作者：赵东坡，冯倩，师淼，吴泽阳，刘学英，孙小燕

单位：

075000河北省张家口市第一医院心内科

Units：

Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou 075000, China

关键词：

心房颤动；心力衰竭；沙库巴曲缬沙坦；维生素D；治疗结果

Keywords：

Atrial fibrillation; Heart failure; Sacubitril/valsartan; Vitamin D; Treatment outcome

CLC：

R 541.75 R 541.62

DOI：

10.12114/j.issn.1008-5971.2023.00.309

Funds：

河北省医学科学研究课题计划项目（20211610）

摘要：

目的　分析沙库巴曲缬沙坦联合维生素D在心房颤动合并射血分数保留的心力衰竭（HFpEF）患者 中的应用效果。方法　选取2019年2月至2022年2月张家口市第一医院收治的心房颤动合并HFpEF患者100例为研究对 象。采用随机数字表法将患者分为联合组和单药组，各50例。单药组患者在常规治疗的基础上口服沙库巴曲缬沙坦 片，联合组患者在单药组的基础上口服骨化三醇软胶囊，两组均连续治疗12周。比较两组临床疗效，治疗前后NYHA 分级、炎症指标（CRP、TNF-α、IL-18）及血清同型半胱氨酸（Hcy）、胱抑素C（Cys-C）水平，治疗期间不良反 应、心血管不良事件发生率。结果　联合组治疗总有效率高于单药组（P＜0.05）。治疗后，联合组NYHA分级优于单 药组（P＜0.05）。治疗后，联合组CRP、TNF-α、IL-18水平低于单药组（P＜0.05）；两组治疗后CRP、TNF-α、 IL-18水平分别低于本组治疗前（P＜0.05）。治疗后，联合组血清Hcy、Cys-C水平低于单药组（P＜0.05）；两组治 疗后血清Hcy、Cys-C水平分别低于本组治疗前（P＜0.05）。两组治疗期间不良反应发生率比较，差异无统计学意义 （P＞0.05）。联合组治疗期间心血管不良事件发生率低于单药组（P＜0.05）。结论　沙库巴曲缬沙坦联合维生素D可 有效提高心房颤动合并HFpEF患者的临床疗效，改善其心功能，减轻炎症反应及病情，且具有较高的安全性。

Abstract：

Objective To analyze the application effect of sacubitril/valsartan combined with vitamin D in the treatment of patients with atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) . Methods A total of 100 patients with atrial fibrillation and HFpEF treated in Zhangjiakou First Hospital from February 2019 to February 2022 were selected as the study objects. The patients were divided into combined group and single drug group using random number table method, with 50 patients in each group. Patients in the single drug group were given orally sacubitril/valsartan tablet on the basis of conventional treatment, and patients in the combined group were given orally calcitriol softgel capsules on the basis of sacubitril/valsartan group. Both groups were treated continuously for 12 weeks. The clinical efficacy, NYHA classification, inflammatory indicators (CRP, TNF-α, IL-18) and serum homocysteine (Hcy) and cystatin C (Cys-C) levels before and after treatment, the incidence of adverse reactions and cardiovascular adverse events during treatment were compared between the two groups. Results The total effective rate of combined group was higher than that of single drug group (P < 0.05) . After treatment, the NYHA classification of the combined group was better than that of the single drug group (P < 0.05) . After treatment, the levels of CRP, TNF-α and IL-18 in combined group were lower than those in single drug group (P < 0.05) . The levels of CRP, TNF-α and IL-18 in the two groups after treatment were lower than those before treatment, respectively (P < 0.05) . After treatment, the serum levels of Hcy and Cys-C in combined group were lower than those in single drug group (P < 0.05) . Serum Hcy and Cys-C levels in the two groups after treatment were lower than those before treatment, respectively (P < 0.05) . There was no significant difference in the incidence of adverse reactions during treatment between the two groups (P > 0.05) . The incidence of adverse cardiovascular events during treatment in the combined group was lower than that in the single drug group ( P < 0.05) . Conclusion Sacubitril/valsartan combined with vitamin D can effectively improve the clinical efficacy of patients with atrial fibrillation and HFpEF, improve their heart function, reduce inflammation and disease, and has a high safety.

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