[1]姬利珂,许清玉,崔艳,等.沙库巴曲缬沙坦治疗终末期肾病合并心力衰竭患者的疗效及安全性[J].新乡医学院学报,2024,(4):333-337.[doi:10.7683/xxyxyxb.2024.04.006]
　JI Like,XU Qingyu,CUI Yan,et al.Efficacy and safety of sacubitril/valsartan in patients with end-stage renal disease combined with heart failure[J].Journal of Xinxiang Medical University,2024,(4):333-337.[doi:10.7683/xxyxyxb.2024.04.006]
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沙库巴曲缬沙坦治疗终末期肾病合并心力衰竭患者的疗效及安全性
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年4
页码:
333-337
栏目:
临床研究
出版日期:
2024-04-05

文章信息/Info

Title:
Efficacy and safety of sacubitril/valsartan in patients with end-stage renal disease combined with heart failure
作者:
姬利珂; 许清玉; 崔艳; 罗雨轻; 朱琼杰; 郭明好
（新乡医学院第一附属医院肾内科，河南　卫辉　453100）
Author(s):
JI Like; XU Qingyu; CUI Yan; LUO Yuqing; ZHU Qiongjie; GUO Minghao
(Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
终末期肾病; 腹膜透析; 心力衰竭; 沙库巴曲缬沙坦; 心室功能; 心室重构; 血压
Keywords:
end-stage renal disease; peritoneal dialysis; heart failure; sacubitril/valsartan; ventricular function; ventricular remodeling; blood pressure
分类号:
R541.6
DOI:
10.7683/xxyxyxb.2024.04.006
文献标志码:
A
摘要:
目的　探讨沙库巴曲缬沙坦治疗终末期肾病合并心力衰竭患者的疗效及安全性。
方法　选择2018年9月至 2021年9月就诊于新乡医学院第一附属医院肾脏病医院的终末期肾病合并心力衰竭患者63例为研究对象，根据治疗方式将患者分为观察组（n=32）和对照组（n=31）。2组患者均接受持续性腹膜透析、慢性心力衰竭的常规治疗。在此基础上，观察组者给予沙库巴曲缬沙坦钠片，起始剂量50 mg，每日2次，根据患者血压每2~4周倍增1次，最高剂量200 mg；对照组患者给予缬沙坦胶囊80 mg，每日1次，根据血压调整剂量，最高剂量160 mg。分别于治疗前后采用彩色多普勒超声测量患者的左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）、每搏输出量（SV）、左心室舒张末期容积（LVEDV）等心室功能参数和左心室舒张末期内径（LVDd）、左心室收缩末期内径（LVDs）、室间隔厚度（IVS）、左心室后壁厚度（LVPW）等心室构型参数，应用美国纽约心脏病学会分级标准评估2组患者的心功能分级，比较2组患者治疗前后的收缩压（SBP）和舒张压（DBP），记录2组患者随访期间低血压、高血钾、肝功能异常、心力衰竭再住院等不良事件发生情况。
结果　治疗前2组患者的心室功能、心室构型参数比较差异均无统计学意义（P>0.05）。对照组患者治疗前后心室功能、心室构型参数比较差异均无统计学意义（P>0.05）；观察组患者治疗后LVEF、LVFS大于治疗前，LVDd、LVDs小于治疗前（P<0.05）；观察组患者其余指标治疗前后比较差异无统计学意义（P>0.05）。治疗后，观察组患者LVDs小于对照组（P<0.05），2组患者其余指标比较差异无统计学意义（P>0.05）。治疗前和治疗后，2组患者心功能分级比较差异均无统计学意义（P>0.05）。观察组患者治疗后心功能分级Ⅳ级患者占比显著低于治疗前（P<0.05），心功能分级Ⅱ～Ⅲ 级患者占比与治疗前比较差异无统计学意义（P>0.05）。对照组患者治疗前后心功能分级比较差异均无统计学意义（P>0.05）。治疗前，2组患者的SBP、DBP比较差异无统计学意义（P>0.05）。对照组患者治疗前后SBP、DBP比较差异无统计学意义（P>0.05）；观察组治疗后患者SBP、DBP显著低于治疗前（P<0.05）。治疗后，观察组患者的SBP、DBP显著低于对照组（P<0.05）。对照组和观察组患者不良反应发生率分别为22.58%（7/31）、43.75%（14/32），2组患者不良反应发生率比较差异无统计学意义（χ2=3.175,P>0.05）。
结论　沙库巴曲缬沙坦可有效改善终末期肾病合并心力衰竭患者心室功能，逆转心室重构，提高心功能分级，降低血压，且安全性良好。
Abstract:
Objective　To explore the efficacy and safety of sacubitril/valsartan in patients with end-stage renal disease combined with heart failure (HF).
Methods　A total of 63 patients with end-stage renal disease combined with heart failure at the First Affiliated Hospital of Xinxiang Medical University from September 2018 to September 2021 were selected as research subjects.According to the treatment methods,these patients were divided into the observation group (n=32) and the control group (n=31).All patients in the two groups received persistent peritoneal dialysis and conventional treatment for chronic heart failure.On this basis,patients in the observation group were given sacubitril valsartan sodium tablets,starting with a dose of 50 mg twice a day.According to the patient′s blood pressure,the dose was doubled every 2 to 4 weeks,and the highest dose was 200mg.Patients in the control group were given valsartan capsules 80 mg once daily,and the dose was adjusted according to the blood pressure,with 160 mg being the highest.Ventricular