不同方案治疗伴顽固性低钠血症AMI后急性心衰临床价值  

Clinical Value of Different Treatment Regimens for Acute Heart Failure After Acute Myocardial Infarction with Refractory Hyponatremia

作　　者：王杰[1] 朱晓晴 徐吉荣 王学斌 WANG Jie;ZHU Xiaoqing;XU Jirong(Suzhou Hospital,Nanjing University School of Medicine,Jiangsu Suzhou 215153,China)

机构地区：[1]南京大学医学院附属苏州医院心血管内科,江苏苏州215153

出　　处：《河北医学》2025年第3期450-457,共8页Hebei Medicine

基　　金：苏州高新区医疗卫生科技计划项目,(编号:2019Z007);江苏省优势学科建设工程项目,(编号:YSHL2101-1021)。

摘　　要：目的:探讨不同方案治疗伴顽固性低钠血症急性心肌梗死(AMI)后急性心衰的临床疗效。方法:选取2021年9月至2024年6月期间,收治的AMI后并发急性心力衰竭和顽固性低钠血症患者102例为研究对象,随机数字表法分为两组,各51例。两组均予以常规治疗,在此基础上,对照组予以托伐普坦片治疗,观察组予以沙库巴曲缬沙坦钠片(ARNI)+托伐普坦片治疗,两组均持续治疗2周。比较两组治疗前、治疗1周、治疗2周后心功能[左室射血分数(LVEF)、左室舒张末期内径(LVEDD)]、肾功能[尿量、血肌酐、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、血清炎症因子[白细胞介素-6(IL-6)、半乳糖凝集素-3(Gal-3)、肿瘤坏死因子-α(TNF-α)]、血清N末端脑钠肽前体(NT-proBNP)、可溶性生长刺激表达因子2(sST2)、心型脂肪酸结合蛋白(H-FABP),同时比较两组临床疗效以及治疗期间的不良反应(胃肠道不适、低血压、头痛等)发生率。结果:观察组总有效率(96.08%)高于对照组(82.35%),差异有统计学意义(P<0.05);治疗1周后、2周后观察组LVEF高于对照组,LVEDD低于对照组,差异有统计学意义(均P<0.05);治疗1周后、2周后观察组尿量高于对照组,血肌酐、尿NGAL低于对照组,差异有统计学意义(均P<0.05);治疗1周后、2周后观察组IL-6、Gal-3、TNF-α均低于对照组,差异有统计学意义(均P<0.05);治疗1周后、2周后观察组NT-proBNP、sST2、H-FABP低于对照组,差异有统计学意义(均P<0.05);观察组不良反应总发生率(3.92%)与对照组(7.84%)比较差异无统计学意义(3.92%vs 7.84%)(P>0.05)。结论:ARNI联合托伐普坦治疗伴顽固性低钠血症AMI后急性心衰患者相较于单独使用托伐普坦,能显著提升临床疗效,有效改善患者心肾功能,显著降低血清炎症因子水平、NT-proBNP、sST2及H-FABP水平,且该联合治疗方案安全性良好。Objective:To investigate the clinical efficacy of different treatment regimens for acute heart failure(AHF)after acute myocardial infarction(AMI)with refractory hyponatremia.Methods:A total of 102 patients with AHF and refractory hyponatremia after AMI admitted between September 2021 and June 2024 were randomly divided into two groups,with 51 patients in each group.Both groups received conventional treatment.The control group was treated with tolvaptan,while the observation group received sacubitril/valsartan(ARNI)combined with tolvaptan.Treatment was continued for 2 weeks.Cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],renal function[urine volume,serum creatinine,urinary neutrophil gelatinase-associated lipocalin(NGAL)],serum inflammatory factors[interleukin-6(IL-6),galectin-3(Gal-3),tumor necrosis factor-α(TNF-α)],and serum biomarkers[N-terminal pro-brain natriuretic peptide(NT-proBNP),soluble growth stimulation expressed gene 2(sST2),heart-type fatty acid-binding protein(H-FABP)]were compared between the two groups before treatment,after 1 week,and after 2 weeks of treatment.Clinical efficacy and the incidence of adverse reactions(gastrointestinal discomfort,hypotension,headache,etc.)were also evaluated.Results:The total effective rate in the observation group(96.08%)was significantly higher than that in the control group(82.35%)(P<0.05).After 1 and 2 weeks of treatment,the observation group showed higher LVEF,lower LVEDD,increased urine volume,and reduced serum creatinine and urinary NGAL levels compared to the control group(all P<0.05).The levels of IL-6,Gal-3,TNF-α,NT-proBNP,sST2,and H-FABP in the observation group were significantly lower than those in the control group(all P<0.05).The total incidence of adverse reactions in the observation group(3.92%)was not significantly different from that in the control group(7.84%)(P>0.05).Conclusion:Compared with tolvaptan alone,the combination of ARNI and tolvaptan significantly improves clinical efficacy

关 键 词：顽固性低钠血症 急性心肌梗死 急性心衰 心功能 肾功能 沙库巴曲缬沙坦钠片 托伐普坦 

分 类 号：R54[医药卫生—心血管疾病]