摘要
目的 探究恩格列净联合沙库巴曲缬沙坦治疗心房颤动(房颤)合并射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的效果.方法 选取2022年7月至2023年7月98例房颤合并HFpEF,采用随机数字表法分为研究组49例和对照组49例.2组均行常规治疗,在此基础上对照组给予沙库巴曲缬沙坦治疗,研究组在对照组基础上联合恩格列净治疗,均治疗6个月后比较效果.比较2组临床疗效,治疗前、治疗3个月后、治疗6个月后心肺功能[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular and diastolic diameter,LVEDD)、最大自主通气量(maximal voluntary ventilation,MVV)、第1秒用力呼气容积(forced expirato-ry volume in one second,FEV1)、左心室重构指数(left ventricular remodeling index,LVRI)],炎性因子[白细胞介素-1β(interleukin-1β,IL-1β)、脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、去乙酰化酶1(si-lent information regulator of transcription 1,SIRT1)],运动耐力[6 min步行距离(six minute walk distance,6MWD)],生活质量[明尼苏达心力衰竭生活质量量表(minnesotaliving with heart failure questionnaire,MLHFQ)],血清微小RNA(miR)-101a、miR-30a水平,以及2组治疗期间主要心血管不良事件(major adverse cardiovascular event,MACE)和不良反应.结果 研究组临床总有效率为89.80%(44/49)高于对照组的73.47%(36/49)(P＜0.05);2组治疗3个月后、6个月后LVEDD、IL-1β、Lp-PLA2、MLHFQ评分、血清miR-30a低于治疗前,LVEF、MVV、FEV1、LVRI、SIRT1、6MWD、血清miR-101a高于治疗前(P＜0.05);研究组治疗3个月后、6个月后LVEDD、IL-1β、Lp-PLA2、MLHFQ评分、血清miR-30a低于对照组,LVEF、MVV、FEV1、LVRI、SIRT1、6MWD、血清miR-101a高于对照组(P＜0.05).研究组MACE发生率低于对照组(P＜0.05);2组不良反应发生率比较差异无统计学意义(P＞0.05).结论 恩格列净联合沙库巴曲缬沙坦治疗房颤合并HFpEF患者效果显著,能减轻炎症反应,改善患者心肺功能,降低MACE风险,增强运动耐力,提高生活质量,且安全性较高.
Abstract
Objective To explore the effect of Empagliflozin combined with sacubitril/valsartan on patients with atri-al fibril-lation(AF)and heart failure with preserved ejection fraction(HFpEF).Methods A total of 98 patients with atrial fi-brillation and HFpEF from July 2022 to July 2023 were selected and randomly divided into the research group(n=49)and the control group(n=49)using a random number table method.Both groups received conventional treatment,and on this basis,the control group was treated with sacubitril/valsartan and the research group was supplemented with Empagliflozin on the ba-sis of the control group.At 6 months after treatment,the effects were compared.The clinical efficacy of the two groups was compared,and the cardiopulmonary function[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),maximum voluntary ventilation(MVV),forced expiratory volume in one second(FEV1),left ventricular remodeling index(LVRI)],inflammatory factors[interleukin-1β(IL-1β),lipoprotein-associated phospholipase A2(Lp-PLA2),sirtuin 1(SIRT1)],exercise tolerance[6-minute walk distance(6MWD)],quality of life[Minnesota Heart Failure Quality of Life Scale(MLHFQ)],serum microRNA(miR)-101a,miR-30a levels,and major adverse cardiovascular events(MACE)and adverse reac-tions during treatment in both groups were compared.Results The total clinical effective rate of the research group was 89.80%(44/49),which was higher than that of the control group[73.47%(36/49)](P<0.05).At 3 and 6 months after treat-ment,LVEDD,IL-1β,Lp-PLA2,MLHFQ score,and serum miR-30a in both groups were lower than those before treatment,while LVEF,MVV,FEV1,LVRI,SIRT1,6MWD,and serum miR-101a were higher than those before treatment(P<0.05).At 3 and 6 months after treatment,LVEDD,IL-1β,Lp-PLA2,MLHFQ score,and serum miR-30a in the research group were lower than those in the control group,while LVEF,MVV,FEV1,LVRI,SIRT1,6MWD,and serum miR-101a were higher than those in the control group(P<0.05).The incidence of MACE in the research group was lower than that in the control group(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The efficacy of Empagliflozin combined with sacubitril/valsartan in the treatment of patients with AF and HFpEF is significant,which can reduce inflammatory response,improve patients'cardiopulmonary function,reduce the risk of MACE,enhance exercise tolerance,improve quality of life,and has high safety.
基金项目
河北省卫生健康委员会医学科学研究项目(20211610)
国家科技期刊平台
NSTL
万方数据