心脑血管病防治2025，Vol.25Issue(6)：30-35,6.DOI:10.3969/j.issn.1009-816x.2025.06.007
沙库巴曲缬沙坦对老年充血性心力衰竭合并快速心房颤动患者心肌能量代谢及对Toll样受体4 mRNA和核因子κB mRNA的影响
Impact of sacubitril/valsartan on myocardial energy metabolism and Toll-like receptor 4/nuclear factor kappa B mRNA expression in elderly patients with congestive heart failure complicated by rapid atrial fibrillation
摘要
Abstract
Objective To investigate the effects of sacubitril/valsartan on myocardial energy metabolism and the expression of Toll-like receptor 4(TLR4)and nuclear factor kappa B(NF-κB)mRNA in elderly patients with congestive heart failure(CHF)complicated by rapid atrial fibrillation(AF).Methods A total of 150 elderly patients with CHF admitted to Xingtai Central Hospital from August 2022 to January 2024 were selected and randomly divided into a control group and an observation group.Patients who did not meet the inclusion and exclusion criteria were excluded.Eventually,145 patients were included,including 71 in the control group and 74 in the observation group.The control group received conventional treatment,while the observation group was treated with additional sacubitril/valsartan.The following parameters were compared between the two groups:clinical efficacy,cardiac function parameters[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)],myocardial injury markers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)],heart rate variability(HRV)indexes[standard deviation of NN intervals(SDNN),standard deviation of average NN intervals(SDANN),percentage of successive NN intervals differing by more than 50 ms(pNN50),and root mean square of successive differences(RMSSD)],myocardial energy metabolism markers[phosphocreatine to adenosine triphosphate(PCr/ATP)ratio,inorganic phosphate to phosphocreatine(Pi/PCr)ratio,and Pi/ATP ratio],mRNA expression levels of TLR4 and NF-κB,and adverse events.Results The total effective rate in the observation group was significantly higher than that in the control group(x2=7.097,P<0.01).After treatment,the observation group showed significant reduction in LVEDD and LVESD,and increase in LVEF(t=3.070,3.903,5.831;P<0.05).Compared to the control group,CK-MB,cTnI,NT-proBNP in the observation group were significantly lower(t=2.475,4.005,16.011;P<0.05),while SDNN,SDANN,PNN50,RMSSD were higher(t=14.236,6.835,8.243,3.292;P<0.05).Compared to the control group,Pi/PCr and Pi/ATP were lower in the observation group,while PCr/ATP were higher(t=2.601,5.015,3.593;P<0.05).The mRNA expressions of TLR4 and NF-κB in the observation group were lower than the control group(t=15.267,10.855;P<0.05).No statistically significant difference in adverse events was observed between the two groups(x2=0.445,P>0.05).Conclusion Sacubitril/valsartan improves cardiac function and myocardial energy metabolism in elderly patients with CHF and rapid AF,while inhibiting TLR4 and NF-κB expressions,demonstrating a favorable safety profile.关键词
血管紧张素受体脑啡肽酶抑制剂/充血性心力衰竭/心房颤动/心肌能量代谢/Toll样受体4/核因子κBKey words
Angiotensin receptor-neprilysin inhibitor/Congestive heart failure/Atrial fibrillation/Myocardial energy metabolism/Toll-like receptor 4/Nuclear factor kappa B引用本文复制引用
王姣,崔江漫,申恂,李欣,周松..沙库巴曲缬沙坦对老年充血性心力衰竭合并快速心房颤动患者心肌能量代谢及对Toll样受体4 mRNA和核因子κB mRNA的影响[J].心脑血管病防治,2025,25(6):30-35,6.基金项目
邢台市重点研发计划项目(2020ZC178) （2020ZC178）
