| 沙库巴曲缬沙坦联合瑞舒伐他汀对AF合并HFpEP的治疗作用 |
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| 引用本文： | 冯倩,赵东坡,师淼,吴泽阳.沙库巴曲缬沙坦联合瑞舒伐他汀对AF合并HFpEP的治疗作用[J].心脏杂志,2022,34(4):399-403. |
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| 作者姓名： | 冯倩 赵东坡 师淼 吴泽阳 |
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| 作者单位： | 张家口市第一医院心内三科 河北 张家口 075000 |
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| 基金项目： | 河北省卫生健康委医学科学研究项目资助（20211610） |
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| 摘 要： | 目的 探讨沙库巴曲缬沙坦联合瑞舒伐他汀对房颤（AF）合并射血分数保留心衰（HFpEP）的治疗作用。 方法 选取2019年10月～2020年10月张家口市第一医院114例AF合并HFpEP患者，随机数字表法分组，对照组和研究组各57例。对照组口服瑞舒伐他汀，研究组基于对照组加服沙库巴曲缬沙坦，均治疗1个月。统计两组临床疗效、不良反应、窦性心律维持有效率，比较治疗前、治疗后1个月心室重构指标左房容积指数（LAVI）、左室质量指数（LVMI）、左室舒张末期内径（LVEDD）、左心室射血分数（LVEF）]、心电图指标（QRS波时限、QTc间期、平面QRS-T夹角）、几丁质酶3样蛋白1（CH1L1）、N末端B型脑钠肽前体（NT-proBNP）、Apelin水平，Spearman分析临床疗效与心室重构指标相关性。 结果 治疗后1个月，研究组治疗总有效率高于对照组（P<0.05）；治疗后1个月研究组LVEF大于对照组，LVEDD、LAVI、LVMI、QRS波时限、QTc间期、平面QRS-T夹角小于对照组（P<0.01）；治疗后1个月研究组血清NT-proBNP、CH1L1水平低于对照组，Apelin水平高于对照组（P<0.01）；两组低血压、头痛、咽炎等不良反应发生率比较，差异无统计学意义；治疗后3个月随访，两组均无失访病例。研究组窦性心律维持有效率与对照组比较，差异无统计学意义。相关性分析显示，AF合并HFpEP患者临床疗效与LVEF呈正相关，与LVEDD、LAVI、LVMI呈负相关（P<0.05）。 结论 沙库巴曲缬沙坦联合瑞舒伐他汀治疗AF合并HFpEP效果确切，且治疗效果与心室重构相关指标的改善有密切相关。
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| 关 键 词： | 房颤 射血分数保留心衰 瑞舒伐他汀 沙库巴曲缬沙坦 心室重构 |
| 收稿时间： | 2021-08-22 |
Relationship between ventricular remodeling and sacubitril and valsartan combined with rosuvastatin in treatment of patients with atrial fibrillation and heart failure with preserved ejection fraction |
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| Affiliation: | Department of Cardiology, First Hospital of Zhangjiakou, Zhangjiakou 075000, Hebei, China |
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| Abstract: | AIM To investigate the therapeutic effect of sacubitril-valsartan combined with rosuvastatin on atrial fibrillation (AF) complicated with heart failure with preserved ejection fraction (HFpEP). METHODS A total of 114 patients with AF combined with HFpEP in our hospital from October 2019 to October 2020 were selected and grouped by random number table, with 57 cases in each group. The control group received oral rosuvastatin and the study group was given oral sacubitril and valsartan based on the treatment of the control group. Both were treated for 1 month. Clinical efficacy, adverse reactions and effective rate of maintaining sinus rhythm were observed. Comparison between the two groups were made in ventricular remodeling indexes before and one month after treatment left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular end-diastole Inner diameter (LVEDD), left ventricular ejection fraction (LVEF)], ECG indicators (QRS wave duration, QTc interval, planar QRS-T angle), chitinase 3-like protein 1 (CH1L1), N-terminal type B Pre-brain natriuretic peptide (NT-proBNP) and Apelin levels. Spearman correlation analysis was performed to determine the correlation between clinical efficacy and ventricular remodeling indicators. RESULTS One month after treatment, the total effective rate of treatment in the study group higher than that in the control group (P<0.05). Compared with those in the control group, the LVEF in the study group was bigger, the time limit of LVEDD, LAVI, LVMI, QRS wave and the QTc interval and the plane QRS-T angle were smaller (P<0.01), the serum NT-proBNP and CH1L1 levels were lower, and the Apelin level was higher (P<0.01). There was no statistically significant difference in the incidence of adverse reactions such as hypotension, headache and pharyngitis between the two groups . Three months after treatment, there was no loss to follow-up in the two groups. There was no statistically significant difference in the effective rate of maintaining sinus rhythm between the two groups . Spearman correlation analysis showed that the clinical efficacy of patients with AF combined with HFpEP was positively correlated with LVEF, and negatively correlated with LVEDD, LAVI, and LVMI (P<0.05). CONCLUSION Sacubitril-valsartan combined with rosuvastatin is effective in the treatment of AF complicated with HFpEP, and the treatment effect is closely related to the improvement of ventricular remodeling-related indicators. |
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