摘要
背景射血分数下降的慢性心力衰竭合并肾功能不全是临床治疗的难点,患者预后不良、住院时间长、病死率高且再住院率高。沙库巴曲缬沙坦可有效治疗射血分数下降的慢性心力衰竭,但其应用于射血分数下降的慢性心力衰竭合并肾功能不全患者的相关研究较少。目的观察沙库巴曲缬沙坦治疗射血分数下降的慢性心力衰竭合并肾功不全的临床疗效。方法选择2017年10月-2018年10月在潍坊市中医院心血管病科住院治疗的射血分数下降的慢性心力衰竭合并肾功能不全患者64例,按照随机数字表法将其分为治疗组和对照组,各32例。对照组予以缬沙坦、倍他乐克缓释片及其他西药治疗,治疗组在对照组的基础上予以沙库巴曲缬沙坦治疗;两组治疗疗程均为6个月。收集两组一般资料,治疗前后左心室功能参数〔包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)〕、白介素(IL)-1、IL-6、N末端脑钠肽前体(NT-proBNP)、肾小球滤过率(GFR),不良反应发生情况。结果研究过程中脱落患者4例,最终纳入患者60例,其中治疗组31例、对照组29例。两组治疗前LVEDD、LVESD、LVEF比较,差异无统计学意义(P>0.05);治疗组治疗后LVEDD、LVESD小于对照组,LVEF大于对照组(P<0.05)。对照组、治疗组治疗后LVEDD、LVESD分别小于本组治疗前,LVEF分别大于本组治疗前(P<0.05)。两组治疗前IL-1、IL-6、NT-proBNP、GFR比较,差异无统计学意义(P>0.05);治疗组治疗后IL-1、IL-6、NT-proBNP低于对照组(P<0.05);两组治疗后GFR比较,差异无统计学意义(P>0.05)。对照组、治疗组治疗后IL-1、IL-6、NT-proBNP分别小于本组治疗前,GFR分别大于本组治疗前(P<0.05)。两组患者均未见明显不良反应。结论沙库巴曲缬沙坦可降低射血分数下降的慢性心力衰竭合并肾功能不全患者的血清IL-1、IL-6、NT-proBNP,升高GFR,同时改善患者心肾功能,且安全性较高。
Background Chronic heart failure(CHF)with decreased ejection fraction and renal insufficiency is the difficulty of clinical treatment.The patient has a poor prognosis,long hospital stay,high mortality and high rehospitalization rate.Sacubatrol/valsartan is effective on treating CHF with decreased ejection fraction,but there are few relevant studies on its application to patients with CHF with decreased ejection fraction and renal insufficiency.Objective To observe the clinical efficacy of sacubitril/vasartan in the treatment of CHF with decreased ejection fraction and renal insufficiency.Methods A total of 64 CHF patients with decreased ejection fraction and renal insufficiency who were hospitalized in the Department of Cardiology of Weifang Traditional Chinese Hospital from October 2017 to October 2018 were selected and divided into treatment group and control group according to the random number table method,32 cases in each group.The control group was treated with valsartan,betaloc sustained-release tablets and other western medicine,while the treatment group was treated with sacubatrol/valsartan on the basis of the control group;the treatment courses of both groups were 6 months.The general data,parameters of left ventricular function〔including left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)〕,interleukin(IL)-1,IL-6,N-terminal pro-B-type natriuretic peptide(NT-proBNP)and glomerular filtration rate(GFR)before and after treatment,and the occurrence of adverse reactions were collected.Results During the study,4 patients fell out,and finally 60 patients were included,including 31 cases in the treatment group and 29 cases in the control group.There was no significant difference in LVEDD,LVESD,and LVEF between the two groups before treatment(P>0.05).After treatment,LVEDD and LVESD in the treatment group were lower than those in the control group,and LVEF was higher than that in the control group(P<0.05).The LVEDD and LVESD were significantly decreased in both groups after treatment,simultaneously,the significant elevation in LVEF compared with the baseline were observed in both groups(P<0.05).There was no significant difference in IL-1,IL-6,NT-proBNP and GFR between the two groups before treatment(P>0.05).After treatment,the IL-1,IL-6 and NT-proBNP in the treatment group were lower than those in the control group(P<0.05).There was no significant difference in GFR between the two groups after treatment(P>0.05).The IL-1,IL-6 and NT-proBNP were significantly decreased in both groups after treatment,simultaneously,the significant elevation in GFR compared with the baseline were observed in both groups(P<0.05).No obvious adverse reactions were found in both groups.Conclusion Sacubitril/valsartan can reduce the serum IL-1,IL-6,NT-proBNP and improve the GFR in CHF patients with decreased ejection fraction and renal insufficiency.Simultaneously,sacubitril/valsartan can improve the cardiac function and the renal function of the patients.In addition,the safety is high.
作者
金子安
陈阳
JIN Zian;CHEN Yang(Department of Cardiology,Weifang Traditional Chinese Hospital,Weifang 261041,China)
出处
《实用心脑肺血管病杂志》
2020年第5期91-95,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
2019年度潍坊市卫生健康委科研项目(wfwsjk_2019_194)。
关键词
心力衰竭
肾功能不全
沙库巴曲缬沙坦
左心室射血分数
治疗结果
Heart failure
Renal insufficiency
Sacubitril/valsartan
Left ventricular ejection fraction
Treatment outcome
