沙库巴曲缬沙坦钠对高原高血压合并肺动脉高压患者疗效及对心肌重构的影响  

Curative effect of sacubitril⁃valsartan on high⁃altitude hypertension combined with pulmonary hypertension and its impact on myocardial remodeling

作　　者：张志敏 买尔哈巴 李梦琦 魏星 路军 周圣华[1] 黄建波 李慧杰[1] 李喆 Zhang Zhimin;Maierhaba;Li Mengqi;Wei Xing;Lu Jun;Zhou Shenghua;Huang Jianbo;Li Huijie;Li Zhe(Department of Cardiovascular Medicine,Xinjiang Military Region General Hospital,Urumqi 830000,China)

机构地区：[1]新疆军区总医院心血管内科,新疆乌鲁木齐830000 [2]海军军医大学海军特色医学中心保健科

出　　处：《海军医学杂志》2023年第10期1033-1037,共5页Journal of Navy Medicine

基　　金：新疆维吾尔自治区自然科学基金(2020D01A138)。

摘　　要：目的观察沙库巴曲缬沙坦钠对高原高血压合并肺动脉高压患者的疗效,以及其对心肌结构及功能的改善作用,探讨其作用的分子机制。方法收集进驻海拔5100 m高原24周以上的32例高血压合并肺动脉高压患者,将其随机分为沙库巴曲缬沙坦钠组和缬沙坦组,每组16例。比较2组患者血压、肺动脉压水平、脉搏波传导速度(PWV)、心脏结构及功能指标、N-末端B型利钠肽原(NT-proBNP)、一氧化氮(NO)、内皮缩血管肽(ET-1)、可溶性生长刺激表达基因2蛋白(sST2)及葡萄糖结合蛋白78(GRP78)表达水平的变化。结果与缬沙坦组相比,沙库巴曲缬沙坦钠组患者治疗后收缩压、肺动脉压及PWV降低更为明显(P<0.01)。沙库巴曲缬沙坦钠组心脏结构及功能指标右心室内径(RVD)、右心室流出道内径(RVOT)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、二尖瓣舒张早期最大速度/心房收缩期最大速度(E/A)较缬沙坦组改善更为明显(P<0.01)。与缬沙坦组相比,沙库巴曲缬沙坦钠组NT-proBNP及ET-1表达水平降低更为明显(P<0.01)。与缬沙坦组相比,沙库巴曲缬沙坦钠组sST2及GRP78表达水平降低更为明显(P<0.01)。结论沙库巴曲缬沙坦钠可明显降低高原高血压合并肺动脉高压患者血压及肺动脉压力,改善患者的心肌重构。内质网应激可能是其作用的分子机制之一。Objective To evaluate the therapeutic effect of sacubitril‑valsartan on high‑altitude hypertension combined with pulmonary hypertension,as well as the improvement of myocardial structure and function and possible molecular mechanism.Methods A total of 32 patients with hypertension and pulmonary hypertension who had stationed in the plateau region with an altitude of 5100 m for more than 24 weeks were enrolled in this study.They were randomly divided into sacubitril‑valsartan group and valsartan group(n=16).The blood pressure,pulmonary arterial pressure,pulse wave velocity(PWV),cardiac structural and functional indicators,and the expression of N‑terminal pro brain natriuretic peptide(NT‑proBNP),nitric oxide(NO),endotheliumderived vasoconstrictor peptide(ET‑1),soluble growth stimulation expressed gene 2 protein(sST2),and glucose‑binding protein 78(GRP78)were compared between the two groups.Results The patients in the sacubitril‑valsartan group had significantly lower systolic blood pressure,pulmonary arterial pressure and PWV than those in the valsartan group.The cardiac structural and functional indicators,such as right ventricular diameter(RVD),right ventricular outflow tract(RVOT),inlet ventricular septal defect(IVST),left ventricular posterior wall thickness(LVPWT)and E/A in the sacubitril‑valsartan group were significantly improved as compared with those in the valsartan group(P<0.01).The levels of NT‑proBNP,ET‑1,sST2,and GRP78 in the sacubitril‑valsartan group were significantly lower than those in the valsartan group(P<0.01).Conclusion Sacubitril‑valsartan can significantly reduce blood pressure and pulmonary arterial pressure,and improve myocardial remodeling in patients with high‑altitude hypertension combined with pulmonary hypertension.Endoplasmic reticulum stress may be one of the molecular mechanisms.

关 键 词：沙库巴曲缬沙坦钠 高原高血压 肺动脉高压 心肌重构 内质网应激 

分 类 号：R544.1[医药卫生—心血管疾病]