摘要
目的探讨恩格列净联合诺欣妥治疗对急性心肌梗死(AMI)后心力衰竭患者血清高敏C反应蛋白(hs-CRP)、N末端B型钠尿肽前体(NT-proBNP)及预后的影响。方法选取2022年8月至2024年6月北京大学第三医院秦皇岛医院收治的AMI后心力衰竭患者178例,根据随机数表法分为对照组(89例)和观察组(89例)。对照组接受诺欣妥治疗,观察组在对照组基础上增加恩格列净治疗。比较两组治疗前、治疗3个月心功能指标(左心室射血分数、左心室收缩末期容积、左心室舒张末期容积)、血清炎症标志物(hs-CRP、脑钠肽、NT-proBNP)、心率、6 min步行试验、预后相关生物标志物(基质金属蛋白酶9、髓过氧化物酶)、治疗后血压及不良反应发生情况,采用多因素Cox比例风险回归分析影响AMI后心力衰竭患者预后[主要不良心血管事件(MACE)、再住院率及全因病死率]的影响因素。结果观察组治疗3个月左心室射血分数、6 min步行试验高于或长于对照组,左心室收缩末期容积、左心室舒张末期容积、hs-CRP、脑钠肽、NTproBNP、心率、基质金属蛋白酶9、髓过氧化物酶水平低于对照组,差异有统计学意义(P<0.05)。两组治疗后血压及不良反应发生率比较,差异无统计学意义(P>0.05)。随访6个月结果显示,观察组MACE发生率、再住院率、全因病死率低于对照组(21.35%vs 35.96%,P<0.05;10.11%vs 24.72%,P<0.05;2.25%vs 10.11%,P<0.05)。多因素Cox比例风险回归分析显示,治疗方式是影响AMI后心力衰竭患者预后的影响因素:与对照组比较,观察组发生MACE的风险降低46.7%(HR=0.533,95%CI:0.312~0.921,P<0.05),再住院风险降低58.6%(HR=0.414,95%CI:0.210~0.803,P<0.05),全因死亡风险降低80.7%(HR=0.193,95%CI:0.042~0.881,P<0.05)。结论在诺欣妥的基础上,联用恩格列净治疗AMI后心力衰竭可显著改善患者心功能,减轻炎症反应,同时提高运动耐量。此外,联合治疗还能降低MACE发生风险、再住院率及全因病死率,且不增加血压波动及不良反应,安全性良好。
Objective To investigate the effects of empagliflozin combined with Entresto(Sacubitril/Valsartan)therapy on serum high-sensitivity C-reactive protein(hs-CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),and prognosis in patients with heart failure after acute myocardial infarction(AMI).Methods A total of 178 patients with heart failure after AMI admitted to Qinhuangdao Hospital of Peking University Third Hospital from August 2022 to June 2024 were selected.They were randomly divided into a control group(89 cases)and an experimental group(89 cases)using a random number table method.Patients in the control group received treatment with Entresto,and patients in the experimental group received empagliflozin in addition to the control group's regimen.Cardiac function indicators(left ventricular ejection fraction,left ventricular end-systolic volume,left ventricular end-diastolic volume),serum inflammatory markers(hs-CRP,B-type natriuretic peptide,NT-proBNP)levels,heart rate,6-minute walk test distance,prognostic biomarkers(matrix metalloproteinase-9,myeloperoxidase)levels,post-treatment blood pressure,and incidence of adverse reactions were compared between the two groups before and after 3 months of treatment.Multivariate Cox proportional hazards regression analysis was used to identify factors influencing patient prognosis[including major adverse cardiovascular events(MACE),readmission rate,and all-cause mortality rate].Results After 3 months of treatment,left ventricular ejection fraction and 6-minute walk test distance in the experimental group were higher/longer than those in the control group,while left ventricular end-systolic volume,left ventricular end-diastolic volume,hs-CRP,B-type natriuretic peptide,NT-proBNP,heart rate,matrix metalloproteinase-9,and myeloperoxidase levels were lower,with statistically significant differences(P<0.05).There was no statistically significant difference in blood pressure or adverse reaction incidence between the two groups after treatment(P>0.05).The 6-month follow-up results showed that the incidence of MACE,readmission rate,and all-cause mortality rate in the experimental group were significantly lower than those in the control group(21.35%vs 35.96%,P<0.05;10.11%vs 24.72%,P<0.05;2.25%vs 10.11%,P<0.05).Multivariate Cox proportional hazards regression analysis showed that treatment modality was an independent factor affecting patient prognosis:compared with the control group,the experimental group had a 46.7%reduced risk of MACE(HR=0.533,95%CI:0.312–0.921,P<0.05),a 58.6%reduced risk of readmission(HR=0.414,95%CI:0.210–0.803,P<0.05),and an 80.7%reduced risk of all-cause mortality(HR=0.193,95%CI:0.042–0.881,P<0.05).Conclusion Adding empagliflozin to Entresto therapy for heart failure after AMI can significantly improve cardiac function,reduce inflammatory response,and increase exercise tolerance.Furthermore,the combination therapy reduces the risk of MACE,readmission rates,and all-cause mortality,without increasing blood pressure fluctuations or adverse reactions,demonstrating good safety.
作者
石琳
王春梅
祁雨
张艳平
程方兵
王雯
SHI Lin;WANG Chunmei;QI Yu;ZHANG Yanping;CHENG Fangbing;WANG Wen(Department of Cardiology,Peking University Third Hospital Qinhuangdao Hospital,Qinhuangdao,Hebei 066000,China;Department of Cardiology,Peking University Third Hospital,Beijing 100080,China)
出处
《转化医学杂志》
2025年第8期145-150,共6页
Translational Medicine Journal
基金
国家自然科学基金(82200298)
2023年度市级科学技术研究与发展计划自筹经费项目(202301A227)。
关键词
恩格列净
诺欣妥
急性心肌梗死
心力衰竭
empagliflozin
Entresto
acute myocardial infarction
heart failure
作者简介
通信作者:石琳,E-mail:shilin8306@163.com。
