沙库巴曲缬沙坦预防心房颤动射频消融术后心室重构的效果及对炎症因子的影响

顾方方; 潘永康; 卢孔杰; 朱颖炜; 邓浪

doi:10.16766/j.cnki.issn.1674-4152.004040

沙库巴曲缬沙坦预防心房颤动射频消融术后心室重构的效果及对炎症因子的影响

doi: 10.16766/j.cnki.issn.1674-4152.004040

湖州市中心医院心血管内科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2023KY316

详细信息

通讯作者:
邓浪，E-mail: langzi213317@126.com

中图分类号: R541.75
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- 文章访问数: 13
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-20
- 网络出版日期: 2025-09-04

Effect of sacubitril valsartan on preventing ventricular remodeling after radiofrequency ablation for atrial fibrillation and its influence on inflammatory factors

Department of Cardiovascular Medicine, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的探讨沙库巴曲缬沙坦预防心房颤动(AF)射频消融术(RFCA)后心室重构的效果及对患者炎症因子的影响，以期为临床治疗提供新策略。方法选取2022年1月—2023年10月湖州市中心医院收治的152例AF患者，均行RFCA术，采用随机信封法分常规组(接受术后常规治疗)和治疗组(在常规组的基础上加用沙库巴曲缬沙坦), 各76例。比较2组治疗前后心室重构指标、炎症因子水平及房颤复发、不良反应发生情况。结果治疗60 d后，治疗组患者左心室射血分数、QRS电压均高于常规组(P＜0.05)，左心室舒张末期内径、心室收缩末期内径、室间壁厚度、P波离散度、QRS时限均低于常规组(P＜0.05)；治疗60 d后，治疗组患者血清C反应蛋白、白细胞介素-6分别为(5.33±1.27)mg/L、(5.44±1.15)pg/mL，均低于常规组的(6.38±1.18)mg/L、(7.08±1.44)pg/mL(F=28.281、61.441，均P＜0.05)；2组患者治疗后3、6、12个月的房颤累计复发率比较差异无统计学意义(P>0.05)；2组患者用药不良反应发生率比较差异无统计学意义(P>0.05)。结论沙库巴曲缬沙用于AF患者RFCA术后可有效改善患者心室重构，减轻炎症反应，且安全性高。
- 心房颤动 /
- 沙库巴曲缬沙坦 /
- 房颤射频消融术 /
- 心室重构 /
- 炎症
Abstract: Objective To investigate the effect of sacubitril valsartan on the prediction of ventricular remodeling after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) and analyze its influence on inflammatory factors, with a view to providing a new strategy for clinical treatment. Methods A total of 152 AF patients in Huzhou Central Hospital from January 2022 to October 2023 were selected and received RFCA. After surgery, according to the random envelope method, patients were divided into a conventional group (receiving conventional postoperative treatment) and a treatment group (sacubitril valsartan in addition to the conventional group), with 76 cases in each group. The indicators of ventricular remodeling, inflammatory factors, recurrence of atrial fibrillation, and adverse reactions before and after treatment were compared between the two groups. Results After 60 days of treatment, the left ventricular ejection fraction and QRS voltage of patients in the treatment group were higher than those in the conventional group (P < 0.05), while the left ventricular end-diastolic diameter, end-systolic diameter, interventricular wall thickness, P wave dispersion and QRS duration were lower than those in the conventional group (P < 0.05). After 60 days of treatment, the levels of serum C-reactive protein and interleukin-6 in the treatment group with (5.33±1.27) mg/L and (5.44±1.15) pg/mL were lower than (6.38±1.18) mg/L and (7.08±1.44) pg/mL in the conventional group (F=28.281, 61.441, both P < 0.05). No statistical differences were observed in the cumulative recurrence rates of atrial fibrillation at 3, 6, and 12 months after treatment between the two groups (P>0.05). There were no statistical differences in the adverse drug reactions between the two groups (P>0.05). Conclusion Sacubitril valsartan can effectively improve ventricular remodeling and reduce the inflammatory response in AF patients after RFCA, and it has high safety.
- Atrial fibrillation /
- Sacubitril valsartan /
- Atrial fibrillation radiofrequency ablation /
- Ventricular remodeling /
- Inflammation

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表 1 2组AF患者基线资料比较

Table 1. Comparison of baseline data between the two groups of AF patients

组别	例数	年龄 (x±s，岁)	AF病程 (x±s，年)	性别(例)		基础疾病(例)			AF分型(例)		左心房大小 (x±s，cm²)
组别	例数	年龄 (x±s，岁)	AF病程 (x±s，年)	男性	女性	高血压	糖尿病	冠心病	阵发性	非阵发性	左心房大小 (x±s，cm²)
常规组	76	58.89±4.15	5.67±1.12	40	36	22	8	32	24	52	29.67±6.22
治疗组	76	59.61±4.02	5.84±1.03	39	37	21	10	36	21	55	30.09±6.73
统计量		1.086^a	0.974^a	0.026^b		0.032^b	0.252^b	0.426^b	0.284^b		0.440^a
P值		0.279	0.332	0.871		0.857	0.616	0.514	0.594		0.690
注：^a为t值，^b为χ²值。

