沙库巴曲缬沙坦对慢性射血分数降低心力衰竭合并肾功能不全患者的肾脏保护作用  

Renal protective effect of sacubitril/valsartan in and renal insufficiency patients with chronic heart failure with reduced ejection fraction

作　　者：贾红丹[1] 毕希乐[1] 赵云凤 宋婷婷[1] 刘丽[1] Jia Hongdan;Bi Xile;Zhao Yunfeng;Song Tingting;Liu Li(Department of Cardiology,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei Province,China)

机构地区：[1]秦皇岛市第一医院心血管内科,河北秦皇岛066000

出　　处：《中华老年多器官疾病杂志》2023年第7期492-496,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：秦皇岛市重点研发计划(201805A042);河北省重点研发计划(182777235)。

摘　　要：目的观察沙库巴曲缬沙坦对合并肾功能不全的慢性心力衰竭(简称心衰)患者肾功能的影响。方法连续纳入2020年12月至2022年3月秦皇岛市第一医院慢性心衰合并肾功能不全患者84例,分为沙库巴曲缬沙坦组(n=48)和对照组(n=36)。沙库巴曲缬沙坦组接受沙库巴曲缬沙坦治疗,对照组接受单一的缬沙坦治疗。观察2组患者服药后6个月和12个月肌酐、估算的肾小球滤过率(eGFR)、尿素氮、尿酸、肾功能恶化(WRF)指标的变化情况。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、非参数秩和检验、非参数检验、Mann-Whitney U检验及χ2检验。结果服药后6个月,对比基线水平,沙库巴曲缬沙坦组肌酐、eGFR的变化值与对照组比较无明显差异;尿素氮及尿酸下降值显著高于对照组[-2.62(1.83,3.90)和0.45(0.29,0.70)mmol/L,P<0.01;-137.00(-92.30,-201.13)和-9.65(49.00,-79.80)μmol/L,P=0.000];与对照组比较,沙库巴曲缬沙坦降低了患者的收缩压及舒张压[(132±17)和(133±24)mmHg(1 mmHg=0.133 kPa),P=0.824;(81±14)和(82±12)mmHg,P=0.732],但尚无统计学差异,NYHA分级明显改善(Z=-2.150,P=0.032)。服药后12个月,对比基线水平,沙库巴曲缬沙坦组eGFR下降值明显低于对照组[-2.21(1.33,3.49)和-22.11(12.32,29.67)ml/(min·1.73m 2),P=0.023];肌酐升高值明显低于对照组[1.50(0.98,2.07)和31.65(22.77,42.53)μmol/L,P=0.043];尿素氮及尿酸下降值也显著高于对照组[-2.80(2.01,4.23)和0.80(0.58,1.14)mmol/L,P<0.01;-141.00(-96.40,-200.25)和-8.45(45.00,-77.70)μmol/L,P=0.000];沙库巴曲缬沙坦组收缩压及舒张压降幅、NYHA分级均显著优于对照组[(123±14)和(130±17)mmHg,P=0.042;(76±11)和(81±11)mmHg,P=0.042;Z=-2.200,P=0.028]。服药后6个月,沙库巴曲缬沙坦组WRF发生率与对照组相比无明显统计学差异[3(6.25%)和7(19.44%),P=0.132];服药后12个月,沙库巴曲缬沙坦组WRF发生率显著低于对照组[4(8.33%)和9(25.00%),P=0.03Objective To observe the effect of sacubitril/valsartan on renal function in patients with chronic heart failure(CHF)and renal insufficiency.Methods A total of 84 consecutive CHF patients with renal insufficiency who visited the First Hospital of Qinhuangdao form December 2020 to March 2022 were enrolled and divided into sacubitril/valsartan group(n=48)and control group(n=36).The sacubitril/valsartan group received sacubitril/valsartan and the control group received single valsartan.The two groups were observed for the changes in serum creatinine,estimated glomerular filtration rate(eGFR),urea nitrogen,uric acid,and worsening renal function(WRF)at 6 and 12 months after medication.SPSS statistics 22.0 was used for statistical analysis.Data comparison between two groups was perfomed using t test,non-parametric rank sum test,non-parametric test,Mann-Whitney U test orχ2 test depending on data type.Results At 6 months,there were no significant differences in serum creatinine(P=0.254)and eGFR(P=0.061)in comparison with the baseline between the two groups.The decreased values of urea nitrogen[-2.62(1.83,3.90)vs 0.45(0.29,0.70)mmol/L;P<0.01]and uric acid[-137.00(-92.30,-201.13)vs-9.65(49.00,-79.80)μmol/L;P=0.000]were significantly higher in the sacubitril/valsartan group than those in the control group.Compared with the control group,sacubitril/valsartan reduced systolic blood pressure[(132±17)vs(133±24)mmHg(1 mmHg=0.133 kPa);P=0.824]and diastolic blood pressure[(81±14)vs(82±12)mmHg;P=0.732],but there was no statistical differences.NYHA classification was significantly improved between two groups(Z=-2.150;P=0.032).Compared with the baseline at,12 months,the decline of eGFR was lower in the sacubitril/valsartan group than the control group[-2.21(1.33,3.49)vs-22.11(12.32,29.67)ml/(min·1.73 m 2);P=0.023];the increase in serum creatinine was significantly lower in the sacubitril/valsartan group than in the control group[1.50(0.98,2.07)vs 31.65(22.77,42.53)μmol/L;P=0.043];the decreases in urea nitrogen[-2.80(2.01,4.23

关 键 词：慢性心力衰竭 肾功能不全 沙库巴曲缬沙坦 肾功能恶化 

分 类 号：R541.61[医药卫生—心血管疾病]