目的: 探究ω-3多不饱和脂肪酸（polyunsaturated fatty acids,PUFAs）治疗老年射血分数保留心力衰竭（heart failure with preserved ejection fraction,HFpEF）患者的治疗效果。方法: 选取2022年9月—2023年6月本院老年医学部老年HFpEF患者108例,随机数字表法分为对照组（n=54）、观察组（n=54）。对照组予以常规心衰治疗,观察组在此基础上予以ω3PUFAs治疗。观察两组临床疗效及治疗前后心功能[左室射血分数（left ventricular ejection fraction,LVEF）、左室舒张末期内径（left ventricular end-diastolic diameter,LVEDD）、室间隔厚度（interventricular septum thickness,IVST）、左室后壁厚度（left ventricular posterior wall thickness,LVPWT）]、心肌损伤标志物[超敏肌钙蛋白T（high-sensitivity troponin T,hs-cTnT）、超敏C反应蛋白（high-sensitivity C-reactive protein,hs-CRP）、氨基末端脑钠肽（amino terminal pro-brain natriuretic peptide,NT-proBNP）]、炎症指标[白介素-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、正五聚蛋白3（pentraxin 3,PTX-3）]、6 min步行距离（6 min walking distance,6MWD）、日常生活能力（activities of daily living,ADL）。观察两组主要不良心血管事件（major adverse cardiovascular events,MACE）发生率。结果: 观察组总有效率高于对照组;观察组治疗6个月后LVEF高于对照组,LVEDD、LVPWT低于对照组;观察组治疗6个月后血清hs-cTnT、hs-CRP、NT-proBNP低于对照组;观察组治疗6个月后血清IL-6、TNF-α、PTX-3水平低于对照组;观察组治疗6个月后6MWD、ADL评分高于对照组;观察组MACE发生率低于对照组。结论: 在常规心衰治疗基础上加用ω3PUFAs治疗老年HFpEF的疗效确切,可改善心功能,减轻心肌损伤,抑制炎症反应,提高运动耐力、日常生活能力,降低MACE发生率。
Abstract
Objective To investigate the therapeutic effect of ω-3 polyunsaturated fatty acids (ω3 PUFAs) in treating elderly patients with heart failure with preserved ejection fraction (HFpEF). Methods A total of 108 elderly patients with HFpEF from the Geriatrics Department of our hospital were selected from September 2022 to June 2023 and randomly divided into a control group (n=54) and an observation group (n=54) by a random number table method. The control group received routine heart failure treatment, while the observation group received treatment with ω3PUFAs on this basis. The clinical efficacy was observed between two groups, as well as the cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT)], myocardial injury markers [high-sensitivity troponin T (hs-cTnT), high-sensitivity C-reactive protein (hs-CRP), amino terminal pro-brain natriuretic peptide (NT-proBNP)], inflammatory indicators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), pentraxin 3 (PTX-3)], 6 min walking distance (6MWD), activities of daily living (ADL) before and after treatment. The incidence of major adverse cardiovascular events (MACE) in the two groups was also observed in two groups. Results The total effective rate of the observation group was higher than the control group. After 6 months of treatment, the LVEF of the observation group was higher than the control group, LVEDD and LVPWT were lower than the control group. After 6 months of treatment, the serum levels of hs-cTnT, hs-CRP, and NT-proBNP in the observation group were lower than those in the control group. After 6 months of treatment, the levels of serum IL-6, TNF-α, and PTX-3 in the observation group were lower than those in the control group. After 6 months of treatment, the 6MWD and ADL score of the observation group were higher than those of the control group. The incidence of MACE in the observation group was lower than the control group. Conclusion The efficacy of adding ω3PUFAs to conventional heart failure treatment for elderly patients with HFpEF is confirmed. It can improve cardiac function, reduce myocardial damage, inhibit inflammatory response, enhance exercise tolerance and activities of daily living, and decrease the incidence of MACE.
关键词
射血分数保留心力衰竭 /
ω-3多不饱和脂肪酸 /
疗效 /
心功能 /
心肌损伤 /
炎症反应
Key words
heart failure with preserved ejection fraction /
ω-3 polyunsaturated fatty acids /
therapeutic effect /
cardiac function /
myocardial damage /
inflammatory response
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参考文献
[1] REQUENA-IBANEZ JA, SANTOS-GALLEGO CG, ZAFAR MU, et al.SGLT2-Inhibitors on HFpEF Patients. Role of Ejection Fraction[J]. Cardiovasc Drugs Ther, 2023, 37(5): 989-996.
[2] BONANNI A, VINCI R, D'AIELLO A, et al. Targeting Collagen Pathways as an HFpEF Therapeutic Strategy[J]. J Clin Med, 2023, 12(18): 5862-5872.
[3] 白静, 常国栋, 张晓惠. 沙库巴曲缬沙坦治疗射血分数保留心力衰竭的临床疗效观察[J]. 中国循证心血管医学杂志, 2022, 14(6): 736-738.
