ARNI在无残余肾功能维持性血液透析合并心力衰竭患者治疗中的应用效果及安全性  

Application effect and safety of ARNI in the treatment of maintenance dialysis without residual renal function patients complicated with heart failure

作　　者：俞盛[1] 何飞民 黄惠英[1] YU Sheng;HE Feimin;HUANG Huiying(Department of Nephrology,Sanming First Hospital,Fujian Province,Sanming 365000,China)

机构地区：[1]福建省三明市第一医院肾内科,365000

出　　处：《临床合理用药》2025年第3期26-31,共6页Chinese Journal of Clinical Rational Drug Use

基　　金：福建省自然科学基金项目(2021J011382)。

摘　　要：目的 观察血管紧张素受体脑啡肽酶抑制剂(ARNI)在无残余肾功能维持性血液透析(MHD)合并心力衰竭(HF)患者治疗中的应用效果及安全性。方法 回顾性选取2021年6月—2023年10月三明市第一医院肾内科收治的无残余肾功能MHD合并HF患者45例,根据治疗方法分为ARNI组17例、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)组16例、常规治疗组12例。常规治疗组采用常规对症处理,ACEI/ARB组患者在常规治疗组基础上服用ACEI或ARB类药物,ARNI组患者在常规治疗组基础上予沙库巴曲缬沙坦钠片。3组均治疗6个月。比较3组临床资料,治疗后相关指标、主要不良心血管事件(MACE)及并发症。结果 治疗6个月后,ARNI组全段甲状旁腺激素水平低于ACEI/ARB组,N末端脑钠肽前体水平低于常规治疗组、ACEI/ARB组,室间隔厚度小于常规治疗组、ACEI/ARB组(P<0.05);3组收缩压、舒张压、中性粒细胞绝对值、淋巴细胞绝对值、血小板计数、血红蛋白、白蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐、胱抑素C、钠离子、钾离子、钙离子、磷离子、C反应蛋白、左室内径、左室后壁厚度、左室射血分数比较,差异无统计学意义(P>0.05)。常规治疗组、ACEI/ARB组、ARNI组MACE发生率比较,差异无统计学意义(33.33%vs. 18.75%vs. 11.76%,χ^(2)=2.070,P=0.355)。3组高钾血症、低血压发生率比较,差异无统计学意义(P>0.05)。结论 将ARNI用于无残余肾功能MHD合并HF患者治疗中可有效改善患者心功能和心室重构,且安全性较高。Objective To observe the application effect and safety of ARNI in the treatment of MHD without residual renal function patients complicated with HF.Methods Forty-five MHD without residual renal function patients complicated with HF admitted to the Department of Nephrology,Sanming First Hospital from June 2021 to October 2023 were retrospectively selected,and the patients were classified into the 17 cases in the ARNI group,16 cases in the ACEI/ARB group and 12 cases in the conventional treatment group according to the treatment methods.Patients in the conventional treatment group were treated with conventional symptomatic treatment,patients in the ACEI/ARB group were given ACEI or ARB drugs on the basis of the conventional treatment group,and patients in the ARNI group were treated with sacubitril valsartan sodium tablets on the basis of the conventional treatment group.All the three groups were treated for 6 months.Clinical data,related indexes after treatment,MACE and complications were compared among the three groups.Results After 6 months of treatment,ARNI group of the level of iPTH was lower than that in the ACEI/ARB group,level of NT-proBNP was lower than that in the conventional treatment group and ACEI/ARB group,thickness of interventricular septum was less than that in the conventional treatment group and ACEI/ARB group(P<0.05);There was no statistically significant difference of systolic blood pressure,diastolic blood pressure,absolute values of neutrophils and lymphocytes,PLT,Hb,Alb,TC,LDL-C,HDL-C,SCr,CysC,sodium,potassium,calcium,phosphorus,CRP,left intraventricular diameter,left ventricular posterior wall thickness or LVEF among the three groups(P>0.05).There was no significant difference of incidence of MACE among the conventional treatment group,ACEI/ARB group,ARNI group(33.33%vs.18.75%vs.11.76%,χ^(2)=2.070,P=0.355).There was no significant difference of incidence of hyperkalemia,hypotension among the three groups(P>0.05).Conclusion The use of ARNI in the treatment of MHD without residual renal fun

关 键 词：心力衰竭 维持性血液透析 无残余肾功能 血管紧张素受体脑啡肽酶抑制剂 

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