Clinical effect of sacubitril valsartan on the cardiac function and myocardial fibrosis indexes of chronic heart failure patients with reduced ejection fraction in qinghai area
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摘要: 目的 比较沙库巴曲缬沙坦钠和盐酸贝那普利对青海地区射血分数降低的心力衰竭(HFrEF)患者心功能及心肌纤维化指标的临床效果。方法 收集2019年5月—2021年5月就诊于青海省人民医院的HFrEF患者78例，随机分为观察组(40例)和对照组(38例)。观察组在常规抗心力衰竭药物的基础上口服沙库巴曲缬沙坦钠片治疗；对照组在常规抗心力衰竭药物基础上口服盐酸贝那普利治疗，2组均连续治疗3个月。比较治疗前后2组患者可溶性生长刺激表达基因2蛋白(sST2)、基质金属蛋白酶组织抑制因子-1(TIMP-1)、基质金属蛋白酶-9(MMP-9)、B型钠尿肽(BNP)、左心室射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室舒张末期容积(LVEDV)、堪萨斯城心肌病问卷(KCCQ)评分、NYHA分级、体质指数(BMI)。结果 ① 观察组用药前后sST2、TIMP-1、BNP、LVEF、LAD、LVEDD、LVESD、LVEDV、KCCQ评分、BMI比较，差异有统计学意义(P< 0.05)；而MMP-9差异无统计学意义(P>0.05)；②对照组用药前后BNP、LVEF、LVEDD、LVEDV、KCCQ评分比较，差异有统计学意义(P< 0.05)，而sST2、TIMP-1、MMP-9、LAD、LVESD、BMI差异无统计学意义(P>0.05)；③两组治疗后sST2、TIMP-1、BNP、LVEF、LAD、LVEDD、LVESD、LVEDV、KCCQ评分、BMI比较，差异有统计学意义(P< 0.05)，其他指标差异无统计学意义。结论 沙库巴曲缬沙坦钠和盐酸贝那普利对于改善HFrEF患者心功能有较好效果，但沙库巴曲缬沙坦钠效果更佳。通过抑制心肌纤维化信号发挥逆转心肌重构的作用，沙库巴曲缬沙坦钠具有独特的优势。
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关键词:
- 射血分数降低的心力衰竭 /
- 沙库巴曲缬沙坦钠 /
- 心肌纤维化 /
- 心功能 /
- 青海地区
Abstract: Objective To observe the clinical effect of sacubitril valsartan and benazepril hydrochloride on cardiac function and myocardial fibrosis indexes of chronic heart failure patients with reduced ejection fraction(HFrEF)in highland area.Methods The patients who suffered from HFrEF were collected as research objects. Seventy-eight patients were obtained from the Department of Cardiology of Qinghai Provincial People's Hospital from May 2019 to May 2021. Patients were randomized to receive either sacubitril valsartan (case group,n=40) or benazepril hydrochloride (control group,n=38) based on conventional anti-heart failure drugs. Both groups were treated continuously for 3 months. Before treatment and after 3 months of treatment, we observed the following parameters: growth Stimulation expressed gene 2(sST2), tissue inhibitor of matrix metalloproteinase-1(TIMP-1), matrix metalloproteinases-9(MMP-9), brain natriuretic peptide(BNP), left ventricular ejection fraction(LVEF), left atrial dianeter(LAD)、left ventricular end-diastolic dimension(LVEDD), left ventricular end-systolic dimension(LVESD), left ventricular end-diastolic volume(LVEDV), KCCQ scores, NYHA grade and body mass index(BMI).Results (1) After treatment in the case group, sST2, TIMP-1, BNP, LVEF, LAD, LVEDD, LVESD, LVEDV, KCCQ score, and BMI were significantly improved (before treatment vs. after treatment, allP< 0.05). In contrast, MMP-9 was not significantly changed after treatment in the case group (before treatment vs. after treatment,P> 0.05). (2) After treatment in the control group, BNP, LVEF, LVEDD, LVEDV, and KCCQ score were significantly improved (before treatment vs. after treatment, all P < 0.05). Conversely, sST2, TIMP-1, MMP-9, LAD, LVESD, and BMI did not significantly change (before treatment vs. after treatment, allP> 0.05). (3) Comparison between the case group and the control group: After treatment, sST2, TIMP-1, BNP, LVEF, LAD, LVEDD, LVESD, LVEDV, KCCQ score, and BMI were significantly better in the case group than in the control group (all,P< 0.05). There was no statistical difference in other indicators.Conclusion Sacubitril valsartan and benazepril hydrochloride can significantly improve cardiac function of chronic heart failure patients with reduced ejection fraction in the highland area, but sacubitril valsartan is more effective. Sacubitril valsartan has unique advantages in reversing myocardial remodeling by inhibiting the myocardial fibrosis signal. -
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表 1 2组临床指标比较
Table 1. Comparison of clinical indicators between the two groups
X±S 指标 治疗前 治疗后 观察组 对照组 t P 观察组 对照组 t P sST2/(ng·mL-1) 12.34±16.87 11.92±7.32 -1.617 0.111 3.80±4.641) 9.97±3.21 6.763 < 0.001 TIMP-1/(ng·mL-1) 2.61±1.15 3.02±1.55 -1.304 0.198 1.73±1.741) 2.76±1.88 2.746 0.008 MMP-9/(ng·mL-1) 3.95±4.75 4.36±2.18 -0.214 0.831 3.71±3.78 4.11±2.54 0.543 0.589 BNP/(pg·mL-1) 835.90±728.25 859.34±788.82 1.846 0.069 320.23±154.101) 795.79±676.561) 4.408 < 0.001 LVEF/% 33.68±5.25 34.47±5.12 0.68 0.499 48.09±10.061) 39.55±68.001) 26.553 < 0.001 LAD/mm 41.83±6.43 42.66±6.49 0.569 0.571 40.15±6.271) 42.39±6.061) 1.251 0.008 LVEDD/mm 58.50±8.38 60.16±8.75 0.855 0.396 54.63±7.741) 58.26±8.92 2.996 0.033 LVESD/mm 46.98±8.50 48.58±9.72 0.784 0.436 41.63±8.351) 48.87±9.72 5.526 < 0.001 LVEDV/mL 177.10±61.69 190.32±64.90 0.922 0.359 149.70±50.311) 184.68±62.421) 3.543 0.016 KCCQ评分/分 39.50±11.82 42.79±14.72 1.09 0.279 68.69±11.181) 48.51±13.841) -7.101 < 0.001 BMI/(kg·m-2) 25.19±2.65 24.75±3.85 0.664 0.509 22.83±1.251) 24.54±3.37 4.933 0.003 与同组治疗前比较，1)P < 0.05。 
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表 2 2组患者NYHA分级疗效比较
Table 2. Comparison of NYHA grading efficacy between the two groups
例(%) 组别 显效 有效 无效 总有效率 χ2 P 观察组(40例) 25(62.5) 14(35.0) 1(2.5) 39(97.52) 128.89 < 0.001 对照组(38例) 13(34.2) 15(42.8) 10(23.0) 28(73.68)
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