恩格列净联合沙库巴曲缬沙坦对射血分数降低的心力衰竭患者的临床疗效

doi:10.3760/cma.j.issn.1007-1245.2024.24.027

摘要/Abstract

摘要：

目的　探讨恩格列净联合沙库巴曲缬沙坦对射血分数降低的心力衰竭（HFrEF）患者心功能及血清可溶性生长刺激表达基因2蛋白（sST2）、基质金属蛋白酶-9（MMP-9）的影响。方法　选择2020年3月至2022年5月神木市医院收治的185例HFrEF患者，按照随机数字表法分为观察组（93例）与对照组（92例）。对照组中男62例，女30例，年龄（54.61±8.83）岁，在常规治疗基础上采用沙库巴曲缬沙坦治疗，每次50 mg，口服，每天2次；根据患者病情逐步提高剂量，最大剂量≤400 mg/d。观察组中男65例，女28例，年龄（55.32±8.21）岁，在常规治疗基础上采用沙库巴曲缬沙坦联合恩格列净治疗，沙库巴曲缬沙坦治疗同对照组，恩格列净每次10 mg，口服，每天1次。两组均治疗6个月。比较两组患者的心功能、运动能力、血清学指标、临床疗效、药物不良反应及预后。统计学方法采用t检验、χ²检验。结果　治疗后，观察组的左心室收缩末期内径、左心室射血分数、6 min步行试验的步行距离、sST2、MMP-9分别为（40.03±3.36）mm、（56.97±6.78）%、（367.29±68.51）m、（3.47±1.20）µg/L、（143.62±13.28）µg/L，对照组上述指标分别为（44.10±4.22）mm、（50.34±5.68）%、（320.06±59.38）m、（8.61±2.34）µg/L、（160.34±16.51）µg/L，差异均有统计学意义（均P<0.05）。治疗后，观察组和对照组总有效率分别为78.49%（73/93）和58.70%（54/92），差异有统计学意义（χ²=8.424，P=0.004）。观察组的心血管不良事件总发生率、再入院率分别为20.43%（19/93）、11.83%（11/93），对照组分别为47.83%（44/92）、28.26%（26/92），差异均有统计学意义（均P<0.05）。观察组药物不良反应发生率为16.13%（15/93），对照组为10.87%（10/92），差异无统计学意义（χ²=1.095，P=0.295）。结论　恩格列净联合沙库巴曲缬沙坦可改善HFrEF患者的运动能力和心功能，抑制心肌纤维化，疗效显著，且安全可靠。

关键词:

心力衰竭, 射血分数, 恩格列净, 沙库巴曲缬沙坦, 心功能, 可溶性生长刺激表达基因2蛋白, 基质金属蛋白酶-9

Abstract:

Objective　To investigate the effects of empagliflozin combined with sacubitril/valsartan on cardiac function, serum soluble suppression of tumorigenicity 2 protein (sST2) and matrix metalloproteinase-9 (MMP-9) in patients with heart failure with reduced ejection fraction (HFrEF). Methods　A total of 185 HFrEF patients from Shenmu Hospital from March 2020 to May 2022 were selected and were divided into an observation group (93 cases) and a control group (92 cases) by the random number table method. In the control group, 62 males and 30 females, aged (54.61±8.83) years, were treated with sacubitril/valsartan on the basis of conventional treatment, 50 mg each time, twice a day, and the dose was gradually increased according to the patients' conditions, with the maximum dose ≤400 mg/d. In the observation group, 65 males and 28 females, aged (55.32±8.21) years, were treated with sacubitril/valsartan combined with empagliflozin on the basis of conventional treatment, and the treatment with sacubitril/valsartan was the same as the control group, with empagliflozin 10 mg each time, once a day. Both groups were treated for 6 months. The cardiac function, motor ability, serological indexes, clinical efficacy, adverse drug reactions, and prognosis of the two groups were compared. Statistical methods used were t test and χ² test. Results　After treatment, the left ventricular end-systolic diameter, left ventricular ejection fraction, 6 min walking distance, and levels of sST2 and MMP-9 in the observation group were (40.03±3.36) mm, (56.97±6.78)%, (367.29±68.51) m, (3.47±1.20) µg/L, and (143.62±13.28) µg/L, and those in the control group were (44.10±4.22) mm, (50.34±5.68)%, (320.06±59.38) m, (8.61±2.34) µg/L, and (160.34±16.51) µg/L, with statistically significant difference (all P<0.05). After treatment, the total effective rates of the observation group and the control group were 78.49% (73/93) and 58.70% (54/92), with a statistically significant difference (χ²=8.424, P=0.004). The total incidence of cardiovascular adverse events and readmission rate were 20.43% (19/93) and 11.83% (11/93) in the observation group, and 47.83% (44/92) and 28.26% (26/92) in the control group, with statistically significant differences (both P<0.05). The incidence of adverse drug reactions was 16.13% (15/93) in the observation group and 10.87% (10/92) in the control group, without statistically significant difference (χ²=1.095, P=0.295). Conclusion　Empagliflozin combined with sacubitril/valsartan can improve the prognosis, exercise ability and cardiac function of HFrEF patients with significant efficacy, and inhibit myocardial fibrosis, which is safe and reliable.

Key words:

Heart failure, Ejection fraction, Empagliflozin, Sacubitril/valsartan, Heart function, Soluble suppression of tumorigenicity 2 protein, , Matrix metalloproteinase-9

刘建军刘军.

恩格列净联合沙库巴曲缬沙坦对射血分数降低的心力衰竭患者的临床疗效 [J]. 国际医药卫生导报, 2024, 30(24): 4197-4201.

Liu Jianjun, Liu Jun.

Effects of empagliflozin combined with sacubitril/valsartan on cardiac function and serum sST2 and MMP-9 levels in patients with heart failure with reduced ejection fraction [J]. International Medicine and Health Guidance News, 2024, 30(24): 4197-4201.

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