标题：沙库巴曲缬沙坦钠片联合维立西呱治疗慢性心力衰竭的效果及对患者心功能、心脏结构重塑、血管内皮功能的影响

      作者：王强，牛津津，周亚非，张铁须    平顶山市第一人民医院心血管内科，河南 平顶山 467000

      卷次： 2024年35卷14期

      【摘要】 目的 探讨沙库巴曲缬沙坦钠片联合维立西呱治疗慢性心力衰竭(CHF)的临床效果及对患者心功能、心脏结构重塑、血管内皮功能的影响。方法 选取2022年5月至2023年6月平顶山市第一人民医院收治的102例CHF患者纳入研究，按随机数法分为对照组(予以沙库巴曲缬沙坦钠片治疗)和观察组(予以沙库巴曲缬沙坦钠片+维立西呱治疗)各51例，两组患者均治疗6个月。治疗6个月后比较两组患者的NYHA心功能分级改善情况，以及治疗前后的血压、明尼苏达心衰量表评分(MLHFQ)、心功能[每搏输出量(SV)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、N端脑钠肽前体(NT-proBNP)]、心室结构重塑指标[室间隔厚度、左心室后壁厚度(LVPWT)、左心室质量分数(LVMI)]、血管内皮功能[内皮素、一氧化氮合酶(NOS)、降钙素基因相关肽(CGRP)、一氧化氮]；同时比较两组患者治疗期间的主要不良事件和不良反应发生率。结果 102例CHF患者中1例中途退出，其余均纳入研究，最终纳入观察组 50例，对照组 51例；治疗后观察组患者的NYHA心功能分级改善 2~3级患者占比分别为66.00%、18.00%，明显高于对照组的39.22%、1.96%，差异有统计学意义(P<0.05)；治疗后，观察组患者的MLHFQ评分为(35.26±4.08)分，明显低于对照组的(47.53±5.29)分，差异有统计学意义(P<0.05)；治疗后，观察组患者的SV、LVEF分别为(75.12±8.30) mL、(49.29±2.30)%，明显高于对照组的(64.56±10.44) mL、(43.77±2.61)%，LVEDD、NT-proBNP分别为(53.00±3.18) mm、(2 969.20±331.74) μg/L，明显低于对照组的(56.13±3.45) mm、(4 007.31±383.52) μg/L，差异均有统计学意义(P<0.05)；治疗后观察组患者的室间隔厚度、LVPWT、LVMI分别为(8.05±1.12) mm、(7.13±0.94) mm、(110.58±17.30) g/m2，明显低于对照组的(9.49±1.83) mm、(8.81±1.57) mm、(119.72±14.02) g/m2，差异均有统计学意义(P<0.05)；治疗后观察组患者的内皮素为(42.00±6.95) ng/L，明显低于对照组的(58.42±8.27) ng/L，NOS、CGRP、一氧化氮分别为(33.92±4.85) U/mL、(39.36±5.07) ng/L、(99.41±6.56) μmol/L，明显高于对照组的(25.41±3.76) U/mL、(27.14±4.82) ng/L、(83.64±5.29) μmol/L，差异均有统计学意义(P<0.05)；观察组患者的主要不良事件发生率为6.00%，明显低于对照组患者的21.57%，差异有统计学意义(P<0.05)；观察组患者的不良反应总发生率为6.00%，与对照组患者的1.96%比较，差异无统计学意义(P>0.05)。结论 沙库巴曲缬沙坦钠片联合维立西呱治疗CHD能有效改善患者的心脏功能，逆转心脏结构重塑，减少心力衰竭再入院等主要不良事件的发生，提高患者的生命质量。
      【关键词】 慢性心力衰竭；沙库巴曲缬沙坦钠片；维立西呱；心功能；心脏结构重塑；血管内皮功能
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2024）14—1991—06

