血管紧张素受体-脑啡肽酶抑制剂对射血分数保留心衰患者肾脏功能及血清BNP、VEGF、TNF-α水平的影响

Effects of Angiotensin Receptor-Neprilysin Inhibitor on Renal Function and Serum BNP,VEGF and TNF-α Levels of Patients with Heart Failure with Preserved Ejection Fraction

目的:探究以血管紧张素受体-脑啡肽酶抑制剂(ARNI)治疗射血分数保留的心衰患者,对肾脏功能及血清B型钠尿肽(brain natriuretic peptide,BNP)、血管内皮生长因子(vascular endothelial growth factor,VEGF)以及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平的影响。方法:选取2020年1月至2021年1月某医疗中心收治的94例射血分数保留的心衰患者,采用随机方式分为观察组和对照组。其中对照组采用常规治疗,观察组采用ARNI治疗。比较两组的临床疗效,血清BNP、VEGF、TNF-α水平以及治疗安全性。结果:观察组治疗总有效率高于对照组(P<0.05)。治疗前,两组患者血清BNP、VEGF、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后,两组患者血清VEGF均升高,BNP、TNF-α均下降,其中观察组变化幅度更显著(P<0.05)。两组患者血清肌酐(Scr)、胱抑素C(CysC)水平、24h尿量和血钾未见异常情况,组间比较差异无统计学意义(P>0.05),症状性低血压发生率差异无统计学意义(P>0.05)。结论:ARNI治疗对射血分数保留的心衰患者血清BNP、VEGF、TNF-α水平有积极影响,对肾脏功能无显著影响。

Objective:To investigate the effects of angiotensin receptor-neprilysin inhibitor(ARNI)on renal function and serum brain natriuretic peptide(BNP),vascular endothelial growth factor(VEGF)and tumor necrosis factor-α(TNF-α)levels of patients with heart failure with ejection fraction preservation(HfpEF).Methods:A total of 94 patients with HfpEF admitted to a medical center from January 2020 to January 2021 were selected.According to the randomized double-blind approach,they were divided into the observation group and the control group.The observation group was treated with ARNI,while the control group was treated with routine treatment.The clinical efficacy,serum BNP,VEGF,TNF-αlevels and the safety of the treatment were compared between the two groups.Results:The total effective rate of clinical efficacy of the observation group was higher than that of the control group(P<0.05).Before treatment,there were no significant difference in BNP,VEGF and TNF-αlevels between the two groups(P>0.05).After treatment,the serum VEGF level increased,BNP and TNF-αlevels decreased in both two groups of paitents,and the change of the observation group was more obviously than the control group(P<0.05).There was no significant difference in SCR,CysC,24 h urine volume,incidence of symptomatic hypotension and blood potassium between the two groups of patients(P>0.05).Conclusion:ARNI has positive effects on serum BNP,VEGF and TNF-αlevels in patients with HfpEF,but has no significant effect on kidney function of HfpEF patients.