沙库巴曲/缬沙坦在心力衰竭腹膜透析患者中的应用  

Sacubitril/valsartan in peritoneal dialysis patients with heart failure

作　　者：张聪[1] 郭艳红 杨自君[1] 于露[1] 王刘伟[1] 唐琳[1] ZHANG Cong;GUO Yanhong;YANG Zijun;YU Lu;WANG Liuwei;TANG Lin(Department of Nephrology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院肾脏内科,郑州450052

出　　处：《肾脏病与透析肾移植杂志》2022年第1期26-32,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金(U1904134);河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020014)。

摘　　要：目的:评价沙库巴曲/缬沙坦治疗心力衰竭腹膜透析患者的疗效。方法:回顾性分析郑州大学第一附属医院肾脏内科102例接受沙库巴曲/缬沙坦治疗的心力衰竭腹膜透析患者,根据射血分数(LVEF)将其分为射血分数降低性心力衰竭(HFrEF组)(25例)、射血分数轻度降低性心力衰竭(HFmrEF)组(30例)和射血分数保留性心力衰竭(HFpEF)组(47例)。比较3组患者治疗前后的心功能指标、实验室指标及不良事件发生情况。结果:三组患者治疗6个月后的LVEF、肺动脉收缩压(PASP)、左心室舒张末期内径(LVEDD)、美国纽约心脏病协会(NYHA)分级、血N末端脑钠肽前体(NT-proBNP)及高敏肌钙蛋白I(hs-cTnI)均明显改善,且HFrEF组的NYHA分级和NT-proBNP改善程度优于HFmrEF组和HFpEF组,HFrEF组和HFmrEF组的LVEF和hs-cTnI改善程度优于HFpEF组(P<0.05)。6个月后三组患者的血红蛋白水平显著提高(P<0.05),血电解质、血白蛋白、估算的肾小球滤过率等指标的不良事件发生率均无明显差异。结论:沙库巴曲/缬沙坦可有效改善心力衰竭腹膜透析患者的心功能,且安全性良好。其中对HFrEF的疗效最佳,对HFpEF疗效相对较差。Objective:To evaluate the efficacy of sacubitril/valsartan in peritoneal dialysis patients with heart failure.Methodology:102 peritoneal dialysis patients with heart failure treated with sacubitril/valsartan in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.According to the left ventricular ejection fraction(LVEF),they were divided into HFrEF group(n=25),HFmrEF group(n=30)and HFpEF group(n=47).The cardiac indexes,laboratory indexes and adverse events of three groups were compared before and 6 months after the treatment.Results:After 6 months of treatment,LVEF,pulmonary artery systolic pressure(PASP),left ventricular end-diastolic diamerer(LVEDD),New York Heart Association(NYHA)classification,NT-proBNP and hs-cTnI of three groups were significantly improved compared with that before treatment.The improvement degree of NYHA classification and NT-proBNP in HFrEF group was better than that in HFmrEF group and HFpEF group,and the improvement degree of LVEF and hs-cTnI in HFrEF group and HFmrEF group was more obvious than that in HFpEF group(P<0.05).After 6 months of treatment,the level of hemoglobin in three groups increased significantly compared with that before treatment(P<0.05),and there was no significant difference in serum electrolyte,albumin or eGFR.There was no significant difference in the incidence of adverse events among three groups.Conclusion:Sacubitril/valsartan can effectively improve the cardiac function in peritoneal dialysis patients with heart failure,with good safety.Among them,the therapeutic effect on HFrEF is the best and HFpEF is relatively worse.

关 键 词：沙库巴曲/缬沙坦 终末期肾病 腹膜透析 心力衰竭 射血分数 

分 类 号：R692.5[医药卫生—泌尿科学] R541.6[医药卫生—外科学]