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沙库巴曲缬沙坦钠对急性前壁心肌梗死合并急性心功能不全患者短期预后的影响
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| 篇名： | 沙库巴曲缬沙坦钠对急性前壁心肌梗死合并急性心功能不全患者短期预后的影响 |
| TITLE： | Effects of Sacubitril Valsartan Sodium on Short-term Prognosis of Patients with Acute Anterior Myocardial Infarction Complicated with Acute Cardiac Insufficiency |
| 摘要： | 目的：考察血管紧张素受体脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦钠对急性前壁心肌梗死（AAMI）合并急性心功能不全患者短期预后的影响。方法：将符合纳入标准的AAMI合并心功能Killip分级为Ⅱ～Ⅳ级的患者共80例，采用随机数字表法分为ARNI组和对照组，各40例。两组患者均同时给予相同的基础规范化药物治疗、生命体征支持治疗以及经皮冠状动脉介入治疗术治疗。在此基础上，ARNI组患者予以沙库巴曲缬沙坦钠片口服，起始剂量为25mg/次，每日2次；此后逐渐调整剂量至200mg/次，每日2次。对照组患者予以马来酸依那普利片口服，起始剂量为5mg/次，每日2次；此后逐渐调整剂量至10mg/次，每日2次。两组患者长期服药，在用药后1、3、6个月时至门诊随访。比较用药前后两组患者的N末端B型利钠肽原（NT-proBNP）、可溶性生长刺激表达基因2蛋白（sST2）水平和超声心动图指标，记录用药后两组患者的6分钟步行试验（6MWT）数据和心源性再入院事件发生情况。结果：与用药前比较，两组患者在用药后1、3、6个月时的各项指标均得到显著改善（P＜0.05）。与对照组比较，用药后3、6个月时，ARNI组患者的NT-proBNP、sST2水平均显著降低（P＜0.05），左室射血分数和6MWT水平均显著提高（P＜0.05），左室收缩末期内径和左室舒张末期内径均显著缩短（P＜0.05）；但两组患者的E峰与A峰流速比值、肺动脉压力、右室舒张末期内径和心源性再入院事件发生率比较，差异均无统计学意义（P＞0.05）。结论：针对AAMI合并急性心功能不全患者，沙库巴曲缬沙坦钠较依那普利能更为明显地改善患者的心功能（尤其是左心室收缩功能），减轻患者心肌细胞的炎症反应并保护心肌细胞，从而改善患者的短期预后。 |
| ABSTRACT： | OBJECTIVE：To investigate the effec ts of angiotensin receptor neprilysin inhibitor （ARNI）sacubitril valsartan sodium（SVS）on the short-term prognosis of patients with acute anterior myocardial infarction （AAMI）complicated with acute cardiac insufficiency. METHODS ：A total of 80 patients with AAMI and Killip grade Ⅱ-Ⅳ of cardiac function ，who met the inclusion criteria ，were randomly divided into ARNI group and control group ，with 40 patients in each group. Both groups were given the same basic standardized drug treatment ，vital signs support treatment and percutaneous coronary intervention treatment at the same time. On this basis ，ARNI group was given SVS tablet orally ，with initial dose of 25 mg each time ，twice a day ； thereafter，gradually adjust the dose to 200 mg each time ，twice a day. Control group was given Enalapril maleate tablets orally ， with an initial dose of 5 mg each time ，twice a day ；thereafter，gradually adjust the dose to 10 mg each time ，twice a day. Both groups took medicine for a long time ，and were followed up after 1，3 and 6 months of medication to the clinic. The levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）， soluble growth stimulation expressed gene 2 protein （sST2） and echocardiography indexes were compared between 2 groups before and after medication. The 6-minute walking test （6MWT）and the incidence of cardiogenic readmission events were recorded in 2 groups after medication. RESULTS ：Compared with before treatment，the indexes of the two groups were significantly improved at 1，3 and 6 months after treatment （P＜0.05）. Compared with control group ，the levels of NT-proBNP and sST 2 in ARNI group decreased significantly （P＜0.05），the levels of left ventricular ejection fraction and 6MWT increased significantly（P＜0.05），and the left ventricular end systolic diameter and left ventricular end diastolic diameter decreased significantly，after 3 and 6 months of treatm ent（P＜0.05）. However ，there was no significant difference in the velocity ratio of peak E to peak A ，pulmonary artery pressure ，right ventricular end diastolic diameter and the incidence of cardiogenic readmission events between 2 groups（P＞0.05）. CONCLUSIONS ：For patients with AAMI complicated with acute cardiac insufficiency ， compared with enalapril ，SVS can significantly improve the cardiac function （especially the left ventricular systolic function ）， reduce the inflammatory reaction of cardiomyocytes ，protect cardiomyocytes ，so as to improve the short-term prognosis of patients. |
| 期刊： | 2021年第32卷第23期 |
| 作者： | 李锦爽，戚冉冉，王万虹，周浩，陈春望，张荣林 |
| AUTHORS： | LI Jinshuang，QI Ranran，WANG Wanhong，ZHOU Hao，CHEN Chunwang，ZHANG Ronglin |
| 关键字： | 血管紧张素受体脑啡肽酶抑制剂；沙库巴曲缬沙坦钠；急性前壁心肌梗死；急性心功能不全；预后 |
| KEYWORDS： | Angiotensin receptor neprilysin inhibitor ；Sacubitril valsartan sodium ；Acute anterior myocardial infarction ；Acute |
| 阅读数： | 310 次 |
| 本月下载数： | 3 次 |
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