沙库巴曲缬沙坦联合芪苈强心胶囊治疗扩张型心肌病的效果

doi:10.3760/cma.j.issn.1007-1245.2024.10.019

摘要/Abstract

摘要：

目的　探讨沙库巴曲缬沙坦联合芪苈强心胶囊治疗扩张型心肌病（DCM）的效果及对心肌纤维化、心室重构（VR）的影响。方法　选取2019年1月至2023年1月陕西中医药大学第二附属医院收治的62例DCM患者作为研究对象，采用随机数字表法将患者分为研究组和对照组各31例。对照组男20例，女11例；年龄（45.72±4.89）岁；美国纽约心脏病协会（NYHA）心功能分级：Ⅱ级15例，Ⅲ级16例。研究组男14例，女17例；年龄（46.91±5.36）岁；NYHA心功能分级：Ⅱ级12例，Ⅲ级19例。对照组给予强心、利尿、β受体阻滞剂、醛固酮抑制剂和沙库巴曲缬沙坦钠口服治疗；研究组在对照组基础上给予芪苈强心胶囊口服治疗；两组均持续治疗3个月。比较两组临床疗效，治疗前后左心室射血分数（LVEF）、左心室舒张末期容积（LVEDV）、左心室舒张末期内径（LVEDD）、血清N末端脑钠肽前体（NT-proBNP）、层粘蛋白（LN）、透明质酸（HA）、转化生长因子-β1（TGF-β1）、6 min步行距离（6MWD）、生活质量综合评定问卷（GQOLI-74）评分及治疗期间不良反应发生率。采用独立样本t检验、配对样本t检验和χ²检验。结果　研究组总有效率为93.55%（29/31），高于对照组的74.19%（23/31）（P<0.05）；治疗后，研究组LVEF高于对照组［（47.11±5.68）%比（43.92±4.35）%］，LVEDV、LVEDD均低于对照组［（145.38±16.37）ml比（163.09±20.42）ml、（45.90±4.26）mm比（49.21±5.12）mm］（均P<0.05）；治疗后，研究组LN、HA和TGF-β1均低于对照组［（153.82±11.24）µg/L比（186.31±14.73）µg/L、（165.48±16.75）µg/L比（197.06±19.62）µg/L、（36.91±3.77）µg/L比（40.52±2.63）µg/L］（均P<0.05）；治疗后，研究组血清NT-proBNP低于对照组［（827.95±76.13）ng/L比（932.74±59.25）ng/L］，GQOLI-74评分高于对照组［（89.61±3.17）分比（81.83±4.92）分］，6MWD长于对照组［（346.75±32.45）m比（308.26±29.71）m］（均P<0.05）；研究组治疗期间不良反应总发生率为19.35%（6/31），与对照组的12.90%（4/31）比较，差异无统计学意义（P>0.05）。结论　沙库巴曲缬沙坦联合芪苈强心胶囊可增强DCM的临床疗效，有效抑制VR和心肌纤维化。

关键词:

扩张型心肌病, 沙库巴曲缬沙坦, 芪苈强心胶囊, 临床疗效, 心肌纤维化, 心室重构

Abstract:

Objective　To explore the curative effect of sacubitril valsartan combined with Qili Qiangxin capsules on dilated cardiomyopathy (DCM) and its influences on myocardial fibrosis and ventricular remodeling (VR). Methods　A total of 62 patients with DCM admitted to Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine were enrolled as the research objects between January 2019 and January 2023. According to the random number table method, they were divided into a study group and a control group with 31 cases in each group. In the control group, there were 20 males and 11 females, aged (45.72±4.89) years, New York Heart Association (NYHA) cardiac function classification: 15 cases of grade II and 16 cases of grade III. There were 14 males and 17 females in the study group, aged (46.91±5.36) years, NYHA cardiac function classification: 12 cases of grade II and 19 cases of grade III. The control group was treated with cardiotonic, diuretic, β-blocker, aldosterone inhibitor, and sacubitril valsartan sodium, and the study group was treated with Qili Qiangxin capsules on the basis of the control group for 3 months. The clinical efficacy, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic inner diameter (LVEDD), serum N-terminal pro-brain nitric peptide (NT-proBNP), laminin (LN), hyaluronic acid (HA), transforming growth factor-β1 (TGF-β1), 6 min walking distance (6MWD), and Generic Quality of Life Inventory-74 (GQOLI-74) score before and after treatment, and incidence of adverse reactions during treatment were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　The total effective rate of the study group was 93.55% (29/31), higher than that of the control group [74.19% (23/31)] (P<0.05). After treatment, the LVEF of the study group was higher than that of the control group [(47.11±5.68)% vs. (43.92±4.35)%], but the LVEDV and LVEDD were lower than those of the control group [(145.38±16.37) ml vs. (163.09±20.42) ml, (45.90±4.26) mm vs. (49.21±5.12) mm] (all P<0.05). After treatment, the levels of LN, HA, and TGF-β1 in the study group were lower than those in the control group [(153.82±11.24) µg/L vs. (186.31±14.73) µg/L, (165.48±16.75) µg/L vs. (197.06±19.62) µg/L, (36.91±3.77) µg/L vs. (40.52±2.63) µg/L] (all P<0.05). After treatment, the serum NT-proBNP level in the study group was lower than that in the control group [(827.95±76.13) ng/L vs. (932.74±59.25) ng/L], the GQOLI-74 score was higher than that in the control group [(89.61±3.17) points vs. (81.83±4.92) points], and the 6MWD was longer than that in the control group [(346.75±32.45) m vs. (308.26±29.71) m] (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions during treatment between the study group and the control group [19.35% (6/31) vs. 12.90% (4/31)] (P>0.05). Conclusion　Sacubitril valsartan combined with Qili Qiangxin capsules can improve the clinical curative effect on DCM, and effectively inhibit the VR and myocardial fibrosis.

