目的 探讨丹参颗粒联合美托洛尔治疗合并冠心病射血分数保留心力衰竭老年患者疗效及其对炎症因子和NT-proBNP、MMP-9水平的影响。方法 回顾性分析2019-12至2022-12陆军第73集团军医院收治的274例射血分数保留心力衰竭合并冠心病老年患者临床资料,按照用药情况分为对照组(n=111)与观察组(n=163)。对照组给予美托洛尔进行治疗,观察组给予美托洛尔+丹参颗粒联合治疗。比较两组患者临床疗效、心功能[左室收缩末期内径(LVESD)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)]、血管内皮功能[内皮素1(ET-1)、一氧化氮(NO)]、炎性因子[超敏 C 反应蛋白(hs-CRP)、可溶性细胞间黏附分子-1(sICAM-1)及白介素-6(IL-6)]、血浆N末端脑钠肽前体(NT-proBNP)与基质金属蛋白酶9(MMP-9)水平及不良反应发生情况。结果 治疗后,观察组临床有效率较对照组高(93.87% vs. 81.98%;P<0.05);治疗后,两组心功能均改善,观察组LVEDD、LVEF、LVESD优于对照组[(47.36±6.43)mm vs.(50.86±4.27)mm;(59.93±4.73)% vs.(56.38±4.21)%;(29.46±4.13)mm vs.(33.56±4.68)mm;P<0.05];治疗后,两组血管内皮功能均改善,观察组ET-1、NO优于对照组[(51.46±7.75)ng/L vs.(59.69±6.73)ng/L;(101.89±11.73)μmol/L vs.(90.71±10.83)μmol/L;P<0.05];治疗后,两组炎性因子水平均改善,观察组hs-CRP、sICAM-1、IL-6优于对照组[(7.27±0.83)mg/L vs.(9.37±0.95)mg/L;(194.68±20.01)ng/ml vs.(223.64±28.79)ng/ml;(27.62±2.93)pg/ml vs.(32.60±3.76)pg/ml;P<0.05];治疗后,两组NT-proBNP、 MMP-9均改善,观察组NT-proBNP、 MMP-9水平优于对照组[(324.19±173.06)ng/L vs.(395.69±186.79)ng/L;(146.72±15.85)μg/L vs.(163.76±16.14)μg/L;P<0.05];两组不良反应发生率无统计学差异(P>0.05)。结论 丹参颗粒联合美托洛尔治疗合并冠心病射血分数保留心力衰竭老年患者疗效明显,可改善炎症状况,降低血清NT-proBNP、MMP-9水平。

Objective To explore the therapeutic effect of Danshen Granules combined with metoprolol in the treatment of elderly patients with preserved ejection fraction heart failure complicated with coronary heart disease, and to analyze its influence on inflammatory factors and the levels of NT proBNP and MMP-9. Methods A retrospective analysis was conducted on the clinical data of 274 elderly patients with preserved ejection fraction heart failure and coronary heart disease admitted to the 73rd Group Military Hospital of PLA Arny from December 2019 to December 2022. The patients were divided into control group (n=111) and observation group (n=163) according to drug use. The control group was treated with metoprolol, while the observation group was treated with a combination of metoprolol and Danshen granules. The clinical efficacy , cardiac function [left ventricular end systolic diameter (LVESD),left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD)], vascular endothelial function [endothelin 1 (ET-1), nitric oxide (NO)], inflammatory factors [hypersensitive C-reactive protein (hs CRP), soluble intercellular adhesion molecule-1 (sICAM-1) and interleukin-6 (IL-6) ], serum levels of NT - proBNP and MMP-9 , and occurrence of adverse reactions were compared between two groups. Results After treatment, the clinical effective rate of the observation group was higher than that of the control group (93.87% vs. 81.98%) (P<0.05). After treatment, the cardiac function of the two groups was improved. The LVEDD, LVEF and LVESD in the observation group were better than those in the control group [(47.36±6.43)mm vs. (50.86±4.27) mm; (59.93±4.73)% vs. (56.38±4.21)%; (29.46±4.13) mm vs. (33.56±4.68 ) mm; P<0.05]. After treatment, the vascular endothelial function of the two groups was improved. The levels of ET-1 and NO in the observation group were better than those in the control group [(51.46±7.75) ng/L vs. (59.69±6.73) ng/L; (101.89±11.73) μmol/L vs. (90.71±10.83) μmol/L; P<0.05]. After treatment, the levels of inflammatory factors in the two groups were improved. The levels of hs-CRP, sI-CAM-1 and IL-6 in the observation group were better than those in the control group [(7.27±0.83) mg/L vs. (9.37±0.95) mg/L; (194.68±20.01) ng/ml vs. (223.64±28.79) ng/ml; (27.62±2.93) pg/ml vs. (32.60±3.76) pg/ml; P<0.05]. After treatment, the levels of NT-proBNP and MMP-9 in the two groups were improved. The levels of NT-proBNP and MMP-9 in the observation group were better than those in the control group [(324.19±173.06) ng/L vs. (395.69±186.79) ng/L; (146.72±15.85)μg/L vs. (163.76±16.14)μg/L; P<0.05]. There was no statistical difference in the occurrence of adverse reactions between two groups (P<0.05). Conclusions The combination of Danshen granules and metoprolol has a significant therapeutic effect on elderly patients with preserved ejection fraction heart failure complicated with coronary heart disease, which can improve inflammation and reduce serum levels of NT proBNP and MMP-9.