作者：金子安，陈阳

单位：

261041 山东省潍坊市中医院心血管病科；通信作者：金子安；E-mail：jinzian2001@163.com

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

Keywords：

Heart failure；Renal insufficiency；Sacubitril/valsartan；Left ventricular ejection fraction；Treatmentoutcome

CLC：

R 541.6　R 692.5

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.018

Funds：

2019 年度潍坊市卫生健康委科研项目（wfwsjk_2019_194）

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。

Abstract：

Background　Chronic heart failure（CHF）with decreased ejection fraction and renal insufficiency isthe difficulty of clinical treatment.The patient has a poor prognosis，long hospital stay，high mortality and high rehospitalizationrate.Sacubatrol/valsartan is effective on treating CHF with decreased ejection fraction，but there are few relevant studies on itsapplication to patients with CHF with decreased ejection fraction and renal insufficiency.Objective　To observe the clinicalefficacy of sacubitril/vasartan in the treatment of CHF with decreased ejection fraction and renal insufficiency.Methods　A totalof 64 CHF patients with decreased ejection fraction and renal insufficiency who were hospitalized in the Department of Cardiologyof Weifang Traditional Chinese Hospital from October 2017 to October 2018 were selected and divided into treatment groupand control group according to the random number table method，32 cases in each group.The control group was treated withvalsartan，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，parametersof 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 natriureticpeptide（NT-proBNP）and glomerular filtration rate（GFR）before and after treatment，and the occurrence of adverse reactionswere collected.Results　During the study，4 patients fell out，and finally 60 patients were included，including 31 cases in thetreatment group and 29 cases in the control group.There was no significant difference in LVEDD，LVESD，and LVEF betweenthe two groups before treatment（P>0.05）.After treatment，LVEDD and LVESD in the treatment group were lower than thosein the control group，and LVEF was higher than that in the control group（P<0.05）.The LVEDD and LVESD were significantlydecreased in both groups after treatment，simultaneously，the significant elevation in LVEF compared with the baseline wereobserved in both groups（P<0.05）.There was no significant difference in IL-1，IL-6，NT-proBNP and GFR between the twogroups before treatment（P>0.05）.After treatment，the IL-1，IL-6 and NT-proBNP in the treatment group were lower thanthose 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 significantelevation in GFR compared with the baseline were observed in both groups（P<0.05）.No obvious adverse reactions were foundin both groups.Conclusion　Sacubitril/valsartan can reduce the serum IL-1，IL-6，NT-proBNP and improve the GFR in CHFpatients with decreased ejection fraction and renal insufficiency.Simultaneously，sacubitril/valsartan can improve the cardiacfunction and the renal function of the patients.In addition，the safety is high.

ReferenceList：