沙库巴曲缬沙坦在腹膜透析合并慢性心功能不全患者中的应用

Application of Sacubatrava Valsartan in Peritoneal Dialysis Patients with Chronic Cardiac Insufficiency

目的评估沙库巴曲缬沙坦(SV)在腹膜透析合并慢性心功能不全患者中的疗效及安全性。方法回顾性分析2019年10月至2020年10月于郑州大学第一附属医院规律行腹膜透析且接受治疗的38例慢性心功能不全患者的病历资料。比较治疗前后患者血压、心率、N-末端脑钠肽前体(NT-proBNP)、血肌酐、肾小球滤过率(eGFR)、血钾、超声心动图参数以及纽约心脏病协会(NYHA)分级,记录主要心血管不良事件(MACE)事件及药物不良反应。结果治疗后,患者心率、收缩压、舒张压均低于治疗前,差异有统计学意义(P<0.05)。治疗后,患者NYHA分级改善,NT-proBNP水平较治疗前降低(P<0.05),左室射血分数(LVEF)升高(P<0.05),左室舒张末期内径(LVEDD)、左室质量指数(LVMI)、左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV)等降低(P<0.05)。治疗前后,患者血肌酐、尿素氮、血尿酸、eGFR比较,差异无统计学意义(P>0.05)。在随访过程中,4例出现症状性低血压,2例患者出现轻度高血钾,未发现其他严重不良反应,其间无患者停止SV治疗,2例患者因心力衰竭再入院,无死亡病例。结论SV可降低腹膜透析合并心力衰竭患者血压、心率、NT-proBNP水平,改善心功能,抑制心室重塑,对残余肾功能无明显影响,安全性良好。

Objective To evaluate the efficacy and safety of sacubatrava valsartan(SV)in peritoneal dialysis(PD)patients with chronic heart failure(CHF).Methods The medical records of 38 patients with chronic cardiac insufficiency who received regular peritoneal dialysis in the First Affiliated Hospital of Zhengzhou University from October 2019 to October 2020 were retrospectively analyzed.Blood pressure,heart rate,N-temrina pro-barin natriuretic peptide(NT-proBNP),blood creatinine,glomerular filtration rate(eGFR),blood potassium,echocardiographic parameters and New York Heart Association(NYHA)classification were compared before and after treatment,and major cardiovascular adverse events(MACE)and adverse drug reactions were recorded.Results After treatment,the heart rate,systolic blood pressure and diastolic blood pressure of the patients were lower than those before treatment(P<0.05).After treatment,NYHA grade was improved,NT-proBNP level was decreased(P<0.05),and left ventricular ejection fraction(LVEF)was increased(P<0.05),and left ventricular end-diastolic diameter(LVEDD),left ventricular mass index(LVMI),left ventricular end diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were all decreased(P<0.05).Before and after treatment,there was no statistically significant in serum creatinine,urea nitrogen,serum uric acid and eGFR(P>0.05).During the follow-up,four patients had symptomatic hypotension,two patients had mild hyperkalemia.No other serious adverse reactions were found,and no patient discontinued SV treatment during the period.Two patients were readmitted due to heart failure.There were no deaths.Conclusion SV can reduce blood pressure,heart rate and NT-proBNP level in patients with peritoneal dialysis complicated with heart failure,improve cardiac function,inhibit ventricular remodeling,and have no significant impact on residual renal function,with good safety.