沙库巴曲/缬沙坦在维持性血液透析高血压患者中的应用  

Application of sacubitril/valsartan in maintenance hemodialysis patients with hypertension

作　　者：孔平平 李炎生[1,2] 朱礼阳 刘章锁 赵占正[1,2] 窦艳娜 KONG Pingping;LI Yansheng;ZHU Liyang;LIU Zhangsuo;ZHAO Zhanzheng;DOU Yanna(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Nephrology Institute of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾脏内科,郑州450052 [2]郑州大学肾脏病研究所

出　　处：《肾脏病与透析肾移植杂志》2021年第5期431-435,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(U1404804);河南省科技攻关项目(202102310056)。

摘　　要：目的:观察沙库巴曲/缬沙坦(SV)治疗对维持性血液透析(MHD)高血压患者的疗效及安全性。方法:采用自身对照研究,选取郑州大学第一附属医院血液净化中心MHD合并高血压接受SV治疗的患者31例,包括难治性高血压患者21例。其中11例将血管紧张素Ⅱ受体拮抗剂(ARB)换为SV。分析治疗前后血压、血常规、血生化等相关指标变化。结果:31例患者治疗后4周、12周透析前收缩压较治疗前下降,治疗后1周、4周、12周透析中收缩压与透析后收缩压均较治疗前下降,治疗后12周透析前舒张压较治疗前下降,治疗后1周、4周、12周透析中舒张压与透析后舒张压均较治疗前下降(P<0.05)。治疗后患者服用其他降压药限定日剂量下降[2.49±1.58 vs 3.42±1.81,P<0.05]。将ARB换为SV的11例患者在治疗后1周、4周、12周透析前、透析中、透析后血压同样较治疗前降低。用药期间未发现与SV相关的不良反应。结论:SV联合使用可有效控制MHD患者高血压,且安全性较好。Objective:To observe the antihypertensive effect and safety of sacubitril/valsartan(SV)in maintenance hemodialysis(MHD)patients with hypertension.Methodology:In a self⁃control study,31 cases of hypertensive MHD patients treated with SV in Blood Purification Center of the First Affiliated Hospital of Zhengzhou University were selected,including 21 patients with refractory hypertension.Among the 31 patients,11 patients changed angiotensin receptor blockers(ARB)to SV.Blood pressure,blood routine,blood biochemistry were analyzed before and after treatment.Results:The antihypertensive effects of 31 patients were as follows:4 weeks and 12 weeks after taking SV,systolic blood pressure(SBP)before HD decreased compared with that before treatment.The SBP during HD and after HD all decreased compared with that before treatment at 1 week,4 weeks and 12 weeks after treatment.12 weeks after the treatment,the diastolic blood pressure(DBP)before HD was lower than that before treatment.At 1 week,4 weeks and 12 weeks after treatment,DBP during and after HD all decreased compared with that before treatment(P<0.05).Aftertreatment,defined daily dose of other antihypertension drugs decreased[2.49±1.58 vs 3.42±1.81,P<0.05].The blood pressure of before,during and after HD of 11 patients who changed ARB to SV also decreased at 1 week,4 weeks and 12 weeks after treatment.No adverse reactions related to SV were found during the treatment.Conclusion:The comination of SV is a safe and effective therapy of hypertension in MHD patients.

关 键 词：血液透析 高血压 沙库巴曲/ 缬沙坦 

分 类 号：R544.1[医药卫生—心血管疾病] R692.5[医药卫生—内科学]