摘要
目的探究恩格列净在射血分数轻度降低的心力衰竭(HFmrEF)中的应用效果。方法选取2022年1~6月信阳市中心医院收治的102例HFmrEF患者纳入研究,按随机数表法分为对照组和观察组各51例。对照组患者采取常规抗心衰治疗,观察组在对照组治疗的基础上加用恩格列净治疗,连续治疗3个月。疗程结束后评价两组患者的疗效,以及治疗前后的免疫炎症[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、长正五聚蛋白3(PTX-3)]、氧化应激[总抗氧化能力(TAC)、超氧化物歧化酶(SOD)、脂质过氧化物(LPO)、丙二醛(MDA)]、心肌微循环(甲襞微循环加权积分评价)和NLRP3-ASC-Caspase-1信号通路[核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、凋亡相关斑点样蛋白(ASC)、半胱氨酸蛋白酶-1(Caspase-1)]的变化;随访12个月,比较两组患者的随访结果。结果治疗后,观察组患者的心功能、6 min步行试验的总有效率分别为94.12%、92.16%,明显高于对照组的74.51%、76.47%,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清IL-6、TNF-α、PTX-3水平分别为(6.17±1.20)ng/L、(232.15±18.24)ng/L、(3.00±0.41)μg/L,明显低于对照组的(9.85±1.47)ng/L、(296.32±22.36)ng/L、(3.67±0.52)μg/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清TAC、SOD水平分别为(16.12±1.85)IU/L、(95.64±9.32)IU/L,明显高于对照组的(11.45±1.67)IU/L、(82.24±11.18)IU/L,血清LPO、MDA水平分别为(3.24±0.64)μmol/L、(3.15±0.52)μmol/L,明显低于对照组的(5.11±0.79)μmol/L、(4.85±0.63)μmol/L,差异均有统计学意义(P<0.05);治疗后,观察组患者的甲襞微循环加权积分中管襻形态、管襻状态、血液流态评分分别为(0.62±0.18)分、(0.32±0.10)分、(1.24±0.25)分,明显低于对照组的组(1.03±0.20)分、(0.56±0.14)分、(1.65±0.32)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的单核细胞中NLRP3、Caspase-1、ASC、IL-1β表达量分别为0.49±0.11、0.52±0.12、0.41±0.10、48.62±5.34,明显低于对照组的0.78±0.21、0.86±0.23、0.72±0.15、55.54±6.28,差异均有统计学意义(P<0.05);随访12个月,观察组患者的主要不良终点事件风险降低40%(HR=0.596,95%CI:0.368~0.986),其中心衰再住院风险(HR=0.548,95%CI:0.305~0.974)明显低于对照组,差异有统计学意义(P<0.05)。结论恩格列净辅助治疗HFmrEF患者有助于提高治疗效果,延缓病情进展,降低主要不良终点事件风险,对炎症免疫、氧化应激及NLRP3/ASC/Caspase-1信号通路产生调控作用。
Objective To observe the effect of englaglizin in patients with heart failure with slightly reduced ejection fraction(HFmrEF).Methods A total of 102 patients with HFmrEF admitted to Xinyang Central Hospital from January to June 2022 were selected for the study.They were randomly divided into a control group and an observation group,with 51 cases in each group,using a random number table method.The control group received conventional anti-heart failure treatment,and the observation group was treated with englaglizin on the basis of the treatment in the control group,continuously for 3 months.Therapeutic effect was evaluated after treatment,and immune inflammation[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),long n-pentamerin 3(PTX-3)],oxidative stress[total antioxidant capacity(TAC),superoxide dismutase(SOD),lipid peroxides(LPO),malondialdehyde(MDA)],myocardial microcirculation(nail-fold microcirculation weighted integral evaluation),NLRP3-ASc-Caspase-1 signaling pathway[nucleotide-binding oligomerized domain-like receptor protein 3(NLRP3),apoptosis-associated speck-like protein(ASC),Cysteine proteinase-1(Caspase-1)]before and after treatment were compared.The patients were followed up for 12 months,and the follow-up results of two groups were compared.Results The curative effect of cardiac function,6-min walking test in the observation group was 94.12%and 92.16%,significantly higher than 74.51%and 76.47%in the control group(P<0.05).Serum IL-6,TNF-α,and PTX-3 levels in the observation group were(6.17±1.20)ng/L,(232.15±18.24)ng/L,(3.00±0.41)μg/L,significantly lower than(9.85±1.47)ng/L,(296.32±22.36)ng/L,and(3.67±0.52)μg/L in the control group after treatment(P<0.05);the levels of TAC and SOD in the observation group were(16.12±1.85)IU/L and(95.64±9.32)IU/L,significantly higher than(11.45±1.67)IU/L and(82.24±11.18)IU/L in the control group;the levels of LPO,MDA were(3.24±0.64)μmol/L and(3.15±0.52)μmol/L,significantly lower than(5.11±0.79)μmol/L,(4.85±0.63)μmol/L of the control group;the differences were statistically significant(P<0.05).After treatment,the weighted integral of the nailfold microcirculation of tubular loop morphology,tubular loop status,and blood flow state were(0.62±0.18)points,(0.32±0.10)points,and(1.24±0.25)points in the observation group,significantly lower than(1.03±0.20)points,(0.56±0.14)points,and(1.65±0.32)points in the control group(P<0.05).NLRP3,Caspase-1,ASC,IL-1βexpression in the mononuclear cells of the observation group after treatment were 0.49±0.11,0.52±0.12,0.41±0.10,48.62±5.34,significantly lower than 0.78±0.21,0.86±0.23,0.72±0.15,55.54±6.28 in the control group(P<0.05).After 12 months of follow-up,the risk of major adverse endpoint events in the observation group was reduced by 40%(HR=0.596,95%CI:0.368-0.986,P=0.042),and the risk of re-hospitalization for heart failure was significantly lower than that in the control group(HR=0.548,95%CI:0.305-0.974,P=0.045).Conclusion The adjuvant treatment with englaglitzin in HFmrEF patients can enhance the therapeutic effect,delay the disease progression,reduce the risk of major adverse endpoint events,and regulate inflammation and immunity,oxidative stress and NLRP3/ASC/Caspase-1 signaling pathway.
作者
杨贵宝
张艳
王一凡
李玉杰
YANG Gui-bao;ZHANG Yan;WANG Yi-fan;LI Yu-jie(Coronary Heart Disease Intensive Care Unit,Xinyang Central Hospital,Xinyang 464099,Henan,CHINA)
出处
《海南医学》
CAS
2024年第6期767-771,共5页
Hainan Medical Journal
基金
2020年度河南省医学科技攻关计划联合共建立项项目(编号:LHGJ20201140)。
关键词
心力衰竭
射血分数轻度降低
恩格列净
免疫炎症
疗效
氧化应激
Heart failure
Slightly reduced ejection fraction
Englizin
Immune inflammation
Curative effect
Heart failure
