中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (09): 650-654.doi: 10.3969/j.issn.1671-4091.2022.09.006

• 临床研究 • 上一篇    下一篇

沙库巴曲缬沙坦治疗维持性血液透析合并心力衰竭患者的疗效分析

卢海峰   徐丹萍   彭望英    董 杨    汪年松    盛晓华   

  1. 336300 宜丰，宜丰县人民医院 1内四科 2临床药学室
    200233 上海，3上海交通大学附属第六人民医院肾内科
  • 收稿日期:2022-03-08 修回日期:2022-06-28 出版日期:2022-09-12 发布日期:2022-09-06
  • 通讯作者: 盛晓华 E-mail:xiaohuasheng@medmail.com.cn
  • 作者简介:(卢海峰、徐丹萍为共同第一作者)

Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with heart failure

LU Hai-feng, XU Dan-ping, PENG Wang-ying, DONG Yang, WANG Nian-song, SHENG Xiao-hua   

  1. 1Department of Nephrology and 2Clinical Pharmacy, Yifeng People's Hospital, Yifeng 336300, China;  3Department of Nephrology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai  200233, China
  • Received:2022-03-08 Revised:2022-06-28 Online:2022-09-12 Published:2022-09-06
  • Contact: SHENG Xiao-hua E-mail:xiaohuasheng@medmail.com.cn

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摘要：

目的 探讨沙库巴曲缬沙坦在维持性血液透析(maintenance hemodialysis,MHD)合并心力衰竭患者中的疗效。 方法 回顾性分析2020年1月～2021年7月上海交通大学附属第六人民医院MHD合并心力衰竭患者的临床和实验室数据，选取连续服用沙库巴曲缬沙坦3个月以上的患者，并收集临床一般资料、实验室指标及超声心动图的计量资料，记录治疗期间不良事件及终点事件。 结果 共入选患者54例，与治疗前比较，随访3个月时N末端B型利钠肽前体 (t=7.053,P＜0.001)、室间隔厚度(t=2.557,P=0.013)、左心室后壁厚度(t=2.728,P=0.009)、左心室质量指数(t=3.059,P =0.003)显著下降，左心室射血分数上升(t=-4.323,P＜0.001)；用药后收缩压(t=12.381,P＜0.001)、舒张压(t =7.070,P＜0.001)较治疗前下降。服药前后干体质量(t=0.465,P=0.644)、体质量增长(t=0.350,P =0.728)、超滤量(t=-0.019,P=0.985)、甲状旁腺激素(t=-1.660,P =0.103)、血肌酐(t=-1.452,P =0.152)、钾(t=-1.806,P =0.077)、钠(t=0.400,P=0.690)、钙(t=-1.376,P=0.175)、磷(t=-0.193,P =0.848)、血红蛋白(t=-0.710,P =0.481)、血白蛋白(t=-1.823,P =0.074)差异均无统计学意义。

结论  沙库巴曲缬沙坦治疗维持性血液透析合并心力衰竭患者可显著缓解心力衰竭症状，改善心脏功能指标，减轻左心室肥厚，逆转左心室重构，降低血压，安全性好。


 

关键词: 沙库巴曲缬沙坦, 维持性血液透析, 心力衰竭, 终末期肾病

Abstract: Objective  To investigate the clinical efficacy of sacubitril/valsartan in maintenance hemodialysis (MHD) patients with heart failure.  Methods  A retrospective cohort study was performed in the MHD patients with heart failure treated in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 1, 2020, to July 31, 2021. Patients who took the medicine for more than 3 months were included in this study. Clinical data, demographic characteristics, laboratory indicators, echocardiography, adverse response of the treatment, and endpoint events were recorded.  Results  A total of 54 patients were enrolled and followed up for 3 months. Sacubitril/valsartan treatment significantly reduced NT-proBNP (15213.15±12110.44 vs. 7823.21±7457.71ng/L, t=7.053, P＜0.001), interventricular septal thickness dimension (IVSTd; 10.24±1.81 vs. 9.79±1.96mm, t=2.557, P=0.013), left ventricular posterior wall thickness dimension (LVPWTd; 10.04±1.69 vs. 9.44±1.61mm, t=2.728, P=0.009), left ventricular mass index (LVMI; 126.30±42.79 vs. 113.81±34.74g/m2, t=3.059, P=0.003), systolic blood pressure (SBP; 160.46±16.43 vs. 139.19±15.21mmHg, t=12.381, P＜0.001) and diastolic blood pressure (DBP; 79.57±11.97 vs. 69.67±10.43mmHg, t=7.070, P＜0.001). Meanwhile, left ventricular ejection fraction (LVEF) increased after three months of the treatment (55.76±8.30% to 60.02±6.18%, t=-4.323, P＜0.001). There were no significant differences in dry body mass (t=0.465, P=0.644), body mass gain (t=0.350, P=0.728), ultrafiltration (t=-0.019, P=0.985), parathyroid hormone (PTH, t=-1.660, P=0.103), serum creatinine (Scr, t=-1.452, P=0.152), Kalium (K, t=-1.806, P=0.077), Natrium (Na, t=0.400, P=0.690), Calcium (Ca, t=-1.376,  P=0.175), Phosphorus (P, t=-0.193, P=0.848), hemoglobin (HGB, t=-0.710, P=0.481) and albumin (ALB, t=-1.823, P=0.074) before and after the treatment.  Conclusion  Sacubitril/valsartan could effectively and safely relieve the clinical symptom of heart failure, improve cardiac function indicators, reduce left ventricular hypertrophy, reverse left ventricular remodeling, and lower blood pressure in MHD patients with heart failure.

Key words: Sacubitril/Valsartan, Maintenance hemodialysis, Heart failure, End-stage renal disease

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