沙库巴曲缬沙坦改善心力衰竭合并心房颤动患者心脏重构并降低血清生长分化因子-15、可溶性Sema4D水平

张峥嵘.沙库巴曲缬沙坦改善心力衰竭合并心房颤动患者心脏重构并降低血清生长分化因子-15、可溶性Sema4D水平[J].内科急危重症杂志,2025,31(4):366-369

DOI：10.11768/nkjwzzzz20250416

中文关键词: 沙库巴曲缬沙坦心力衰竭心房颤动心脏重构血清生长分化因子-15 可溶性Sema4D

英文关键词:

基金项目:四川省乐山市科技计划项目（20ZDYJ0086）;四川省自然科学基金项目（2017 ZRQN 077）

作者	单位	E-mail
张峥嵘	武警四川省总队医院	liaox0408082@163.com

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中文摘要:

摘要目的：研究沙库巴曲缬沙坦对心力衰竭（简称心衰）合并心房颤动（简称房颤）患者心脏重构及血清生长分化因子-15（GDF-15）和可溶性Sema4D（sSema4D）表达的影响。方法：选择慢性心衰合并房颤患者200例，随机分为观察组和对照组，各100例。对照组急性期患者给予静脉注射去乙酰毛花甙注射液、呋塞米、硝酸甘油，口服美托洛尔、华法林和赖诺普利，缓解期患者给予口服药治疗；观察组患者在对照组治疗基础上口服沙库巴曲缬沙坦。6个月后比较2组临床疗效、房颤复发情况、心功能、6 min步行距离，并检测血N末端脑钠肽前体（NT-proBNP）、超敏C反应蛋白（hs-CRP）、可溶性ST2（sST2）、GDF-15、sSema4D水平。结果：6个月后，观察组治疗总有效率高于对照组（90% vs 75%， P <0.05），阵发性房颤发生率低于对照组（9% vs 20%， P <0.05），转成永久性和持续性房颤发生率低于对照组（5% vs 11%， P <0.05）。2组患者的左室舒张末内径（LVEDd）、左室短轴缩短率（LVFS）、左室射血分数（LVEF）和舒张期E峰与A峰比值（E/A）均有明显改善，且观察组优于对照组（ P 均<0.05）。观察组患者的6 min步行距离优于对照组（ P <0.05）。2组患者的血NT-proBNP、hs-CRP、sST2、GDF-15和sSema4D水平均有所降低，且观察组低于对照组（ P 均<0.05）。结论：沙库巴曲缬沙坦对心衰合并房颤患者心功能和临床症状有改善作用，并降低患者血清GDF-15和sSema4D水平。

英文摘要:

Abstract Objective: To study the effect of sacubitril-valsartan on cardiac remodeling and serum growth differentiation factor-15 (GDF-15) and soluble Sema4D (sSema4D) levels in patients with heart failure and atrial fibrillation. Methods: A total of 200 patients with chronic heart failure complicated with atrial fibrillation admitted at our hospital for treatment were selected, and the patients were randomly divided into two groups: 100 cases in the observation group and 100 cases in the control group. The treatment methods for the patients in the acute stage in the control group were intravenous injection of deacetylanthoside, furosemide, nitroglycerin, and oral administration of metoprolol, warfarin and lisinopril, and all patients in the remission stage were given oral administration. The patients in the observation group were additionally treated with sacubitril and valsartan on the basis of the control group. After 6 months of treatment, the clinical efficacy, recurrence of atrial fibrillation, cardiac function, 6-min walking distance, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), serum high-sensitivity C-reactive protein (hs-CRP), soluble ST2 ( sST2), growth differentiation factor-15 (GDF-15) and soluble Sema4D (sSema4D) levels were examined. Results: After treatment for 6 months, the total effective rate was higher in the observation group than in the control group (90% vs 75%, P<0.05). The incidence of paroxysmal atrial fibrillation in the observation group was 9%, significantly lower than that in the control group (20%, P< 0.05). The incidence of permanent atrial fibrillation and persistent atrial fibrillation was 5% in the observation group, significantly lower than that in the control group (11%, P< 0.05). After treatment for 6 months, the LVEDd, LVFS, LVEF and E/A in the two groups were significantly improved as compared with those before treatment (P< 0.05), and those in the observation group displayed better results than in the control group (P< 0.05). After treatment for 6 months, the 6-min walking distance in the observation group was significantly longer than in the control group. After treatment for 6 months, the levels of NT-proBNP, hs-CRP, sST2, GDF-15 and sSema4D in the two groups were decreased (P< 0.05), and those in the observation group displayed better results than in the control group (P< 0.05). Conclusion: The application of sacubitril and valsartan can improve the cardiac function and clinical symptoms in patients with heart failure complicated with atrial fibrillation, and it can effectively reduce the levels of serum GDF-15 and sSema4D in patients.