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表 2 2组AF患者治疗前后超声心动图指标比较(x±s)

Table 2. Comparison of echocardiographic indexes between the two groups of AF patients before and after treatment (x±s)

组别	例数	LVEF(%)		LVEDD(mm)		LVESD(mm)		IVST(mm)
组别	例数	治疗前	治疗60 d后	治疗前	治疗60 d后	治疗前	治疗60 d后	治疗前	治疗60 d后
常规组	76	41.71±4.65	53.32±6.55^b	61.25±5.87	55.04±3.92^b	53.27±4.51	41.08±3.06^b	10.55±1.25	8.51±0.81^b
治疗组	76	42.64±4.75	56.05±7.35^b	61.94±5.02	53.11±3.66^b	52.99±4.78	39.44±2.87^b	10.36±1.31	8.14±0.55^b
统计量		1.220^a	5.495^c	0.779^a	5.651^c	0.371^a	5.184^c	0.915^a	7.632^c
P值		0.224	0.020	0.437	0.019	0.711	0.024	0.362	0.006
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 3 2组AF患者治疗前后心电图指标比较(x±s)

Table 3. Comparison of ECG indexes between the two groups of AF patients before and after treatment (x±s)

组别	例数	P波离散度(ms)		QRS电压(mV)		QRS时限(ms)
组别	例数	治疗前	治疗60 d后	治疗前	治疗60 d后	治疗前	治疗60 d后
常规组	76	43.81±3.50	35.35±3.93^b	12.57±1.33	13.64±1.45^b	130.65±20.13	116.47±15.22^b
治疗组	76	44.06±3.29	33.79±3.57^b	12.62±1.26	14.41±1.47^b	131.44±19.48	112.54±14.63^b
统计量		0.454^a	6.438^c	0.238^a	8.629^c	0.246^a	6.150^c
P值		0.651	0.012	0.812	0.004	0.806	0.014
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 4 2组AF患者治疗前后血液生化指标比较(x±s)

Table 4. Comparison of biochemical indexes between the two groups of AF patients before and after treatment (x±s)

组别	例数	CRP(mg/L)		IL-6(pg/mL)
组别	例数	治疗前	治疗60 d后	治疗前	治疗60 d后
常规组	76	9.87±1.57	6.38±1.18^b	18.87±4.19	7.08±1.44^b
治疗组	76	10.03±2.34	5.33±1.27^b	19.13±3.94	5.44±1.15^b
统计量		0.495^a	28.281^c	0.394^a	61.441^c
P值		0.621	＜0.001	0.694	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 5 2组AF患者治疗后累计房颤复发情况比较[例(%)]

Table 5. Comparison of cumulative recurrence of atrial fibrillation between the two groups of AF patients after treatment [cases (%)]

组别	例数	治疗后3个月	治疗后6个月	治疗后12个月
常规组	76	1(1.32)	3(3.95)	6(7.89)
治疗组	76	0	1(1.32)	2(2.63)
注：治疗后各时间点间比较，Z_时间=3.061，P_时间=0.068；治疗后2组间比较，Z_组间=2.174，P_组间=0.109；时间、组间的交互作用，Z_交互=1.153，P_交互=0.562。

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表 6 2组AF患者药物不良反应发生情况比较[例(%)]

Table 6. Comparison of the occurrence of adverse drug reactions between the two groups of AF patients [cases (%)]

组别	例数	低血压	高血钾	心动过缓	房室传导阻滞	出血倾向	合计
常规组	76	1(1.32)	2(2.63)	1(1.32)	1(1.32)	0	5(6.58)
治疗组	76	2(2.63)	2(2.63)	2(2.63)	1(1.32)	1(1.32)	8(9.21)
注：2组总不良反应发生情况比较，χ²=0.757，P=0.384。

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参考文献(19)

