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

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