[4] 王文静, 王晓玥, 王雅坤. 心通口服液联合瑞舒伐他汀对射血分数保留心力衰竭病人血清可溶性ST2和白细胞介素-33水平的影响[J]. 中西医结合心脑血管病杂志, 2022, 20(8): 1457-1460.
[5] TSENG PT, ZENG BY, ZENG BS, et al.Omega-3 polyunsaturated fatty acids in sarcopenia management: A network meta-analysis of randomized controlled trials[J]. Ageing Res Rev, 2023, 90(1): 102014-102022.
[6] ZAILANI H, SATYANARAYANAN SK, LIAO WC, et al.Roles of Omega-3 Polyunsaturated Fatty Acids in Managing Cognitive Impairment in Chronic Obstructive Pulmonary Disease: A Review[J]. Nutrients, 2023, 15(20): 4363-4371.
[7] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.
[8] 王蔚文. 临床疾病诊断与疗效判断标准[M]. 北京: 科学技术文献出版社, 2010: 161.
[9] NAKANISHI K, YAMAGA T, IKEYA M.Gaps between Activities of Daily Living Performance and Capacity in People with Mild Dementia[J]. Int J Environ Res Public Health, 2022, 19(23): 15949-15958.
[10] CAPONE F, NAMBIAR N, SCHIATTARELLA GG.Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF[J]. Curr Opin Cardiol, 2024, 39(3): 148-153.
[11] ROSANO GMC, VITALE C, SPOLETINI I.Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF[J]. Int J Heart Fail, 2024, 6(2): 47-55.
[12] 卜星彭, 李春霞, 李丽, 等. 达格列净对老年射血分数保留的心力衰竭的疗效观察[J]. 中华老年心脑血管病杂志, 2022, 24(7): 689-692.
[13] 张小丹, 张巧玲, 朱志勇, 等. 沙库巴曲缬沙坦钠联合常规对症治疗射血分数保留心力衰竭患者的临床疗效及安全性研究[J]. 海南医学, 2024, 35(2): 174-178.
[14] MICHAELOUDES C, CHRISTODOULIDES S, CHRISTODOULOU P, et al.Variability in the Clinical Effects of the Omega-3 Polyunsaturated Fatty Acids DHA and EPA in Cardiovascular Disease-Possible Causes and Future Considerations[J]. Nutrients, 2023, 15(22): 4830-4840.
[15] NOMALI M, HEIDARI ME, AYATI A, et al.Omega-3 supplementation and outcomes of heart failure: A systematic review of clinical trials[J]. Medicine (Baltimore), 2024, 103(3): e36804-e36814.
[16] LAZZARIN T, MARTINS D, BALLARIN RS, et al.The Role of Omega-3 in Attenuating Cardiac Remodeling and Heart Failure through the Oxidative Stress and Inflammation Pathways[J]. Antioxidants (Basel), 2023, 12(12): 2067-2075.
[17] KELLING M, DIMZA M, BARTLETT A, et al.Omega-3 fatty acids in the treatment of heart failure[J]. Curr Probl Cardiol, 2024, 49(9): 102730-102740.
[18] 诸葛瑞琪. ω-3多不饱和脂肪酸防治心血管疾病的研究进展[J]. 中国循环杂志, 2022, 37(5): 543-547.
[19] 李鼎, 王大新. ω-3多不饱和脂肪酸改善心血管预后临床研究进展[J]. 中南医学科学杂志, 2020, 48(6): 655-659.
[20] KOZHUHAROV N, MICHOU E, WUSSLER D, et al.Quantifying Hemodynamic Cardiac Stress and Cardiomyocyte Injury in Normotensive and Hypertensive Acute Heart Failure[J]. Biomedicines, 2024, 12(5): 1099-1107.
[21] WANG ZY, LI GN, HUANG R, et al.Prognostic value of fibrosis-5 index combined with C-reactive protein in patients with acute decompensated heart failure[J]. BMC Cardiovasc Disord, 2023, 23(1): 492-500.
[22] 幸泽茂, 熊丽红, 张宪华, 等. ω-3多不饱和脂肪酸对重症脓毒症心肌损伤的保护作用[J]. 中国医师进修杂志, 2013, 36(22): 9-11.
[23] 张凤梅, 蔡颖, 吴迪, 等. 多不饱和脂肪酸ω-3/多不饱和脂肪酸ω-6与冠状动脉病变相关性研究[J]. 陕西医学杂志, 2023, 52(10): 1326-1330.
[24] ALOGNA A, KOEPP KE, SABBAH M, et al.Interleukin-6 in Patients With Heart Failure and Preserved Ejection Fraction[J]. JACC Heart Fail, 2023, 11(11): 1549-1561.
[25] ZHANG Y, XIONG XY, WANG JQ, et al.Prognostic value of serum IGF-1, Gal-3, and PTX-3 levels in elderly patients with chronic heart failure[J]. Am J Transl Res, 2024, 16(4): 1393-1400.
基金
昆明市卫生科技人才培养项目“达格列净治疗射血分数保留心衰合并2型糖尿病老年患者心功能影响的研究” [2022-SW(后备)-52号]
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