摘要
目的 分析达格列净联合沙库巴曲缬沙坦对经皮冠状动脉介入治疗(PCI)术后心力衰竭患者炎性因子及可溶性基质裂解素2(sST2)、基质金属蛋白酶-9(MMP-9)、胱抑素C(CysC)的影响,并分析影响心力衰竭PCI术后疗效的影响因素.方法 选取东部战区总医院2020年1月～2021年1月收治的PCI术后心力衰竭患者106例作为研究对象,采用随机数字表法分为对照和观察两组.对照组患者采用沙库巴曲缬沙坦治疗,观察组则在对照组基础上联合达格列净治疗.对所有患者进行为期两年的随访,比较两种治疗方式的疗效差异.结果 两组患者治疗前的心功能、血清炎性因子、心室重构生化指标比较无明显的差异(P＞0.05),但治疗后两组患者左心射血分数(LVEF)高于治疗前[(44.32±6.49)％比(52.56±7.27)％、(44.36±6.58)％比(48.03±6.14)％],LVEF 水平治疗后观察组高于对照组[(52.56±7.27)％比(48.03±6.14)％、(P＜0.05)];左心室舒张末期内径(LVEDD)、左心室收缩末期直径(LVESD)、N末端B型利钠肽原(Nt-proBNP)、血清炎性指标肿瘤坏死因子-α(TNF-α)、白介素(IL)-1β、IL-6、超敏C反应蛋白(hs-CRP)、sST2、MMP-9、CysC水平均低于治疗前,且观察组低于对照组(P＜0.05);治疗后1个月两组患者的6 min步行试验(6MWT)无差异(P＞0.05),治疗后3个月和6个月观察组患者的6MWT均大于对照组患者(P＜0.05),且组内存在差异(P＜0.05).两组不良反应情况比较无统计学差异(P＞0.05).结论 达格列净联合沙库巴曲缬沙坦治疗PCI术后心力衰竭患者相较于单独使用沙库巴曲缬沙坦疗效更佳,效果显著,且对于患者的心功能改善好,降低炎症反应,并且具有较高安全性.
Abstract
Objective To analyze the effects of dagliflozin combined with sarcutrosovalsartan on inflammatory factors and soluble matrix lysin 2(sST 2),matrix metalloproteinase-9(MMP-M9),cystatin C(CysC)in patients with heart failure after percutaneous coronary intervention(PCI),and the effects of heart failure PCI.Methods 106 patients with heart failure after PCI surgery admitted to our hospital from January 2020 to January 2021 were selected as the research subjects.They were randomly divided into control and observation groups using a random number table method.The control group patients were treated with sacubitril valsartan,while the observation group was treated with dapagliflozin in addition to the control group.Conduct a two-year follow-up of all patients to compare the efficacy differences between the two treatment methods.Results There was no significant difference in cardiac function,serum inflammatory factors,and biochemical indicators of ventricular remodeling between the two groups of patients before treatment(P＞0.05),but after treatment,the left ventricular ejection fraction(LVEF)of the two groups of patients was higher than before treatment[(44.32±6.49)％vs.(52.56±7.27)％,(44.36±6.58)％vs.(48.03±6.14)％].After treatment,the LVEF level in the observation group was higher than that in the control group[(52.56±7.27)％vs.(48.03±6.14)％,P＜0.05];The left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),N-terminal B-type natriuretic peptide precursor(Nt-proBNP),serum inflammatory markers tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,high-sensitivity C-reactive protein(hs-CRP),sST2,MMP-9,and CysC levels were all lower than before treatment,and the observation group was lower than the control group(P＜0.05).One month after treatment,there was no significant difference in the 6-minute walk test(6MWT)between the two groups of patients(P＞0.05).3 and 6 months after treatment,the 6MWT of the observation group was higher than that of the control group(P＜0.05),and there was a difference within the group(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The combination of dapagliflozin and sacubitril/valsartan is more effective in treating heart failure patients after PCI compared to using sacubitril/valsartan alone.The effect is significant,and it improves the patient's heart function,reduces inflammatory reactions,and has high safety.
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