沙库巴曲缬沙坦钠联合阿托伐他汀治疗急性ST段抬高型心肌梗死合并心力衰竭的临床疗效<sup>*</sup>

doi:10.3969/j.issn.1671-7171.2026.04.002

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摘要 【目的】探讨沙库巴曲缬沙坦钠联合阿托伐他汀治疗急性ST段抬高型心肌梗死(STEMI)合并心力衰竭(HF)患者的临床效果。【方法】选择2022年6月至2024年10月本院收治的80例STEMI合并HF患者,根据随机数字表法将患者分为对照组(在常规治疗的基础上给予阿托伐他汀钙片治疗)和观察组(在对照组的基础上给予沙库巴曲缬沙坦钠片治疗),每组40例。比较两组患者临床疗效、心功能指标[左室射血分数(LVEF)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、心肌损伤标志物[氨基末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)]、血管内皮功能指标[血管内皮生长因子(VEGF)、内皮素-1(ET-1)、一氧化氮(NO)]、心肌能量代谢指标[游离脂肪酸(FFA)、左心室收缩末期圆周室壁应力(cESS)、心肌能量消耗(MEE)]及不良反应发生率。【结果】观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组LVEF均高于治疗前,LVESD、LVEDD短于治疗前,且观察组LVEF高于对照组,LVESD、LVEDD短于对照组,差异均有统计学意义(P<0.05);两组MDA水平均低于治疗前,SOD水平高于治疗前,且观察组MDA水平低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05);两组患者NT-proBNP、CK-MB、cTnI水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05);两组NO、VEGF水平高于治疗前,ET-1水平低于治疗前,且观察组NO、VEGF水平高于对照组,ET-1水平低于对照组,差异均有统计学意义(P<0.05);两组FFA、cESS、MEE均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者不良反应发生率低于对照组,差异有统计学意义(P<0.05)。【结论】沙库巴曲缬沙坦钠联合阿托伐他汀治疗STEMI合并HF患者临床效果较好,可调控氧化应激反应及心肌能量代谢情况,具有较好的心肌细胞及血管内皮功能保护作用,安全性较好。

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	江冠颖
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	李岩
	王珍珍
	刘怡凯
	孙利强

关键词 ： ST段抬高型心肌梗死, 急性病, 心力衰竭, 缬沙坦, 阿托伐他汀, 药物疗法, 联合

Abstract：【Objective】 To investigate the clinical efficacy of sacubitril valsartan sodium combined with atorvastatin in patients with acute ST-segment elevation myocardial infarction (STEMI) complicated with heart failure (HF). 【Methods】 A total of 80 patients with STEMI complicated with HF admitted to our hospital from June 2022 to October 2024 were enrolled and randomly divided into a control group and an observation group using a random number table, with 40 cases in each group. The control group received atorvastatin calcium tablets on the basis of conventional treatment, while the observation group was additionally given sacubitril valsartan sodium tablets on the basis of the control group. Clinical efficacy, cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD)], oxidative stress indexes [superoxide dismutase (SOD), malondialdehyde (MDA)], myocardial injury markers [N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI)], vascular endothelial function indexes [vascular endothelial growth factor (VEGF), endothelin-1 (ET-1), nitric oxide (NO)], myocardial energy metabolism indexes [free fatty acid (FFA), circumferential end-systolic wall stress (cESS), myocardial energy expenditure (MEE)], and the incidence of adverse reactions were compared between the two groups. 【Results】 The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). After treatment, LVEF in both groups was increased, while LVESD and LVEDD were decreased compared with baseline; the observation group had higher LVEF and lower LVESD and LVEDD than the control group (all P<0.05). MDA was decreased and SOD was increased in both groups, with lower MDA and higher SOD in the observation group (P<0.05). Levels of NT-proBNP, CK-MB and cTnI were all reduced in both groups, and were lower in the observation group (P<0.05). Levels of NO and VEGF were elevated while ET-1 was reduced in both groups, with higher NO and VEGF and lower ET-1 in the observation group (P<0.05). FFA, cESS and MEE were decreased in both groups, and were lower in the observation group (P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05). 【Conclusion】 Sacubitril valsartan sodium combined with atorvastatin shows favorable clinical efficacy in STEMI patients complicated with HF. It can regulate oxidative stress and myocardial energy metabolism, protect cardiomyocytes and vascular endothelial function, and presents good safety.

Key words： ST Elevation Myocardial Infarction Acute Disease Heart Failure Valsartan Atorvastatin Drug Therapy, Combination

收稿日期: 2025-10-20

中图分类号:

R542.22

基金资助:^*河南省医学科技攻关计划项目(LHGJ20220440)

通讯作者: ^**E-mail:sunliqiang9805@126.com

引用本文:

江冠颖, 张丽华, 单秋菊, 熊海燕, 李岩, 王珍珍, 刘怡凯, 孙利强. 沙库巴曲缬沙坦钠联合阿托伐他汀治疗急性ST段抬高型心肌梗死合并心力衰竭的临床疗效^*[J]. 医学临床研究, 2026, 43(4): 532-536.
JIANG Guanying, ZHANG Lihua, SHAN Qiuju, XIONG Haiyan, LI Yan, WANG Zhenzhen, LIU Yikai, SUN Liqiang. Clinical Efficacy of Sacubitril Valsartan Sodium Combined with Atorvastatin in the Treatment of Acute ST-Segment Elevation Myocardial Infarction Complicated with Heart Failure. JOURNAL OF CLINICAL RESEARCH, 2026, 43(4): 532-536.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.04.002 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I4/532

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