Key words:

Dilated cardiomyopathy, Sacubitril valsartan, Qili Qiangxin capsules, Clinical curative effect, Myocardial fibrosis, Ventricular remodeling

赵运邢雪董静康启.

沙库巴曲缬沙坦联合芪苈强心胶囊治疗扩张型心肌病的效果 [J]. 国际医药卫生导报, 2024, 30(10): 1677-1681.

Zhao Yun, Xing Xue, Dong Jing, Kang Qi.

Curative effect of sacubitril valsartan combined with Qili Qiangxin capsules on dilated cardiomyopathy [J]. International Medicine and Health Guidance News, 2024, 30(10): 1677-1681.

参考文献

[1] Heymans S, Lakdawala NK, Tschöpe C, et al. Dilated cardiomyopathy: causes, mechanisms, and current and future treatment approaches[J]. Lancet, 2023, 402(10406):998-1011. DOI: 10.1016/S0140-6736(23)01241-2.
[2] Orphanou N, Papatheodorou E, Anastasakis A. Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments[J]. Heart Fail Rev, 2022, 27(4):1173-1191. DOI: 10.1007/s10741-021-10139-0.
[3] 白杨,姜伟鹏,夏成蕴,等.血清NT-proBNP、HE4、β2-MG、sST2与扩张型心肌病患者心室重构的关系及对出院后短期预后的预测价值[J].现代生物医学进展,2022,22(17):3259-3263,3274.DOI:10.13241/j.cnki.pmb.2022.17.011.
[4] Docherty KF, Vaduganathan M, Solomon SD, et al. Sacubitril/valsartan: Neprilysin inhibition 5 years after PARADIGM-HF[J]. JACC Heart Fail, 2020, 8(10):800-810. DOI: 10.1016/j.jchf.2020.06.020.
[5] 任晓荣.沙库巴曲缬沙坦联合芪苈强心胶囊治疗慢性心力衰竭患者的疗效评价[J].中国药物与临床,2021,21(22):3661-3663.DOI:10.11655/zgywylc2021.22.003.
[6] 赵玉清,常秀红,崔文燕,等.芪苈强心胶囊联合沙库巴曲缬沙坦治疗慢性心力衰竭伴房颤疗效及对心功能影响[J].现代中西医结合杂志,2020,29(35):3939-3943.DOI:10.3969/j.issn.1008-8849.2020.35.015.
[7] 格日勒,吴云,郭欣君,等.芪苈强心胶囊联合沙库巴曲缬沙坦钠治疗非射血分数减低型心力衰竭的疗效[J].疑难病杂志,2021,20(7):653-657.DOI:10.3969/j.issn.1671-6450. 2021.07.002.
[8] 中华医学会心血管病学分会,中国心肌炎心肌病协作组.中国扩张型心肌病诊断和治疗指南[J].临床心血管病杂志,2018,34(5):421-434.DOI:10.13201/j.issn.1001-1439. 2018.05.001.
[9] 颜红兵,柯元南.美国成人慢性心力衰竭诊断与治疗指南(修订版)[M].北京:中国环境科学出版社,2005:75-81.
[10] 杨萍,代天,张苏川.沙库巴曲缬沙坦联合芪苈强心胶囊治疗慢性收缩性心力衰竭的临床研究[J].中西医结合心脑血管病杂志,2022,20(2):268-271.DOI:10.12102/j.issn.1672- 1349.2022.02.015.
[11] 王丽昀,商秀洋,吴华芹,等.芪苈强心胶囊对扩张型心肌病失代偿心力衰竭治疗好转出院患者易损期心功能的影响[J].疑难病杂志,2022,21(2):134-138.DOI:10.3969/j.issn.1671-6450.2022.02.006.