[1]	李祺, 罗贵全, 刘磊, 等. 导管射频消融术对心力衰竭合并持续性心房颤动患者心脏结构与远期预后的影响[J]. 中华全科医学, 2025, 23(2): 227-230, 247. doi: 10.16766/j.cnki.issn.1674-4152.003873 LI Q, LUO G Q, LIU L, et al. The effect of catheter radiofrequency ablation on cardiac structure and long-term prognosisin patients with heart failure and persistent atrial fibrillation[J]. Chinese Journal of General Practice, 2025, 23(2): 227-230, 247. doi: 10.16766/j.cnki.issn.1674-4152.003873
[2]	赵恩晨, 金仁波, 宁伟, 等. 射血分数保留心力衰竭合并持续性心房颤动患者超声测得左心房容积指数、左房内径和N末端脑钠肽前体变化及临床意义[J]. 中国临床医学影像杂志, 2024, 35(2): 100-104. ZHAO E C, JIN R B, NING W, et al. Changes and clinical significance of left atrial volume index and left atrial diameter measured by ultrasound and serum N-terminal pro-brain natriuretic peptide in patients with heart failure with preserved ejection fraction and persistent atrial fibrillation[J]. Journal of China Clinic Medical Imaging, 2024, 35(2): 100-104.
[3]	赵鹏宇, 何长健, 刘倩, 等. 射频消融联合左心耳封堵术对老年心房颤动患者生活质量及衰弱的影响[J]. 中华老年心脑血管病杂志, 2022, 24(12): 1283-1287. doi: 10.3969/j.issn.1009-0126.2022.12.014 ZHAO P Y, HE C J, LIU Q, et al. Effect of RFCA combined with left atrial appendage closure on quality of life and frailty in elderly patients with AF[J]. Chinese Journal of Geriatric Heart, Brain and Vessel Diseases, 2022, 24(12): 1283-1287. doi: 10.3969/j.issn.1009-0126.2022.12.014
[4]	刘曦, 李骁, 张磊, 等. 房室结消融联合左束支起搏治疗心房颤动合并心力衰竭的效果[J]. 中华心律失常学杂志, 2024, 28(3): 218-223. doi: 10.3760/cma.j.cn113859-20240410-00036 LIU X, LI X, ZHANG L, et al. Efficacy of atrioventricular node ablation combined with left bundle branch pacing in the treatment of atrial fibrillation complicated with heart failure[J]. Chinese Journal of Cardiac Arrhythmias, 2024, 28(3): 218-223. doi: 10.3760/cma.j.cn113859-20240410-00036
[5]	冯倩, 师淼, 赵东坡, 等. 恩格列净联合沙库巴曲缬沙坦治疗心房颤动合并射血分数保留的心力衰竭效果观察[J]. 临床误诊误治, 2024, 37(11): 46-51, 82. doi: 10.3969/j.issn.1002-3429.2024.11.009 FENG Q, SHI M, ZHAO D P, et al. Observation of the effect of empagliflozin combined with sacubitril/valsartan on atrial fibrillation complicated by heart failure with preserved ejection fraction[J]. Clinical Misdiagnosis & Mistherapy, 2024, 37(11): 46-51, 82. doi: 10.3969/j.issn.1002-3429.2024.11.009
[6]	黄琼, 刘荣, 陈立鸿, 等. 持续性心房颤动射频消融术后应用沙库巴曲缬沙坦的疗效分析[J]. 中华老年医学杂志, 2021, 40(7): 872-876. doi: 10.3760/cma.j.issn.0254-9026.2021.07.012 HUANG Q, LIU R, CHEN L H, et al. Clinical effects of Sacubitril/Valsartan on persistent atrial fibrillation after catheter ablation[J]. Chinese Journal of Geriatrics, 2021, 40(7): 872-876. doi: 10.3760/cma.j.issn.0254-9026.2021.07.012
[7]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 心房颤动基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2020, 19(6): 465-473. doi: 10.3760/cma.j.cn114798-20191118-00838 Chinese Medical Association, Chinese Medical Journals Publishing House, Chinese Society of General Practice of Chinese Medical Association, et al. Guideline for primary care of atrial fibrillation (2019)[J]. Chinese Journal of General Practitioners, 2020, 19(6): 465-473. doi: 10.3760/cma.j.cn114798-20191118-00838
[8]	CALKINS H, HINDRICKS G, CAPPATO R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation[J]. Heart Rhythm, 2017, 14(10): e275-e444.
[9]	FRANZT S, HUNDERTMARK MJ, SCHULZ-MENGER J, et al. Left ventricular remodelling post-myocardial infarction: pathophysiology, imaging, and novel therapies[J]. Eur Heart J, 2022, 43(27): 2549-2561.
