沙库巴曲缬沙坦治疗射血分数保留型心力衰竭临床观察OACSTPCD
Clinical Observation of Sacubitril and Valsartan in the Treatment of Heart Failure with Preserved Ejection Fraction
目的 探讨沙库巴曲缬沙坦对射血分数保留型心力衰竭(HFpEF)患者动态心电图指标和血清血管紧张素Ⅱ(AngⅡ)、半乳糖凝集素-3(Gal-3)蛋白表达水平的影响.方法 选取安徽省合肥市第八人民医院 2020年 2月至 2023年 2月收治的HFpEF患者 110例,随机分为观察组和对照组,各 55 例.观察组患者口服沙库巴曲缬沙坦,对照组患者口服培哚普利,两组均治疗 6 个月.结果 观察组总有效率为 92.73%,显著高于对照组的 72.73%(P<0.05).治疗后,两组患者的明尼苏达心力衰竭生活质量评估量表(MLHFQ)评分、左室舒张末期内径、左室收缩末期内径及血清AngⅡ和Gal-3 蛋白表达水平均显著降低(P<0.05),且观察组均显著低于对照组(P<0.05);两组患者的 6 分钟步行试验距离均显著延长(P<0.05),且观察组显著长于对照组(P<0.05);两组患者的左室射血分数、二尖瓣前向血流舒张早期峰值流速(E峰)与晚期峰值流速(A峰)的比值及 24h每 5 min正常R-R间期平均值的标准差(SDANN)、正常窦率R-R间期标准差(SDNN)、相邻R-R间期差值大于 50 ms者占分析总心搏数量的百分比(PNN50)均显著高于治疗前(P<0.05),且观察组均显著高于对照组(P<0.05).结论 沙库巴曲缬沙坦治疗HFpEF的临床疗效良好,可改善患者的心功能,提高运动耐力,其机制可能为通过降低血清Ang-Ⅱ和Gal-3 的蛋白表达水平,减少心脏间质纤维化形成,从而逆转心肌重构.
Objective To investigate the effect of sacubitril and valsartan on holter electrocardiogram indicators and expression levels of serum angiotensin Ⅱ(Ang Ⅱ)and galactin-3(Gal-3)proteins in patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 110 patients with HFpEF admitted to the Eighth People's Hospital of Hefei from February 2020 to February 2023 were selected and randomly divided into the observation group and the control group,with 55 cases in each group.The patients in the observation group took sacubitril and valsartan orally,while the patients in the control group took perindopril.Both groups were treated for 6 months.Results The total effective rate in the observation group was 92.73%,which was significantly higher than 72.73% in the control group(P<0.05).After treatment,the Minnesota Heart failure Quality of Life Questionnaire(MLHFQ)score,left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),and the expression levels of serum Ang Ⅱ and Gal-3 protein in the two groups significantly decreased(P<0.05),and those in the observation group were significantly lower than those in the control group(P<0.05).The 6-minute walking test(6MWT)distance in the two groups significantly prolonged(P<0.05),and that in the observation group was significantly longer than that in the control group(P<0.05).The left ventricular ejection fraction(LVEF),the ratio of peak early mitral velocity to peak late mitral velocity(E/A)of anterior mitral valve diastolic blood flow,and the mean standard deviation of R-R interval per 5 min segment within 24 h(SDANN),the standard deviation of all normal to normal R-R intervals(SDNN),and the composition ratio of R-R interval difference between adjacent normal cardiac cycles≥50 ms(PNN50)were significantly higher than those before treatment(P<0.05),and those in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Sacubitril and valsartan has good clinical efficacy in the treatment of patients with HFpEF,which can improve the heart function and exercise endurance of patients.The mechanism may be through reducing the expression levels of serum Ang Ⅱ and Gal-3 proteins,and the formation of interstitial fibrosis in the heart,so as to reverse myocardial remodeling.
苏陶涛;孙震;汪春妹;袁昌梅;蔡宏亮
安徽省合肥市第八人民医院,安徽 合肥 230011安徽医科大学第一临床医学院,安徽 合肥 230032
药学
沙库巴曲缬沙坦射血分数保留型心力衰竭血管紧张素Ⅱ半乳糖凝集素-3
sacubitril and valsartanheart failure with preserved ejection fractionangiotensin Ⅱgalactose lectin-3
《中国药业》 2024 (013)
103-107 / 5
安徽省教育厅高校优秀拔尖人才培育资助项目[gxbjZD2020061].
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