沙库巴曲缬沙坦对慢性心力衰竭患者心肾功能的影响研究  

Study on the effect of sacubitril-valsartan on cardio-renal function in patients with chronic heart failure

作　　者：邹振强 林新兴 王秀艳 徐奕 李自成[2] ZOU Zhen-qiang;LIN Xin-xing;WANG Xiu-yan;XU Yi;LI Zi-cheng(Dongyuan County Hospital of Chinese Medicine,Heyuan 517000,China;Department of Cardiology,The First Affiliated Hospital of Ji’Nan University,Guangzhou 510630,China)

机构地区：[1]广东省东源县中医院,广东河源517000 [2]暨南大学附属第一医院心血管内科,广东广州510630

出　　处：《实用医院临床杂志》2024年第6期153-156,共4页Practical Journal of Clinical Medicine

基　　金：广东省医学科研基金项目(编号:A2022034)。

摘　　要：目的探究沙库巴曲缬沙坦对慢性心力衰竭合并轻中度肾功能不全患者心肾功能指标血清胱抑素C(Cys-C)及N末端脑钠肽前体(NT-proBNP)水平的影响。方法选择纽约心功能分级Ⅱ~Ⅳ级合并轻中度肾功能不全的慢性心力衰竭患者183例,随机数字表法分为治疗组92例及对照组91例,治疗组在常规治疗(利尿剂、醛固酮受体拮抗剂、β受体阻滞剂)基础上给予沙库巴曲缬沙坦治疗;对照组在常规治疗基础上给予氯沙坦治疗,均治疗12周。比较两组患者治疗前后血清Cys-C、肌酐水平、血浆NT-proBNP水平及临床疗效相关指标。结果两组患者治疗12周后血清CysC、肌酐及血浆NT-proBNP水平均较治疗前显著降低(P<0.05),心脏超声相关指标和估测肾小球滤过率明显改善(P<0.05),6分钟步行试验距离显著改善,生活质量评分提示生活质量改善(P<0.05),但治疗组心肾功能相关指标改善更显著,差异有统计学意义(P<0.05)。结论沙库巴曲缬沙坦能显著降低慢性心力衰竭合并轻中度肾功能不全患者的血清Cys-C、肌酐水平及血浆NT-proBNP水平,能显著改善心脏超声相关指标和肾小球滤过率,提升生活质量。Objective To investigate the effects of sacubitril-valsartan on the levels of serum cystatin C(Cys-C)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with chronic heart failure and mild to moderate renal insufficiency.Methods A total of 183 patients with chronic heart failure classified as New York Heart Association(NYHA)Ⅱ~Ⅳ and mild to moderate renal insufficiency were enrolled.The patients were divided into a treactment group(n=92)and a control group(n=91).The sacubitril-valsartan group received sacubitril-valsartan in addition to conventional treatment such as diuretics,aldosterone receptor antagonists andβ-blockers.The control group received losartan in addition to the conventional treatment.Both groups were treated for 12 weeks.The levels of serum Cys-C and creatinine,and plasma NT-proBNP as well as clinical efficacy related indicators before and after treatment were compared between the two groups.Results After 12 weeks of treatment,the levels of serum Cys-C and creatinine,and plasma NT-proBNP were significantly decreased in both groups compared to before treatment(P<0.05).Cardiac ultrasound-related indicators and estimated glomerular filtration rate(eGFR)were significantly improved(P<0.05).The distance of six-minute walking test(6MWT)was significantly improved as well as the scores of quality of life suggested an improvement in quality of life(P<O.05).Moreover,the heart and kidney function-related indicators were more pronounced in the treactment group compared to the control group(P<0.05).Conclusions Sacubitril-valsartan can significantly reduce the levels of serum Cys-C and creatinine,and plasma NT-proBNP in patients with chronic heart failure and mild to moderate renal insufficiency.It can also significantly improve the cardiac ultrasound-related indicators and glomerular filtration rate to improve the quality of life.

关 键 词：沙库巴曲缬沙坦 慢性心力衰竭 肾小球滤过率 胱抑素C 利钠肽 

分 类 号：R541.6[医药卫生—心血管疾病]