| Objective: By detecting serum CgA,NT-proBNP and cardiac function indexes(LVEDV、LVESV、LVEF)of patients with dilated cardiomyopathy before and after treatment with Shakubata/Valsartan or perindopril,investigated the effect of sakubaculosartan on ventricular remodeling in patients with heart failure with dilated cardiomyopathy,and further explored its mechanism of action.Methods: In this prospective clinical study,60 patients with heart failure due to dilated cardiomyopathy admitted to the department of cardiology of the second hospital of hebei medical university from January 2018 to May 2018(all patients’ heart function grades were based on the heart function grading standards set by NYHA)were selected as the observation group.There were 34 males and 26 females aged 34 to 71(53.23±11.77)years.According to the NYHA heart function classification,including Ⅱ level 16 cases,Ⅲ 32 cases,12 cases Ⅳ level.At the same time,20 healthy people without cardiac structural and functional changes confirmed by echocardiography in the outpatient physical examination of the second hospital of hebei medical university during the same period were selected as the normal control group,including 12 males and 8 females aged 33-75(51.05±11.73).Sixty patients in the observation group were given cardiac tonic,diuretic,nitrate and other conventional anti-heart failure treatment,and the influence of beta blockers was not escluded in this experiment,observation group was given 2.5mg bisoprolol fumarate orally 1/day,and on this basis,they were randomly divided into two groups,A and B,with 30 patients in each group.Group A was given perindopril tert-butylamine(yashida),starting with 2mg orally 1/ day,gradually increasing the dose until the target dose of 8mg orally 1/day.Group B,50 mg of Shakubata/Valsartan(noxintal)was given orally twice a day,and the dose was doubled once every two weeks until the target dose of 200 mg orally twice a day.During the medication,the systolic blood pressure was guaranteed to be 95 mmHg,which was adjusted to the maximum tolerated dose and maintained for 3 months.The levels of serum NT-proBNP,CgA before and after treatment were determined respectively: left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),and left ventricular ejection fraction(LVEF).Results:1.Comparison of general conditions and related biochemical indexes between the normal control group and the observation group.There were no statistically significant differences in gender,age,blood pressure,body mass index,blood lipid(total cholesterol(TC),low density lipoprotein cholesterol(LDL),high density lipoprotein white cholesterol(HDL),blood glucose and other biochemical indicators among all the subjects(P>0.05).At the same time,there were no statistically significant differences in gender,age,blood pressure,body mass index,blood lipids,blood glucose and other biochemical indexes among the heart function grades in the observation group(P>0.05).2.Comparison of serum NT-proBNP and CgA levels between the normal control group and DCM heart failure group with different cardiac function grades.The levels of serum NT-proBNP and CgA in the DCM heart failure group were significantly higher than those in the normal control group(P<0.01).According to NYHA heart function classification different heart function of patients with NT-proBNP,CgA level,with the severity of heart failure,the higher the heart function grade,the higher the serum NT-proBNP,CgA level(P<0.05).3.Correlation analysis of NT-proBNP and CgA levels with LVEDV,LVESV and LVEF in the DCM heart failure group.Correlation analysis of serum NT-proBNP and CgA levels with LVEDV,LVESV and LVEF in the observation group showed that NT-proBNP levels were positively correlated with LVEDV and LVESV(the correlation was(Pearson correlation)r=0.702,P<0.01,respectively).R =0.707,P<0.01),negatively correlated with LVEF(r=-0.391,P<0.01).CgA level was positively correlated with LVEDV and LVESV(r=0.571,P<0.01,respectively).R =0.596,P<0.01),negatively correlated with LVEF(r=-0.650,P<0.01).There was also a strong correlation between CgA and NT-proBNP,and the correlation coefficient,r was 0.603.4.Changes of serum NT-proBNP,CgA,LVEDV,LVESV and LVEF in each group after treatment.Before treatment,serum NT-proBNP,CgA level and cardiac function indexes LVEDV,LVESV and LVEF were compared between the two groups,and the difference was not statistically significant(P>0.05).Compared with before treatment,the serum levels of NT-proBNP,CgA,LVEDV and LVESV in the two groups after treatment were significantly lower than before treatment(P<0.05),and LVEF was significantly higher than before treatment(P<0.05).Comparison between the two groups,group B after treatment CgA level and LVEDV,LVESV decreased significantly higher than observation group A,the difference was statistically significant(P<0.05),LVEF level increased more significantly than A group,the difference was statistically significant(P<0.05),but the two groups after treatment NT-proBNP difference was not statistically significant(P >0.05).Conclusions:By reducing the expression of serum CgA,Shakubata/Valsartan further inhibits ventricular remodeling and effectively improve cardiac function in patients. |
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