RESUMO
Objective To investigate the effects of Sacubitril/Valsartan on amino terminal probrain natriuretic peptide (NT-proBNP),high sensitivity C-reactive protein (hs-CRP),soluble suppression of tumorigenicity 2(sST2)levels and on left ventricular(LV)structure in NYHA Ⅳ heart failure with reduced ejection fraction(HFrEF) patients.Methods A total of 67 HFrEF patients with NYHA Ⅳ were randomly divided into the control group (n =30)receiving conventional medical treatment,and the observation group(n=32)receiving Sacubitril/Valsartan instead of ACEI(or ARB if ACEI induced cough) in conventional medical treatment.NT-proBNP levels were determined by fluorescer-enhanced chemiluminescence.hs CRP levels were detected by latecx enhanced immunoturbidimetric assay.sST2 levels were determined by enzyme-linked immunosorbent assay (ELISA).The modified Simpson method was used to detect left ventricular end-diastolic diameter (LVEDD),LV posterior wall(LVPW)and LV ejection fraction(LVEF).Two groups of patients were treated and followed-up for 6 months.Results Clinical efficacy was better in the observation group than in the control group(effective rate,20 cases or 61.3％ vs.8 cases or 26.7％,P＜0.05).As compared with the control group,the observation group of patients had an increased LVEF[(46.7±9.2) ％ vs.(41.8±8.0)％,P＜0.05]and a decreased LVEDD[(52.6±6.7)mm vs.(58.8±7.5)mm,P＜0.05].After vs.before treatment,NT-proBNP,hs-CRP and sST2 levels were decreased in both control and observation groups [(1 427 ± 219) μg/L vs.(2 615 ± 273)μg/L,(1.14 ± 1.02) mg/L vs.(1.55±1.38)mg/L,(0.30±0.12)μg/L vs.(0.41±0.10)μg/L,all P＜0.05],and the decrements were much more in the observation group than in the control group (P＜0.05).The annual accumulated frequence and duration of hospitalization were less in the observation group than in the control group[(0.8±0.6)times vs.(1.8±1.0) times,(10.2±5.8)d vs.(16.5±7.2)d,P＜0.05].The maintenance dose of tolasemide was lower in the observation group than in the control group [(15.2±8.4)mg vs.(20.6±10.8)mg,P＜0.05].Conclusions Sacubitril/valsartan therapy is safe and effective and it can reduce hs-CRP and sST2 levels and improve the ventricular remodeling in HFrEF patients of HYHA Ⅳ.
RESUMO
Objective To investigate correlations of hyperuricemia and matrix metalloproteinase -9 level with left ventricular remodeling in patients with type 2 diabetes and the clinical effect of intervention for hyperuricemia.Methods 100 type 2 diabetic patients with hyperuricemia in our hospital from June 2011 to June 2012 were selected as hyperuricemia group,50 type 2 diabetic cases with normal uric acid were considered as DM group.Levels of blood glucose,blood lipids,glycosylated hemoglobin and matrix metalloproteinase-9 were detected.All patients underwent echocardiography.Patients in hyperuricemia group were randomly divided into treatment group (receiving allopurinol and alkaline urine-alkalify therapy added to hypoglycemic treatment,n=50) and control group (receiving hypoglycemic treatment,n=50).After 6 months of treatment,levels of blood glucose,blood lipids,glycosylated hemoglobin,matrix metalloproteinase-9 and echocardiography were rechecked.Results The levels of triglyceride (TG),blood uric acid,MMP-9,left ventricular posterior wall thickness (LVPWT),interventricular septal thickness (IVST) and left ventricular mass index (LVMI) were increased in hyperuricemia group versus DM group[(2.3±0.5) mmol/L vs.(1.6±0.30) mmol/L,(498.9±32.5) μmol/L vs.(322.8±35.6) μmol/L,(765±38) g/L vs.(420±26) pg/L,(11.0±1.1) mm vs.(9.2±0.8) mm,(11.5±1.6) mm vs.(10.1±1.1) mm,(138.7±35.6) g/m2 vs.(115.0±10.4)g/m2,t=4.945,5.124,4.895,3.985,3.965,3.989,respectively,all P＜0.05].Levels of TG,blood uric acid,MMP,LVPWT,IVST were decreased in treatment group after treatment versus before treatment [(1.6±0.5) mmol/L vs.(2.3±0.6) mmol/L,(323.0±30.5) μmol/L vs.(496.6±32.6) μmol/L,(766±34) pg/L vs.(410±25)pg/L,(9.1±0.8) mm vs.(11.0±1.1) mm,(9.2±1.1) mm vs.(11.6±1.5) mm,(116±10.5)g/m2 vs.(138.8±35.2) g/m2,t=3.386,4.525,4.865,3.256,3.895,3.985,all P＜0.05].Correlation analysis showed that LVMI had positive correlations with levels of blood uric acid,TG,MMP-9 (r=0.435,0.348,0.356,respectively).Conclusions Hyperuricemia involves in left ventricular remodeling,and therapeutic intervention on the hyperuricemia can reverse this remodeling.