摘要
目的探究重组人脑钠肽(rhBNP)联合沙库巴曲缬沙坦钠对高原性心脏病(HAHD)急性心力衰竭患者疗效及对肺动脉压力的影响。方法选取2021年1月至2023年12月新疆军区总医院收治的32例HAHD急性心力衰竭患者为研究对象,按入院顺序编号分为对照组和观察组,每组各16例。对照组给予急性心力衰竭常规治疗方案+缬沙坦,观察组给予常规治疗方案+rhBNP联合沙库巴曲缬沙坦钠,比较2组疗效、心功能指标、肺动脉压力、脉搏波传导速度(PWV)及氨基末端脑钠肽前体(NT‑proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、一氧化氮(NO)、内皮素‑1(ET‑1)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平。结果观察组临床疗效优于对照组(P<0.05);观察组临床缓解天数、6 min步行距离、出院时心功能改善例数均优于对照组(P<0.05),NT‑proBNP较对照组显著降低(P<0.01)。观察组左心室射血分数(LVEF)、左心室舒张早期/晚期充盈流速比与入院时比较明显改善(P<0.05),LVEF、左心室内径(LVD)较对照组增加(P<0.05);观察组右心室内径(RVD)、右心室流出道内径(RVOT)、肺动脉内径(PAD)、肺动脉压力(PASP)较对照组均明显降低(P<0.05)。与对照组相比,观察组PWV明显降低。与对照组相比,观察组sST2、NT‑proBNP、ET‑1、MDA水平均明显降低(P<0.05),SOD、NO水平明显升高(P<0.01)。结论rhBNP联合沙库巴曲缬沙坦钠可显著提高治疗HAHD急性心力衰竭的临床疗效及改善预后,并可明显降低肺动脉压力;从生物标志物变化来看,该联合方案可能通过影响氧化应激、NO水平及心肌纤维化相关指标发挥作用,但相关机制仍需更多基础实验及大样本临床研究进一步验证。
Objective To explore the efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with sacubitril‑valsartan in the treatment of acute heart failure(AHF)due to high‑altitude heart disease(HAHD)and its effect on pulmonary artery pressure.Methods A total of 32 patients with HAHD‑related AHF who were admitted to the General Hospital of Xinjiang Military Command from January 2021 to December 2023 were selected and assigned to control group or observation group(16 cases in each group)by admission order.The control group received conventional AHF treatment+valsartan,while the observation group received conventional treatment+rhBNP+sacubitril‑valsartan sodium.The efficacy,cardiac function indexes,pulmonary artery pressure,pulse wave velocity(PWV),and the levels of N‑terminal pro brain natriuretic peptide(NT‑proBNP),soluble ST2(sST2),nitric oxide(NO),endothelin(ET‑1),superoxide dismutase(SOD),and malondialdehyde(MDA)were compared between the two groups.Results The clinical efficacy of the observation group was significantly better than that of the control group(P<0.05).The clinical remission time,6‑minute walking distance,and the number of patients with improved cardiac function at discharge in the observation group were significantly superior to the control group(P<0.05).NT‑proBNP level in the observation group was significantly lower than that in the control group(P<0.01).Left ventricular ejection fraction(LVEF)and E/A in the observation group were significantly improved after treatment(P<0.05);LVEF and left ventricle diameter(LVD)in the observation group were significantly higher than those in the control group(P<0.05).Right ventricle diameter(RVD),right ventricular outflow tract(RVOT),pulmonary artery diameter(PAD),pulmonary arterial systolic pressure(PASP),PWV,and the levels of sST2,NTproBNP,ET‑1,and MDA in the observation group were significantly lower than those in the control group(P<0.05).SOD and NO levels in the observation group were significantly higher than those in the control group(P<0.01).Conclusion rhBNP combined with sacubitril‑valsartan sodium can significantly improve the clinical efficacy and prognosis of HAHD‑related AHF,and reduce pulmonary artery pressure.Based on the changes of biomarkers,the combined regimen may play a role by affecting oxidative stress,NO level and myocardial fibrosis‑related indexes,but the mechanism needs further confirmation by more basic experiments and largesample clinical studies.
作者
张志敏
段翔译
李兴辉
李慧杰
路军
李喆
马丽群
Zhang Zhimin;Duan Xiangyi;Li Xinghui;Li Huijie;Lu Jun;Li Zhe;Ma Liqun(General Hospital of Xinjiang Military Command,Urumqi 830000,China)
出处
《海军医学杂志》
2026年第2期137-142,共6页
Journal of Navy Medicine
基金
新疆维吾尔自治区自然科技基金面上项目(2020D01A138)。
关键词
重组人脑利钠肽
沙库巴曲缬沙坦
高原性心脏病
心力衰竭
肺动脉压力
Recombinant human brain natriuretic peptide
Sacubitril‑valsartan
High‑altitude heart disease
Heart failure
Pulmonary artery pressure