[12] 丁鹂,寿宇雁.奥马哈系统结合压力管理对心肌梗死患者介入治疗中Barthel指数、舒适度评分及GQOLI-74评分的影响[J].中国急救复苏与灾害医学杂志,2021,16(10):1160-1162,1166.DOI:10.3969/j.issn.1673-6966.2021. 10.021.
[13] Harding D, Chong MHA, Lahoti N, et al. Dilated cardiomyopathy and chronic cardiac inflammation: pathogenesis, diagnosis and therapy[J]. J Intern Med, 2023, 293(1):23-47. DOI: 10.1111/joim.13556.
[14] 蔡振璇,柯晓霞.温肾健脾利水汤对扩张型心肌病心力衰竭患者心室重构及血清Hcy、BNP水平的影响[J].现代中西医结合杂志,2020,29(2):199-202.DOI:10.3969/j.issn.1008-8849.2020.02.021.
[15] 叶丛,滕丽峰,王裕岱,等.缬沙坦/沙库巴曲对心肌肥大大鼠的治疗作用[J].药物生物技术,2020,27(6):513-518.DOI:10.19526/j.cnki.1005-8915.20200604.
[16] 段依璠,顾静,舒亚妃,等.心肌成纤维细胞来源的外泌体miRNA参与放射性心肌纤维化损伤[J].中国生物化学与分子生物学报,2023,39(1):108-120.DOI:10.13865/j.cnki.cjbmb.2022.11.1330.
[17] 周旋.沙库巴曲缬沙坦治疗慢性心力衰竭的临床观察[J].国际医药卫生导报,2021,27(6):894-896.DOI:10.3760/cma.j.issn.1007-1245.2021.06.028.
[18] 苏杭,刘思丽,吴婕.急性心肌梗死并发室性心律失常及心室重构患者12导联同步心电图监测及预后分析[J].海南医学,2023,34(2):180-184.DOI:10.3969/j.issn.1003-6350. 2023.02.006.
[19] 张义,韩东建,刘志煜,等.不同起始剂量沙库巴曲缬沙坦治疗扩张型心肌病心力衰竭的短期疗效与安全性[J].实用心脑肺血管病杂志,2022,30(5):102-107.DOI:10.12114/j.issn.1008-5971.2022.00.127.
[20] 刘菲,杨文灿.沙库巴曲缬沙坦对扩张型心肌病心力衰竭患者心室重构和心脏功能的影响[J].中南医学科学杂志,2023,51(2):222-225.DOI:10.15972/j.cnki.43-1509/r.2023.02.016.
[21] 张宁,毋会芃,安斌.重组人脑利钠肽联合芪苈强心胶囊治疗老年急性心肌梗死合并心力衰竭的临床价值[J].中华老年心脑血管病杂志,2022,24(7):685-688.DOI:10.3969/j.issn.1009-0126.2022.07.004.
[22] 莘翼翔,刘恒,于祯,等.芪苈强心胶囊联合参附注射液治疗慢性肺源性心脏病心力衰竭疗效观察[J].现代中西医结合杂志,2023,32(9):1273-1277.DOI:10.3969/j.issn.1008- 8849.2023.09.022.
[23] 张艳,吴昆华,李清,等.肥厚型心肌病患者心肌纤维化范围的相关因素分析[J].中华心血管病杂志,2021,49(1):31-36.DOI:10.3760/cma.j.cn112148-20200609-00475.
[24] 赵金艳,崔少楠,曹月娟.沙库巴曲缬沙坦钠治疗老年高血压慢性心力衰竭的疗效观察[J].中华老年心脑血管病杂志,2021,23(12):1268-1271.DOI:10.3969/j.issn.1009-0126. 2021.12.010.
[25] 王四坤,张臻,王春明,等.沙库巴曲缬沙坦联合芪苈强心胶囊治疗扩张型心肌病心力衰竭的临床研究[J].中西医结合心脑血管病杂志,2020,18(21):3620-3622.DOI:10.12102/j.issn.1672-1349.2020.21.027.
[26] 田楠楠,曹梦杰.扩张型心肌病患者NT-proBNP表达水平与预后的相关性[J].哈尔滨医药,2021,41(6):49-50.DOI:10.3969/j.issn.1001-8131.2021.06.021.