沙库巴曲缬沙坦对心力衰竭的腹透患者肺动脉压力的影响

Effect of sacubitril valsartan on pulmonary artery pressure in peritoneal dialysis patients with heart failure

目的 探讨沙库巴曲缬沙坦在缓解心力衰竭的腹透患者症状外,对肺动脉压力的影响。方法回顾性选取2020年5月至2021年12月徐州医科大学附属医院肾内科规律行腹透治疗的心力衰竭患者60例,经心内科医师会诊及患者知情同意后予沙库巴曲缬沙坦口服治疗,随访3个月。应用心脏彩色多普勒超声得到三尖瓣反流速度及估测的肺动脉收缩压,将患者分为PH(pulmonary hypertension,PH)组和Non-PH组,比较两组一般资料、实验室指标的差异,分析沙库巴曲缬沙坦对患者肺动脉压的影响。结果 60例患者中,肺动脉高压占有26例,PH发病率为43.3%。PH组年龄、谷草转氨酶、尿素、三尖瓣反流速度、肺动脉收缩压均高于Non-PH组,差异具有统计学意义(P<0.05)。用药3月后,PH组收缩压、血钙、三尖瓣反流速度、肺动脉收缩压下降,差异具有统计学意义(P<0.05),而Non-PH组上述指标无明显变化;两组射血分数均有提高(PH组:P<0.001;Non-PH组:P=0.026)。此外,两组患者随访期间无不良事件发生。结论 沙库巴曲缬沙坦在心力衰竭合并肺动脉高压的腹透患者中的治疗是有效且安全的,可显著降低患者的肺动脉压力。

Objective To explore the effect of Sacubitril Valsartan on pulmonary artery pressure in the peritoneal dialysis(PD)patients with heart failure.Methods 60 patients with heart failure regularly treated with PD at the Department of Nephrology of the Affiliated Hospital of Xuzhou Medical University from May 2020 to December 2021 and treated with Sacubitril Valsartan orally after the consultation with a specialist cardiologist were cllected,with a follow-up observation of 3 months.Initially,the informed consent was required through the patients.Cardiac color Doppler ultrasound was used to obtain the tricuspid valve regurgitation velocity and the estimated pulmonary artery systolic blood pressure.Patients were divided into the pulmonary hypertension group(PH group)and Non-PH group,and the differences in general data and laboratory indicators of the two groups were compared,focusing on the effect of Sacubitril Valsartan on pulmonary artery pressure in the patients.Results Among the 60 patients,pulmonary hypertension occupied 26 cases,and the incidence of PH was 43.3%.The age,Glutathione aminotransferase,urine,tricuspid regurgitation velocity and pulmonary artery systolic pressure in the PH group were all higher than those in the non-PH group,and the difference was statistically significant(P<0.05).After 3 months of the administration,systolic blood pressure,blood calcium,tricuspid regurgitation velocity and pulmonary artery systolic pressure decreased in the PH group,notably significant(P<0.05),while the above index was not changed significantly in the non-PH group.The ejection fraction of both groups increased than before(PH group:P<0.001;non-PH group:P=0.026).Furthermore,there was no significant adverse events during the followup period in the 2 groups.Conclusion Sacubitril valsartan is effective and safe in the treatment of peritoneal dialysis patients with heart failure combined with pulmonary hypertension.It can significantly reducing patient’s pulmonary artery pressure.