沙库巴曲缬沙坦对维持性血液透析患者心脏结构及功能的影响  

Cardiovascular outcomes with Sacubitril-Valsartan in patients undergoing hemodialysis

作　　者：朱丽 杨冰[1] 倪梦凡 赵玉超 甘良英 左力[1] ZHU Li;YANG Bing;NI Meng-fan;ZHAO Yu-chao;GAN Liang-ying;ZUO Li(Department of Nephrology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院肾内科,北京100044

出　　处：《中国血液净化》2021年第12期809-813,共5页Chinese Journal of Blood Purification

基　　金：北京市科学技术委员会首都临床特色应用研究支持项目(Z131107002213122)。

摘　　要：目的探讨沙库巴曲缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏结构及功能的影响。方法入选北京大学人民医院MHD患者,入选标准:无显性水肿,近期无严重感染、急性心血管事件等,依从性好,临床评估适合服用沙库巴曲缬沙坦。随访6个月。采用超声心动图评估用药前后心脏结构及功能变化,并记录血压、容量、化验及不良事件。应用配对t检验分析沙库巴曲缬沙坦对心脏结构及功能的影响及安全性。结果①入选13例MHD患者(男/女:8/5),年龄50(39,72)岁,透析龄99(14,155)月。原发病慢性肾小球肾炎5例,糖尿病肾病5例,高血压肾损害1例,其他2例。②应用沙库巴曲缬沙坦6个月后,左心室射血分数较基线水平改善(t=-4.769,P<0.001),左心房前后径(t=2.665,P=0.021)、左心室舒张末期内径(t=2.439,P=0.031)、左心室收缩末期内径(t=3.680,P=0.003)、左心室舒张末期容积(t=2.505,P=0.028)、左心室收缩末期容积(t=3.485,P=0.005)、三尖瓣反流最大流速(t=3.402,P=0.042)均较基线水平改善。③用药6个月后N末端B型利钠肽前体(NT-proBNP)较基线水平显著下降(t=2.979,P=0.012)。④1例患者出现症状性低血压,药物减量后好转,无严重低血压、血管神经性水肿、高钾血症、肝功能异常等发生。结论沙库巴曲缬沙坦可改善维持性血液透析患者心脏结构及功能,安全有效。Objective To explore the cardiovascular outcomes with sacubitril-valsartan in patients undergoing hemodialysis.Methods 13 maintenance hemodialysis(MHD)patients from Peking University People's Hospital were selected,without obvious edema,severe infection or acute cardiovascular events recently.Blood pressure and echocardiography of the patients were recorded.Paired-Samples T test was used to identify the effects of sacubitril-valsartan in MHD patients.Results①A total of 13 patients on MHD for 99(14~155)months(8 males and 5 females)were included in this study.②Compared with baseline levels,left ventricular ejection fractions(LVEF)(43.0±10.2%vs.60.0±13.9%,t=-4.769,P<0.001)were markedly improved after treatment with sacubitril-valsartan.③Compared with baseline levels,NT-proBNP levels(25594 pg/ml vs.15325 pg/ml,t=2.979,P=0.012)were markedly decreased after treatment with sacubitril-valsartan.④No serious adverse events occurred.Conclusions Sacubitril-valsartan is effective and safe for MHD patients.

关 键 词：血液透析 沙库巴曲缬沙坦 心功能 生物电阻抗 

分 类 号：R459.5[医药卫生—治疗学]