2024 年第 3 期 第 19 卷

托拉塞米联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭患者的效果分析

Effects of torasemide combined with sacubitril/valsartan sodium table in patients with chronic heart failure

作者：张成伟1黄娟1毕松杰1尹锐1李小平2

英文作者：Zhang Chengwei1 Huang Juan1 Bi Songjie1 Yin Rui1 Li Xiaoping2

单位：1成都医学院第二附属医院·核工业四一六医院心血管内科，成都610051；2西南医科大学临床医学院,泸州646000

英文单位：1Department of Cardiovascular Medicine the Second Affiliated Hospital of Chengdu Medical College·Nuclear Industry 416 Hospital Chengdu 610051 China; 2School of Clinical Medicine Southwest Medical University Luzhou 646000 China

关键词：慢性心力衰竭；托拉塞米；沙库巴曲缬沙坦钠片；心室重构；肾素活性；血管紧张素Ⅱ；N末端B型脑钠肽前体

英文关键词：Chronicheartfailure;Torasemide;Sacubitril/valsartansodiumtable;Ventricularremodeling;Reninactivity;AngiotensinⅡ;N-terminalpro-brainnatriureticpeptide

• 摘要：

• 目的 分析托拉塞米联合沙库巴曲缬沙坦钠片治疗慢性心力衰竭（CHF）患者的效果。方法 选择成都医学院第二附属医院·核工业四一六医院2022年1—12月收治的CHF患者147例，按照随机数字表法分为观察组（74例）及对照组（73例）。2组均予以基础治疗，对照组口服沙库巴曲缬沙坦钠片治疗，观察组在对照组基础上口服托拉塞米治疗。2组均连续治疗2个月。比较2组疗效、治疗前后心室重构指标、血浆肾素活性及血管紧张素Ⅱ（AngⅡ）、血清N末端B型脑钠肽前体（NT-proBNP）、炎症因子水平和6 min步行距离（6MWD）、生活质量及不良反应发生情况。结果 观察组治疗总有效率高于对照组［93.2%（69/74）比82.2%（60/73）］（P=0.041）。治疗后，2组左心室质量指数、室间隔厚度及左心室后壁厚度均低于/小于治疗前，且观察组均低于/小于对照组（均P＜0.05）。治疗后，2组血浆肾素活性、AngⅡ及血清NT-proBNP水平均低于治疗前，且观察组均低于对照组（均P＜0.05）。治疗后，2组血清白细胞介素6及降钙素原水平均低于治疗前，且观察组均低于对照组（均P＜0.05）。治疗后，2组6MWD长于治疗前，且观察组长于对照组，明尼苏达心功能不全生活质量量表评分低于治疗前，且观察组低于对照组（均P＜0.05）。2组治疗期间未发生不良反应。结论 托拉塞米联合沙库巴曲缬沙坦钠片治疗CHF能提高疗效，抑制患者心室重构，改善运动功能及生活质量，其机制可能与调节肾素活性、AngⅡ及NT-proBNP表达、降低炎症因子水平有关。

• Objective To analyze the effects of torasemide combined with sacubitril/valsartan sodium table in patients with chronic heart failure (CHF). Methods A total of 147 CHF patients admitted to the Second Affiliated Hospital of Chengdu Medical College·Nuclear Industry 416 Hospital from January to December 2022 were selected, and they were divided into observation group (74 cases) and control group (73 cases) according to the random number table method. Both groups were given basic treatment, the control group was treated with sacubitril/valsartan sodium tablet, and the observation group was treated with torasemide on the basis of the control group. Both groups were treated for 2 months. The efficacy, ventricular remodeling indexes, plasma renin activity, angiotensin Ⅱ(Ang Ⅱ), serum N-terminal pro-brain natriuretic peptide(NT-proBNP), inflammatory factor levels, 6 min walking distance (6MWD), quality of life before and after treatment and adverse reactions were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group ［93.2% (69/74) vs 82.2%(60/73), P=0.041］. After treatment, the left ventricular mass index, interventricular septum thickness and left ventricular posterior wall thickness in the two groups were lower/smaller than those before treatment, and those in the observation group were lower/smaller than those in the control group (all P<0.05). After treatment, the levels of plasma renin activity, Ang Ⅱ and serum NT-proBNP in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). After treatment, the levels of serum interleukin-6 and procalcitonin in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). After treatment, the 6MWD of the two groups was longer than that before treatment, and that of the observation group was longer than that of the control group, the score of Minnesota Cardiac Insufficiency Quality of Life Scale was lower than that before treatment, and that of the observation group was lower than that of the control group (all P<0.05). No adverse reactions occurred in the two groups during treatment. Conclusions  Torasemide combined with sacubitril/valsartan sodium table can improve the efficacy, inhibit ventricular remodeling, improve motor function and quality of life in patients with CHF. The mechanism may be related to the regulation of renin activity, the expression of Ang Ⅱ and NT-proBNP, and the reduction of inflammatory factors.