不同方案治疗伴顽固性低钠血症AMI后急性心衰临床价值

doi:10.3969/j.issn.1006-6233.2025.03.018

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Abstract Objective: To investigate the clinical efficacy of different treatment regimens for acute heart failure (AHF) after acute myocardial infarction (AMI) with refractory hyponatremia. Methods: A total of 102 patients with AHF and refractory hyponatremia after AMI admitted between September 2021 and June 2024 were randomly divided into two groups, with 51 patients in each group. Both groups received conventional treatment. The control group was treated with tolvaptan, while the observation group received sacubitril/valsartan (ARNI) combined with tolvaptan. Treatment was continued for 2 weeks. Cardiac function [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)], renal function [urine volume, serum creatinine, urinary neutrophil gelatinase-associated lipocalin (NGAL)], serum inflammatory factors [interleukin-6 (IL-6), galectin-3 (Gal-3), tumor necrosis factor-α (TNF-α)], and serum biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble growth stimulation expressed gene 2 (sST2), heart-type fatty acid-binding protein (H-FABP)] were compared between the two groups before treatment, after 1 week, and after 2 weeks of treatment. Clinical efficacy and the incidence of adverse reactions (gastrointestinal discomfort, hypotension, headache, etc.) were also evaluated. Results: The total effective rate in the observation group (96.08%) was significantly higher than that in the control group (82.35%) (P<0.05). After 1 and 2 weeks of treatment, the observation group showed higher LVEF, lower LVEDD, increased urine volume, and reduced serum creatinine and urinary NGAL levels compared to the control group (all P<0.05). The levels of IL-6, Gal-3, TNF-α, NT-proBNP, sST2, and H-FABP in the observation group were significantly lower than those in the control group (all P<0.05). The total incidence of adverse reactions in the observation group (3.92%) was not significantly different from that in the control group (7.84%) (P>0.05). Conclusion: Compared with tolvaptan alone, the combination of ARNI and tolvaptan significantly improves clinical efficacy, enhances cardiac and renal function, reduces serum inflammatory factors and biomarkers, and demonstrates good safety in treating AHF after AMI with refractory hyponatremia.

Key words： Refractory hyponatremia Acute myocardial infarction Acute heart failure Cardiac function Renal function Sacubitril/valsartan Tolvaptan

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	WANG Jie
	ZHU Xiaoqing
	XU Jirong
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Cite this article:

WANG Jie,ZHU Xiaoqing,XU Jirong, et al. Clinical Value of Different Treatment Regimens for Acute Heart Failure After Acute Myocardial Infarction with Refractory Hyponatremia[J]. HeBei Med, 2025, 31(3): 450-456.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2025.03.018 OR http://www.hbyxzzs.cn/EN/Y2025/V31/I3/450

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