中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (01): 10-14.doi: 10.3969/j.issn.1671-4091.2022.01.003

• 临床研究 • 上一篇    下一篇

沙库巴曲缬沙坦在维持性血液透析患者中治疗慢性心功能不全的有效性和安全性

胡楠1,朱颖辉2,吕楠1,陈育青1   

  1. 1北京大学第一医院肾内科，北京大学肾脏病研究所，卫生部肾脏疾病重点实验室，慢性肾脏病防治教育部重点实验室(北京大学)，中国医学科学院免疫介导肾病诊治创新单元
    2首都医科大学石景山医院肾内科

  • 收稿日期:2021-09-22 修回日期:2021-10-27 出版日期:2022-01-12 发布日期:2022-01-04
  • 通讯作者: 陈育青 cyq@bjmu.edu.cn E-mail:konan112x@163.com

Sacubitril/valsartan improves cardiac systolic function independently from blood volume management in hemodialysis patients with heart failure

  1. 1Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China; Research Units of Diagnosis and Treatment of ImmunEmediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; 2Department of Nephrology, Shijingshan Teaching Hospital of Capital Medical University, Beijing 100043, China.
  • Received:2021-09-22 Revised:2021-10-27 Online:2022-01-12 Published:2022-01-04
  • Contact: Nan Hu E-mail:konan112x@163.com

PDF

272

摘要： 【摘要】目的观察沙库巴曲缬沙坦在血液透析患者中治疗心力衰竭的有效性和安全性。方法纳入血液透析合并慢性心功能不全患者，以用药前为基线，加用沙库巴曲缬沙坦后随访3个月。期间监测心力衰竭生物标记物及生化指标，体质成分分析评估容量，超声评价心脏结构及功能。结果纳入受试者17例，4例因药物不良反应、1例因肾移植退出。随访终点左心室射血分数(left ventricular ejection fraction, LVEF) (62.7%±10.1%)较基线(54.2%±15.8%)改善(t=-4.429, P=0.001)；基线LVEF减低 者(＜55% )改善更明显(t=-6.204, P=0.003)，伴随左心室收缩末容积[基线(109.0±62.7)ml，终点(79.4±52.1)ml，t=4.725，P=0.009]下降。LVEF 正常者左心室后壁厚度[基线(1.08±0.27)cm，终点(0.99±0.16)cm, t=3.176, P=0.025]下降。随访终点时血肌酐(t=-2.856, P=0.016)，尿素(t=-3.149, 
P=0.009)及甲状旁腺激素(t=-2.230, P=0.048)水平较基线升高。结论沙库巴曲缬沙坦可改善血液透析患者的心脏收缩功能，在LVEF 正常者中减轻左心室肥厚。治疗中可引起肌酐、尿素及甲状旁腺激素水平上调。

关键词: 血液透析, 心功能不全, 沙库巴曲缬沙坦, 继发性甲状旁腺功能亢进

Abstract: 【Abstract】Objective To observe the efficacy and safety of sacubitril/valsartan for the treatment of heart failure in maintenance hemodialysis patients. Methods Patients on hemodialysis complicated with chronic cardiac insufficiency and with stably controlled volume status were enrolled. They were treated with sacubitril/valsartan and followed up for 3 months. Before treatment with sacubitril/valsartan (baseline) and during follow- up, biomarkers of heart failure were tested, and volume status was assessed by body composition monitor (BCM). Changes of cardiac structure and function were examined by echocardiography. Results A total of 17 patients were included, while 4 patients withdrew due to drug-related adverse reactions and one due to renal transplantation during follow-up. Left ventricular ejection fraction (LVEF) increased from baseline 54.2±15.8% to endpoint 62.7±10.1% (t=-4.429, P=0.001) and greater improvement was found in patients with declined baseline LVEF (≤55%; t=-6.204, P=0.003), in line with a significant reduction in left ventricular end systolic volume (baseline 109.0±62.7ml vs. endpoint 79.4±52.1ml; t=4.725, P=0.009). In patients with normal LVEF, left ventricular posterior wall thickness decreased significantly (baseline 1.08 ± 0.27cm vs. endpoint
0.99 ± 0.16cm; t=3.176, P=0.025). The endpoints of serum creatinine (t=- 2.856, P=0.016), urea (t=- 3.149, P=0.009) and parathyroid hormone (baseline 328±161pg/ml vs. endpoint 409±191pg/ml; t=-2.230, P=0.048) elevated significantly as compared with the baseline values. Conclusion Sacubitril/valsartan significantly improves cardiac systolic function in hemodialysis patients with heart failure and reduces ventricular wall thickness in patients with normal LVEF. However, this treatment may also induce the increase of creatinine, urea and parathyroid hormone levels.

Key words: Hemodialysis, Heart failure, Sacubitril/valsartan, Secondary hyperparathyroidism

中图分类号: