血管紧张素受体脑啡肽酶抑制剂对不同类型左心室射血分数心力衰竭的维持性血液透析患者疗效评估  

Efficacy of angiotensin receptor neprilysin inhibitor for maintenance hemodialysis patients with different types of left ventricular ejection fraction heart failure

作　　者：李金聪 张楠辉 王雷 彭君梦 王慧慧 陈文慧 Li Jin-cong;Zhang Nan-hui;Wang Lei;Peng Jun-meng;Wang Hui-hui;Chen Wen-hui(Department of Nephrology,First Municipal People’s Hospital,Hubei University of Medicine,Xiangyang 441002,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院肾内科,襄阳441002

出　　处：《临床肾脏病杂志》2024年第12期1001-1009,共9页Journal Of Clinical Nephrology

基　　金：湖北省自然科学基金项目(2022CFB873);2023年襄阳市第一人民医院院级科技创新项目(XXY2023SD11);襄阳市教师发展基金(XYY2021D05)。

摘　　要：目的探讨血管紧张素受体脑啡肽酶抑制剂(angiotensin receptor neprilysin inhibitors,ARNI)代表药物沙库巴曲缬沙坦(Sacubitril/Valsartan,S/V)对维持性血液透析(maintenance hemodialysis,MHD)合并不同类型左心室射血分数(left ventricular ejection fraction,LVEF)心力衰竭患者治疗效果。方法选取2022年6月1日至2023年5月31日湖北医药学院附属襄阳市第一人民医院MHD合并心力衰竭且连续服用S/V 3个月以上的患者,根据患者LVEF分为射血分数降低性心力衰竭(heart failure with reduced ejection fraction,HFrEF)组、射血分数中间值心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)组及射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFpEF)组。回顾性分析用药前后心率、血压、血红蛋白(hemoglobin,Hb)、钾离子(K+)、尿酸(uric acid,UA)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、肌酐(creatinine,Cr)、脑钠肽(brain natriuretic peptide,BNP)及超声心动图检查结果。结果共155例患者纳入研究,其中HFrEF组、HFmrEF组和HFpEF组患者分别有41例、42例及72例。用药后,总体人群心率[78.0(71.0,89.0)次/min比82.0(73.0,95.0)次/min]、收缩压[138.0(123.0,158.0)mmHg比155.0(139.0,173.0)mmHg(1mmHg=0.133kPa)]、舒张压[78.0(68.0,90.0)mmHg比90.0(76.0,100.0)mmHg]、BNP水平[729.6(234.9,1942.2)pg/ml比2562.7(928.9,4957.1)pg/ml]及室间隔厚度[12.0(11.0,13.0)mm比13.0(12.0,14.0)mm]低于治疗前(均P<0.05);LVEF[58.0(51.0,61.0)%比49.0(40.0,56.0)%]水平较用药前升高(P<0.05)。患者用药前后纽约心脏协会(New York Heart Association,NYHA)心功能分级比例分布差异具有统计学意义(P<0.05)。HFrEF组患者用药后心率[81.0(70.0,100.0)次/min比94.0(75.5,110.0)次/min]、收缩压[130.0(118.0,152.0)mmHg比146.0(128.0,166.0)mmHg]、舒张压[80.0(63.5,89.0)mmHg比79.0(72.0,96.0)mmHg]、BNP[1366.9(612.0,2991.4)pg/ml比4294.9(2562.3,5000.0)pg/ml]及室间隔厚度[12.0(11.0,13.0)mm比1Objective To explore the therapeutic efficacy of sacubitril/valsartan(S/V),a repre-sentative drug of angiotensin receptor enkephalinase inhibitors(ARNI),in patients with different types of left ventricular ejection fraction(LVEF)heart failure(HF)on maintenance hemodialysis(MHD).Methods From June 1,2022 to May 31,2023,155 MHD patients with concurrent HF continuously tak-ing S/V for more than 3 months were selected.According to the level of LVEF,they were assigned into three groups of HF with reduced ejection fraction(HFrEF,n=41),HF with mid-range ejection fraction(HFmrEF,n=42)and HF with preserved ejection fraction(HFmrEF,n=2).Heart rate(HR),blood pressure(BP),hemoglobin(Hb),Potassium(K+),uric acid(UA),estimated glomerular filtration rate(eGFR),creatinine(Cr),brain natriuretic peptide(BNP)and echocardiographic findings before and after dosing were retrospectively reviewed.Results After drug dosing,overall population HR[78.0(71.0,89.0)beats/min vs 82.0(73.0,95.0)beats/min],systolic blood pressure[138.0(123.0,158.0)mmHg vs 155.0(139.0,173.0)mmHg(1 mmHg=0.133 kPa)],diastolic blood pressure[78.0(68.0,90.0)mmHg vs 90.0(76.0,100.0)mmHg],BNP level[729.6(234.9,1942.2)pg/ml vs 2562.7(928.9,4957.1)pg/ml]and interventricular septal thickness[12.0(11.0,13.0)mm vs 13.0(12.0,14.0)mm]were lower than those pre-treatment(all P<0.05);LVEF was higher than pre-dosing[58.0(51.0.61.0)%vs 49.0(40.0,56.0)%](P<0.05).The difference in proportional distribution of New York Heart Association(NYHA)cardiac function class before and after drug administration was statistically significant(P<0.05).In HFrEF group,heart rate[81.0(70.0,100.0)beats/min vs 94.0(75.5,110.0)beats/min],systolic blood pres-sure[130.0(118.0,152.0)mmHg vs 146.0(128.0,166.0)mmHg],diastolic blood pressure[80.0(63.5,89.0)mmHg vs 79.0(72.0,96.0)mmHg],BNP[1366.9(612.0,2991.4)pg/ml vs 4294.9(2562.3,5000.0)pg/ml]and ventricular septal thickness[12.0(11.0,13.0)mm vs 13.0(11.0,11.0,14.0)mm]lower than pre-dosing(all P<0.05);LVEF was higher post-dosing than pre-dosing[48.0(42.5,55.0)%

关 键 词：沙库巴曲缬沙坦 维持性血液透析 心力衰竭 左心室射血分数 

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