沙库巴曲缬沙坦联合伊伐布雷定治疗老年左室射血分数降低型心力衰竭的疗效及对左心室重构的影响  

Clinical effect of sacubatrol valsartan combined with ivabradine in the treatment of elderly patients with chronic heart failure and the impact on cardiac remodeling

作　　者：刘静[1] 付红 晋辉[1] 王中明 曾辉[1] 韩风杰 杭晓阳 周庆庆 朱艳霞 郑海军 LIU Jing;FU Hong;JIN Hui;WANG Zhongming;ZENG Hui;HAN Fengjie;HANG Xiaoyang;ZHOU Qingqing;ZHU Yanxia;ZHENG Haijun(Department of Cardiology,Jiaozuo People's Hospital,Xinxiang Medical College,Jiaozuo 454002,China)

机构地区：[1]新乡医学院附属焦作市人民医院心内科,河南焦作454002

出　　处：《实用医学杂志》2023年第20期2651-2657,共7页The Journal of Practical Medicine

基　　金：焦作市二〇二一年科技计划项目(编号:2021109)。

摘　　要：目的探讨沙库巴曲缬沙坦联合伊伐布雷定治疗老年左心室射血分数降低型心力衰竭(HFrEF)的疗效及对左心室重构的影响,并筛选再发不良心脑血管事件的预测指标。方法144例HFrEF患者按照数字表法随机分成观察组(74例,完成72例)和对照组(74例,完成72例)。对照组给予伊伐布雷定治疗,观察组给予沙库巴曲缬沙坦联合伊伐布雷定治疗。治疗6个月后,比较两组患者的临床疗效、治疗前后的心排血指数(CI),左心室心肌质量指数(LVMI)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、肌钙蛋白T(cTnT)、血清转化生长因子-β1(TGF-β1)、氨基末端脑钠肽前体(NT-proBNP)、心肌能量代谢指标(MEE),以及药物不良反应发生率;随访治疗后12个月内两组患者再发不良心脑血管事件;应用受试者工作特征曲线(ROC)筛选再发不良心脑血管事件的预测指标。结果治疗6个月后,观察组患者的临床疗效优于对照组(Z=-5.352,P<0.001);观察组患者的治疗总有效率高于对照组(χ^(2)=4.765,P=0.029);两组患者CI、LVMI、TNF-α、IL-6、cTnT、TGF-β1、NT-proBNP及MEE均较治疗前明显改善,且观察组患者上述指标的改善更显著(均P<0.05);两组患者药物不良反应发生率比较(χ^(2)=0.085,P=0.771),差异无统计学意义。治疗前两组患者的CI、LVMI水平与NT-proBNP、MEE、TNF-α、IL-6、cTnT及TGF-β1水平呈极高度相关(均|r|>0.90,P<0.001)。NT-proBNP和cTnT预测效能均较大,且具有互补性。结论沙库巴曲缬沙坦联合伊伐布雷定能够改善HFrEF患者心功能,提高临床疗效,延缓和改善心室重构,其机制可能与其抑制炎症反应及心肌纤维化,降低神经内分泌因子水平,减轻心肌损伤,降低心肌能量代谢等作用有关,且安全性好。NT-proBNP和cTnT联合检测可作为再发不良心脑血管事件的预测指标。Objective To investigate the efficacy of sakubactril valsartan combined with ivabradine in the treatment of heart failure with reduced left ventricular ejection fraction(HFrEF)in elderly patients,as well as its effect on left ventricular remodeling,and identify the predictors of recurrent cardiac and cerebrovascular events.Methods A total of 144 HFrEF patients were randomly divided into observation group(n=74,completed by 72 cases)and control group(n=74,completed by 72 cases)using a random number table.The control group and the observation group were treated with ivabradine and sacubactril valsartan combined with ivabradine,respectively.After 6 months of treatment,the two groups were compared in terms of the clinical efficacy and cardiac output index(CI),left ventricular myocardial mass index(LVMI),tumor necrosis factorα(TNF-α),interleukin6(IL-6)and troponin T(cTnT),serum transforming growth factor-β1(TGF-β1),serum amino terminal brain natriuretic peptide precursor(NT-proBNP),myocardial energy metabolism(MEE)and incidence of adverse reactions before and after treatment.Recurrent adverse cardiac and cerebrovascular events were assessed in both groups within 12 months of follow-up and a receiver operating characteristic curve(ROC)was used to select predictors of recurrent adverse cardiac and cerebrovascular events.Results After 6 months of treatment,the clinical efficacy of the observation group was better than that of control group(Z=-5.352,P<0.001);The total effective rate of the observation group was higher than that of control group(χ^(2)=4.765,P=0.029).CI,LVMI,TNF-α,IL-6,cTnT,TGF-β1,NT-proBNP,and MEE in both groups were significantly improved after treatment,and the improvement in these indicators was more significant in the observation group(all P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups(χ^(2)=0.085,P=0.771).The levels of CI and LVMI were highly correlated with the levels of NT-proBNP,MEE,TNF-α,IL-6,cTnT and TGF-β1 in the two groups

关 键 词：慢性心力衰竭 左心室射血分数降低型 沙库巴曲缬沙坦 伊伐布雷定 左心室重构 

分 类 号：R541.61[医药卫生—心血管疾病]