Clinical efficacy of Sacubitril Valsartan Sodium Tablets combined with Vericiguat in the treatment of chronicheart failure and its effects on cardiac function, cardiac structural remodeling, and vascular endothelial functionin patients.
WANG Qiang, NIU Jin-jin, ZHOU Ya-fei, ZHANG Tie-xu. Department of Cardiovascular Medicine, the FirstPeople's Hospital of Pingdingshan City, Pingdingshan 467000, Henan, CHINA
【Abstract】 Objective To investigate the clinical efficacy of Sacubitril Valsartan Sodium Tablets combinedwith Vericiguat in the treatment of chronic heart failure (CHF) and the effects on cardiac function, cardiac structural re-modeling, and vascular endothelial function in patients. Methods A total of 102 patients with CHF admitted to theFirst People's Hospital of Pingdingshan City from May 2022 to June 2023 were selected and randomly divided into acontrol group (treated with Sacubitril Valsartan Sodium Tablets) and an observation group (treated with Sacubitril Val-sartan Sodium Tablets combined with Vericiguat), with 51 cases in each group. Both groups of patients were treated for6 months. After treatment, the improvement of NYHA cardiac function classification was compared between the twogroups, as well as blood pressure, Minnesota Living with Heart Failure Questionnaire (MLHFQ), cardiac function[stroke volume (SV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), N-termi-nal pro-brain natriuretic peptide (NT-proBNP)], ventricular structural remodeling indicators [interventricular septumthickness, left ventricular posterior wall thickness (LVPWT), left ventricular mass fraction (LVMI)], vascular endothelialfunction [endothelin, nitric oxide synthase (NOS), calcitonin gene-related peptide (CGRP), nitric oxide]. The incidences ofmajor adverse events and adverse reactions during treatment were also compared between the two groups. Results Ofthe 102 patients with CHF, one patient withdrew halfway. Ultimately, 50 patients were included in the observation groupand 51 patients in the control group. After treatment, the proportions of patients with NYHA classification improvementof 2 grades, 3 grades in the observation group were 66.00% and 18.00%, respectively, which were significantly higherthan 39.22% and 1.96% in the control group (P<0.05). After treatment, the MLHFQ score of patients in the observationgroup was (35.26±4.08) points, which was significantly lower than (47.53±5.29) points in the control group (P<0.05). Af-ter treatment, the SV and LVEF of patients in the observation group were (75.12±8.30) mL and (49.29±2.30)%, respec-tively, which were significantly higher than (64.56±10.44) mL and (43.77±2.61)% in the control group, respectively;LVEDD and NT-proBNP were (53.00±3.18) mm and (2969.20±331.74) μg/L, respectively, which were significantly low-er than (56.13±3.45) mm and (4 007.31±383.52) μg/L in the control group; the differences were statistically significant(P<0.05). After treatment, the interventricular septum thickness, LVPWT, and LVMI in the observation group were(8.05±1.12) mm, (7.13±0.94) mm, and (110.58±17.30) g/m2, respectively, which were significantly lower than (9.49±1.83) mm, (8.81±1.57) mm, and (119.72±14.02) g/m2 in the control group (P<0.05). After treatment, the endothelin levelin the observation group was (42.00±6.95) ng/L, which was significantly lower than (58.42±8.27) ng/L in the controlgroup; NOS, CGRP, and nitric oxide levels were (33.92±4.85) U/mL, (39.36±5.07) ng/L, and (99.41±6.56) μmol/L, re-spectively, which were significantly higher than (25.41±3.76) U/mL, (27.14±4.82) ng/L, and (83.64±5.29) μmol/L in thecontrol group; the differences were statistically significant (P<0.05). The incidence of major adverse events in the obser-vation group was 6.00%, which was significantly lower than 21.57% in the control group (P<0.05). The total incidenceof adverse reactions in the observation group was 6.00%, which was not significantly different from 1.96% in the controlgroup (P>0.05). Conclusion Sacubitril Valsartan Sodium Tablets combined with Vericiguat can effectively improve thecardiac function of patients with CHD, reverse cardiac structural remodeling, reduce the occurrence of major adverseevents such as readmission for heart failure, and improve the quality of life of patients.
      【Key words】 Chronic heart failure; Sacubitril Valsartan Sodium Tablets; Vericiguat; Cardiac function; Cardiacstructural remodeling; Vascular endothelial function