functional parameters,including left ventricular ejection fraction (LVEF),left ventricular fraction shortening (LVFS),stroke volume (SV) and left ventricular end-diastolic volume（LVEDV）,and ventricular configuration parameters,including left ventricular end-diastolic diameter (LVDd),left ventricular end-systolic diameter (LVDs),interventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW),were measured by color Doppler ultrasound before and after treatment.The cardiac function grade of patients in the two groups was assessed using the New York Heart Association′s grading criteria before and after treatment.The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of patients in the two groups were compared before and after treatment.The occurrence of adverse events such as hypotension,hyperkalemia,abnormal liver function,and rehospitalization for HF during the follow-up period in the two groups was recorded.
Results　There was no significant difference in ventricular functional and configuration parameters between the two groups before treatment (P>0.05).There was no significant difference in ventricular functional and configuration parameters before and after treatment in the control group (P>0.05).The LVEF and LVFS of patients in the observation group were greater than those before treatment,while the LVDd and LVDs were smaller than those before treatment (P<0.05);there was no significant difference in the remaining indicators before and after treatment in the observation group (P>0.05).After treatment,the LVDs of patients in the observation group was less than that in the control group (P<0.05),and there was no significant difference in the remaining indicators between the two groups (P>0.05).No significant difference was found in the cardiac function grade of patients in the two groups before and after treatment (P>0.05).The proportion of patients with cardiac function grade Ⅳ after treatment in the observation group was significantly lower than that before treatment (P<0.05),and there was no significant difference in the proportion of patients with cardiac function grade Ⅱ-Ⅲ before and after treatment (P>0.05).There was no significant difference in the cardiac function grade before and after treatment in the control group (P>0.05).The SBP and DBP showed no significant difference between the two groups before treatment (P>0.05).The SBP and DBP also showed no significant difference before and after treatment in the control group (P>0.05).The SBP and DBP of patients in the observation group after treatment were significantly lower than those before treatment (P<0.05).The SBP and DBP of patients in the observation group were significantly lower than those in the control group after treatment (P<0.05).The incidences of adverse reactions in the control group and observation group were 22.58% (7/31) and 43.75% (14/32),respectively,showing no statistically significant difference between the two groups (χ2=3.175,P>0.05).
Conclusion　Sacubitril/valsartan can effectively improve the ventricular function,reverse the ventricular remodeling,increase the cardiac function grade,and reduce the blood pressure of patients with end-stage renal disease combined with heart failure,exhibiting good safety.

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更新日期/Last Update: 2024-04-05