization rate in the combination group was 3.70%,which was significantly lower than 16.67%in the control group(P<0.05).Conclusion Sacubactril valsartan sodium combined with conventional symptomatic treatment in HF-pEF can further improve patients'heart function,heart rate variability,and vascular endothelial function,alleviate inflam-matory state,reduce the rehospitalization rate,with definite clinical efficacy and high safety.
作者
张小丹
张巧玲
朱志勇
闫菲
ZHANG Xiao-dan;ZHANG Qiao-ling;ZHU Zhi-yong;YAN Fei(Department of Cardiology,Xuchang Hospital,Xuchang 461000,Henan,CHINA;Department of Coronary Heart Disease Intensive Care Unit,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451460,Henan,CHINA;The Second Department of Cardiology,General Hospital of Pingmei Shenma Medical Group,Pindingshan 467002,Henan,CHINA;Department of Coronary Heart and Pulmonary Function,Fuwai Central China Cardiovascular Hospital,Zhengzhou 451460,Henan,CHINA)
出处
《海南医学》
2024年第2期174-178,共5页
Hainan Medical Journal
基金
2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20200089)。
关键词
射血分数保留心力衰竭
沙库巴曲缬沙坦钠
心功能
心率变异
疗效
安全性
Heart failure with preserved ejection fraction
Sacubactril valsartan sodium
Heart function
Heart rate variation
Curative effect
Safety