[10]	龚敏, 丁士勤. 芪苈强心胶囊治疗顽固性心力衰竭患者的疗效及对其心室重构的影响[J]. 世界中西医结合杂志, 2023, 18(5): 954-959, 964. GONG M, DING S Q. Efficacy of Qili Qiangxin capsules in the treatment of refractory heart failure and the effect on ventricular remodeling[J]. World Journal of Integrated Traditional and Western Medicine, 2023, 18(5): 954-959, 964.
[11]	许云树, 司马祎鋆, 莫裕萍. 沙库巴曲缬沙坦钠对缺血性心肌病型冠心病患者血管硬化和心室重构的影响[J]. 中国医师进修杂志, 2023, 46(5): 385-390. doi: 10.3760/cma.j.cn115455-20220915-00802 XU Y S, SIMA Y Y, MO Y P. Effects of sacubitril valsartan sodium on vascular sclerosis and ventricular remodeling in patients with ischemic cardiomyopathical coronary heart disease[J]. Chinese Journal of Postgraduates of Medicine, 2023, 46(5): 385-390. doi: 10.3760/cma.j.cn115455-20220915-00802
[12]	刘菲, 杨文灿. 沙库巴曲缬沙坦对扩张型心肌病心力衰竭患者心室重构和心脏功能的影响[J]. 中南医学科学杂志, 2023, 51(2): 222-225. LIU F, YANG W C. Effect of sacubitril-valsartan on ventricular remodeling and cardiac function in patients with dilated cardiomyopathy heart failure[J]. Medical Science Journal of Central South China, 2023, 51(2): 222-225.
[13]	周琴, 严炜. 沙库巴曲缬沙坦对合并与不合并2型糖尿病射血分数降低心力衰竭患者心室重构及预后的影响[J]. 中国现代医学杂志, 2022, 32(10): 70-74. doi: 10.3969/j.issn.1005-8982.2022.10.013 ZHOU Q, YAN W. Effect of sacubitril and valsartan on ventricular remodeling and prognosis in patients with heart failure with reduced ejection fraction with or without T2DM[J]. China Journal of Modern Medicine, 2022, 32(10): 70-74. doi: 10.3969/j.issn.1005-8982.2022.10.013
[14]	刘帆, 张保俭. 胺碘酮联合沙库巴曲缬沙坦治疗扩张型心肌病合并心律失常的效果及对心电节律的改善作用[J]. 中国医院用药评价与分析, 2022, 22(5): 544-548. LIU F, ZHANG B J. Efficacy of amiodarone combined with sacubitril valsartan in the treatment of dilated cardiomyopathy complicated with cardiac arrhythmia and its effect on improvement of electrocardiograph rhythm[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2022, 22(5): 544-548.
[15]	FONSECA F A, IZAR M C. Role of inflammation in cardiac remodeling after acute myocardial infarction[J]. Front Physiol, 2022, 13: 927163. DOI: 10.3389/fphys.2022.927163.
[16]	王进, 王蓉, 陆蕙. 老年冠心病心力衰竭患者血清IL-8、Hcy、CRP水平与心室重构及预后的关系[J]. 心血管康复医学杂志, 2023, 32(6): 569-574. doi: 10.3969/j.issn.1008-0074.2023.06.05 WANG J, WANG R, LU H. Relationship among serum IL-8, Hcy, CRP levels, ventricular remodeling and prognosis in aged patients with coronary heart failure and heart failure[J]. Chinese Journal of Cardiovascular Rehabilitation Medicine, 2023, 32(6): 569-574. doi: 10.3969/j.issn.1008-0074.2023.06.05
[17]	吴梅芳, 吴莹, 许开祖, 等. 沙库巴曲缬沙坦通过下调转化生长因子β1/Smads信号通路改善急性心肌梗死大鼠心肌纤维化和心功能[J]. 中华高血压杂志, 2021, 29(6): 549-554. WU M F, WU Y, XU K Z, et al. Sacubitril/valsartan improves cardiac fibrosis and function via inhibiting transforming growth factor beta 1/Smads pathway in rats with acute myocardial infarction[J]. Chinese Journal of Hypertension, 2021, 29(6): 549-554.
[18]	吴金家, 宋旭东, 廖佩娟, 等. 沙库巴曲缬沙坦对房颤伴心功能不全、心功能正常射频消融术后患者心功能及房颤复发率的影响[J]. 临床医学研究与实践, 2024, 9(24): 18-21. WU J J, SONG X D, LIAO P J, et al. Effects of sacubitril valsartan on cardiac function and recurrence rate of atrial fibrillation in patients with atrial fibrillation complicated with cardiac insufficiency and normal cardiac function after radiofrequency ablation[J]. Clinical Research and Practice, 2024, 9(24): 18-21.
[19]	梁晓芳, 李文华, 宋艳斌, 等. 沙库巴曲缬沙坦对持续性心房颤动导管消融术后临床疗效的影响: 基于倾向性评分的单中心队列研究[J]. 临床心血管病杂志, 2023, 39(9): 699-706. LIANG X F, LI W H, SONG Y B, et al. Effect of sacubitril/valsartan on clinical outcomes in patients with persistent atrial fibrillation undergoing catheter ablation: a single-center cohort study using propensity score matching[J]. Journal of Clinical Cardiology, 2023, 39(9): 699-706.