重组人脑利钠肽与沙库巴曲缬沙坦钠片联用对急性心肌梗死合并心力衰竭患者心室重构及心功能的影响

Effects of recombinant human brain natriuretic peptide combined with sacubatril valsartan sodium tablets on ventricular remodeling and cardiac function of pationts with acute myocardial infarction and heart failure

摘要:

目的 评价重组人脑利钠肽与沙库巴曲缬沙坦钠片联用对急性心肌梗死合并心力衰竭患者心室重构及心功能的影响。方法 选取2019年5月至2021年5月于华北理工大学附属遵化市人民医院收治的急性ST段抬高型心肌梗死合并心力衰竭患者60例, 采用随机数表法随机分为2组,每组患者30例。对照组单用重组人脑利钠肽治疗,观察组采用重组人脑利钠肽+沙库巴曲缬沙坦钠片治疗,其余抗心力衰竭措施2组相同。治疗1个月后,比较2组左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、氨基末端 B 型利钠肽前体(NT-proBNP)及6min步行距离(6MWD)。采用SPSS 19.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ²检验。采用 SPSS 19.0 统计软件进行数据分析。组间比较采用 t检验、秩和检验或χ²检验。结果 治疗后,2组LVEDD、LVESD水平较治疗前均降低,LVEF水平较治疗前均升高,差异均有统计学意义(P＜0.05)；观察组LVEDD、LVESD水平显著低于对照组,差异有统计学意义[(42.25±4.28)和(48.61±4.47) mm,(38.60±4.06) 和(44.20±4.15) mm, P＜0.05],LVEF水平显著高于对照组,差异有统计学意义[(49.25±4.19)%和 (44.38±3.87)%, P＜0.05]。治疗后,观察组 NT-proBNP水平明显低于对照组,差异有统计学意义 [(353.15±66.23)和(389.46±54.21)pg/ml),P＜0.05]；观察组6 min 步行距离长于对照组,差异有统计学意义[(441.17± 32.18)和(334.76± 31.16)m,P＜0.05]。结论 重组人脑利钠肽与沙库巴曲缬沙坦钠片联用能有效提高急性心肌梗死合并心力衰竭患者的心功能指标,逆转心室重构,临床效果显著。

Abstract:

Objective To investigate the effects of recombinant human brain natriuretic peptide (rhBNP) combined with sacubitril valsartan sodium tablets on ventricular remodeling and cardiac function of patients with acute myocardial infarction and heart failure. Methods A total of 60 patients with acute ST-segment elevation myocardial infarction complicated with heart failure admitted to our department from May 2019 to May 2021 were prospectively recruited in the clinical trial. They were randomly divided into control and observation groups, with 30 patients in each group. The control group was treated with rhBNP alone. The observation group was treated with rhBNP+sacubitril valsartan sodium tablets. Other anti-heart failure measures were the same in the 2 groups. After 1 month of treatment, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), N-terminal pro-brain natriuretic peptide (NT-proBNP) level, and 6-minute walking distance (6MWD) were compared between the 2 groups. SPSS statistics 19.0 was used for statistical analysis. Data comparison between 2 groups was conducted using student′s t test, rank sum test or Chi-square test depending on data types. Results After 1 month of treatment, LVEDD and LVESD were decreased and LVEF was increased in both groups when compared with those before treatment (P<0.05). The levels of LVEDD [(42.25±4.28) vs (48.61±4.47) mm] and LVESD[(38.60±4.06) vs (44.20±4.15)mm] were significantly lower, and that of LVEF [(49.25±4.19)% vs (44.38±3.87)%] was obviously higher in the observation group than the control group (all P<0.05). The treatments also resulted in statistically lower NT-proBNP level [(353.15±66.23) vs (389.46±54.21) pg/ml] and longer 6MWD [(441.17±32.18) vs (334.76±31.16) m] in the observation group than the control group (both P<0.05). Conclusion RhBNP combined with sacubitril valsartan sodium tablets can effectively improve the cardiac function and reversal of ventricular remodeling of acute myocardial infarction patients complicated with heart failure.