摘要
目的探讨沙库巴曲/缬沙坦对腹膜透析(PD)合并射血分数保留的心力衰竭(HFpEF)患者的疗效及其对残肾功能的影响。方法回顾性队列研究。纳入2018年3月至2021年8月在宁波市第一医院行PD治疗且合并HFpEF的患者,在常规治疗的基础上,根据是否使用沙库巴曲/缬沙坦分为两组,观察组加用沙库巴曲/缬沙坦,对照组加用缬沙坦,分别收集两组患者治疗前基线资料和治疗后6、12个月期间的临床指标,并记录不良反应。结果共纳入99例患者,观察组61例,男44例,女17例,年龄(52±13)岁;对照组38例,男23例,女15例,年龄(57±14)岁。两组患者年龄、性别、体质指数、透析龄等基线资料差异均无统计学意义(均P>0.05)。治疗后6、12个月时,观察组氨基末端B型脑钠肽前体(NT-proBNP)、左心室收缩末期内径(LVDs)均低于对照组,左心室射血分数(LVEF)高于对照组(均P<0.05)。两组患者在治疗后6、12个月时收缩压与舒张压均低于基线值,差异均有统计学意义(均P<0.05),但两组患者在治疗后6、12个月时收缩压与舒张压下降幅度差异均无统计学意义(均P>0.05)。观察组在治疗12个月时残余估算肾小球滤过率(eGFR)下降幅度[0.52(-0.05,1.19)比1.72(0.97,2.39)ml·min^(-1)·(1.73 m^(2))^(-1),P<0.001]及24 h残余尿量下降幅度[200(-100,300)比300(137,400)ml,P=0.018]均小于对照组。随访期间,观察组与对照组分别有16例(26.2%)和13例(34.2%)发生高钾血症,分别有3例(4.9%)和1例(2.6%)出现低血压。两组患者均未出现咳嗽、血管神经性水肿等不良反应。结论沙库巴曲/缬沙坦可安全有效地改善PD合并HFpEF患者的心脏功能和控制血压。与缬沙坦相比,沙库巴曲/缬沙坦可能更有利于延缓PD合并HFpEF患者残肾功能的丢失。
Objective To investigate the efficacy of sacubitril/valsartan in peritoneal dialysis(PD)patients with heart failure with preserved ejection fraction(HFpEF)and its effect on residual renal function.Methods PD patients with HFpEF in Ningbo First Hospital from March 2018 to August 2021 were retrospectively enrolled and divided into study group with sacubitril/valsartan and control group with valsartan.The clinical baseline data before treatment and clinical indicators during follow-up(6 and 12 months after treatment)were collected and compared between the two groups,and the adverse reactions were also recorded.Results A total of 99 patients were included in the study.There were 61 patients in the study group,including 44 males and 17 females,with a mean age of(52±13)years.Meanwhile,there were 38 patients in the control group,including 23 males and 15 females,with a mean age of(57±14)years.There was no statistically significant difference in clinical baseline data between the two groups(e.g.,age,sex,body mass index,duration of dialysis)(all P>0.05).The N-terminal pro-B-type natriuretic peptide(NT-proBNP)and left ventricular end-systolic dimension(LVDs)were lower,but the left ventricular ejection fraction(LVEF)was higher in the study group than those in the control group at 6 and 12 months after treatment(all P<0.05).The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the two groups were lower than baseline values at 6 and 12 months after treatment respectively,with statistically significant differences(all P<0.05).However,there were no statistically significant differences in the decreases of SBP and DBP between the two groups at 6 and 12 months after treatment(all P>0.05).The decrease extents in residual estimated glomerular filtration rate(eGFR)[0.52(-0.05,1.19)vs 1.72(0.97,2.39)ml·min^(-1)·(1.73 m^(2))^(-1),P<0.001]and 24-h residual urine volume[200(-100,300)vs 300(137,400)ml,P=0.018]at 12 months after treatment were lower in the study group than those in the control group.During the follow-up period,hyperkalemia occurred in 16 cases(26.2%)and 13 cases(34.2%)in the study group and the control group,and hypotension occurred in 3 cases(4.9%)and 1 case(2.6%)in the study group and the control group,respectively.There were no adverse reactions such as cough and angioneurotic edema in the two groups.Conclusions Sacubitril/valsartan can safely and effectively improve cardiac function and lower blood pressure in PD patients with HFpEF.Compared with valsartan,sacubitril/valsartan may be more beneficial to delay the loss of residual renal function in PD patients with HFpEF.
作者
马建伟
任利玲
黄坚成
包斯增
戴丽丽
应霁
边学燕
Ma Jianwei;Ren Liling;Huang Jiancheng;Bao Sizeng;Dai Lili;Ying Ji;Bian Xueyan(Department of Nephrology,Ningbo First Hospital(Ningbo Hospital of Zhejiang University),Ningbo 315000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第2期117-124,共8页
National Medical Journal of China
基金
浙江省医药卫生科技计划项目(2022KY309)
