沙库巴曲缬沙坦在N末端脑钠肽前体重度升高腹膜透析患者中的应用  

Sacubitril/valsartan in peritoneal dialysis patients with severely elevated N-terminal pro-B type natriuretic peptide

作　　者：徐天[1] 章倩莹[1] 张春燕[1] 黄晓敏[1] 杨俪[1] 李晓[1] 陈楠[1] 任红[1] XU Tian;ZHANG Qianying;ZHANG Chunyan;HUANG Xiaomin;YANG Li;LI Xiao;CHEN Nan;REN Hong(Department of Nephrology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《肾脏病与透析肾移植杂志》2022年第2期120-125,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：转化医学协同创新中心合作研究项目(TM201905);中国医院协会净化中心分会研究项目(CHABP2021-03)。

摘　　要：目的:评价沙库巴曲缬沙坦在N末端脑钠肽前体(NT-proBNP)重度升高腹膜透析患者应用的安全性和有效性。方法:从2020年6月前瞻性入选在上海交通大学医学院附属瑞金医院维持性腹膜透析、NT-proBNP>10000 pg/mL的患者40例,予以沙库巴曲缬沙坦治疗。收集基线、3月和6月血压、NT-proBNP、心功能分级、心超等临床资料;并根据尿量进行亚组分析,比较治疗前后的各项临床指标。结果:39例患者完成随访。治疗3月、6月后患者血钾均稳定在正常范围(3月3.8±0.6 mmol/L,6月4.0±0.5 mmol/L);平均收缩压(167.1 mmHg vs 154.5 mmHg vs 153.4 mmHg,P=0.013)、中位NT-proBNP(333109 pg/mL vs 14049 pg/mL vs 19735 pg/mL,P=0.005)较基线时明显改善;残余尿患者较无尿患者治疗效果更好。6月后心超各项参数较基线时无明显差异;无尿患者心室舒张功能(室间隔侧e’:8.03±3.95 cm/s vs 5.58±1.56 cm/s,P=0.046;左室侧壁e’:10.24±4.19 cm/s vs 7.06±2.70 cm/s,P=0.028)较基线时恶化。结论:沙库巴曲缬沙坦不影响腹膜透析患者血钾;可以显著降低血压、改善心功能,尤其在残余尿患者治疗效果更好;对于逆转心室重构的作用,需要更大样本、更长随访时间的研究来进一步探讨。Objective:To evaluate the safety and effectiveness of sacubitril/valsartan in peritoneal dialysis(PD)patients with severely elevated N-terminal pro-B type natriuretic peptiede(NT-proBNP).Methodology:From June 2020,40 patients with maintenance PD>3 months and NT-proBNP>10000 pg/mL in Ruijin Hospital,Shanghai Jiaotong University School of Medicine,were selected to be treated with sacubitril/valsartan.Baseline,3-month’s,6-month’s blood pressure,NT-proBNP,cardiac function classification,echocardiogram and other clinical features were collected.According to daily urine output,these patients were further divided into subgroups to compare the clinical parameters before and after treatment.Results:Until Oct 2021,39 patients had completed the follow-up.After 3 and 6 months’treatment,the patients’serum potassium was still stable within the normal range(3 moths 3.8±0.6 mmol/L,6 moths 4.0±0.5 mmol/L),mean systolic blood pressure(167.1 mmHg vs 154.5 mmHg vs 153.4 mmHg,P=0.013)and median NT-proBNP(333109 pg/mL vs 14049 pg/mL vs 19735 pg/mL,P=0.005)were significantly improved compared to the baseline’s,the patients with residual urine had a better treatment effect than those with anuria.There was no significant improvement in the various parameters of echocardiography before and after treatment.Ventricular diastolic function in patients with anuria(ventricular septum e′:8.03±3.95 cm/s vs 5.58±1.56 cm/s,P=0.046;left ventricular side wall e’:10.24±4.19 cm/s vs 7.06±2.70 cm/s,P=0.028)was even worse than the baseline’s.Conclusion:Sacubitril/valsartan not only doesn’t affect blood potassium,but also can significantly improve the PD patient’s blood pressure and heart function,especially in those with residual urine.The role of reversing ventricular remodeling requires a larger sample and longer follow-up to further explore.

关 键 词：腹膜透析 心力衰竭 沙库巴曲缬沙坦 NT-PROBNP 

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