作者：许丁，赵慧慧，周淑文，李洋

单位：

101200北京市平谷区医院心血管内科 通信作者：许丁，E-mail：xuding010@163.com

Units：

Department of Cardiovascular Medicine, Pinggu District Hospital, Beijing, Beijing 101200, China Corresponding author: XU Ding, E-mail: xuding010@163.com

关键词：

心力衰竭; 射血分数降低的心力衰竭; 沙库巴曲缬沙坦; 缬沙坦; 治疗结果; 肿瘤坏死因子α; 半乳糖凝集素3; 基质金属蛋白酶9;

Keywords：

Heart failure; Heart failure with reduced ejection fraction; Sacubitril/valsartan; Valsartan; Treatment outcome; Tumor necrosis factor-alpha; Galectin-3; Matrix metalloproteinase-9

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.188

Funds：

首都卫生发展科研专项基金（首发2019-4025-03）

摘要：

目的 比较沙库巴曲缬沙坦与缬沙坦治疗射血分数降低的心力衰竭（HFrEF）的临床疗效及其对血清肿瘤坏死因子α(TNF-α)、半乳糖凝集素3(Gal-3)、基质金属蛋白酶9(MMP-9)水平的影响。方法 选取北京市平谷区医院2018年4月至2019年4月收治的200例HFrEF患者，采用随机数字表法将患者分为观察组（n=100）和对照组（n=100）。在常规治疗基础上，对照组给予缬沙坦治疗，观察组给予沙库巴曲缬沙坦治疗，两组均连续治疗6个月。比较两组临床疗效，治疗前后心功能指标[心率、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）]、心室重构指标[左心室后壁厚度（LVPWT）、室间隔厚度（IVST）、左心室心肌质量指数（LVMI）]及血清TNF-α、Gal-3、MMP-9水平；记录两组患者治疗期间不良反应发生情况。结果 观察组临床疗效优于对照组（P<0.05）。治疗后，两组心率分别低于本组治疗前，LVEDD分别小于本组治疗前，LVEF分别低于本组治疗前（P<0.05）。治疗后，观察组心率低于对照组，LVEDD小于对照组，LVEF高于对照组（P<0.05）。治疗后，两组LVPWT、IVST分别小于本组治疗前，LVMI分别低于本组治疗前（P<0.05）；治疗后，观察组LVPWT、IVST小于对照组，LVMI低于对照组（P<0.05）。治疗后，两组血清TNF-α、Gal-3、MMP-9水平分别低于本组治疗前，且观察组低于对照组（P<0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论 与缬沙坦相比，沙库巴曲缬沙坦治疗HFrEF的临床疗效更好，能进一步改善患者心功能、减轻心室重构，其作用机制可能与抑制血清TNF-α、Gal-3、MMP-9表达有关。

Abstract：

【Abstract】　Objective To compare the clinical efficacy of sacubitril/valsartan and valsartan in the treatment of heart failure with reduced ejection fraction (HFrEF) and their effect on serum levels of tumor necrosis factor-alpha (TNF- α) , Galectin-3 (Gal-3) , matrix metalloproteinase-9 (MMP-9) . Methods A total of 200 patients with HFrEF treated in Pinggu District Hospital, Beijing from April 2018 to April 2019 were selected and randomly divided into observation group ( n=100) and control group (n=100) . On the basis of routine treatment, the control group was treated with valsartan, and the observation group was treated with sacubitril/valsartan. Both groups were continuously treated for 6 months. The clinical effect, cardiac function indexes [heart rate, left ventricular end diastolic diameter (LVEDD) , left ventricular ejection fraction (LVEF) ] , ventricular remodeling indexes [left ventricular posterior wall thickness (LVPWT) , interventricular septal thickness (IVST) , left ventricular mass index (LVMI) ] and serum levels of TNF-α, Gal-3 and MMP-9 before and after treatment were compared between the two groups; the adverse reactions of the two groups during treatment were recorded. Results The clinical effect of the observation group was better than that of the control group (P < 0.05) . After treatment, the heart rate of the two groups was lower than that before treatment, LVEDD was smaller than that before treatment, and LVEF was lower than that before treatment, respectively (P < 0.05) . After treatment, the heart rate of the observation group was lower than that of the control group, LVEDD was smaller than that of the control group, and LVEF was higher than that of the control group (P < 0.05) . After treatment, LVPWT and IVST of the two groups were smaller than those before treatment, and LVMI was lower than that before treatment, respectively (P < 0.05) ; after treatment, LVPWT and IVST in the observation group were smaller than those in the control group, and LVMI was lower than that in the control group (P < 0.05) . After treatment, serum levels of TNF-α, Gal-3 and MMP-9 of the two groups were lower than those before treatment, respectively (P < 0.05) ; after treatment, serum levels of TNF-α, Gal-3 and MMP-9 in the observation group were lower than those in the control group (P < 0.05) . There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05) . Conclusion Compared with valsartan, the clinical efficacy of sacubitril/valsartan in the treatment of HFrEF is better, which can further improve cardiac function and reduce ventricular remodeling. Its mechanism may be related to the inhibition of expression of serum TNF- α, Gal-3 and MMP-9.

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