沙库巴曲缬沙坦治疗慢性肾脏病合并高血压非心力衰竭患者的疗效

Sacubactril valsartan in hypertension without heart failure in chronic kidney disease patients

目的:研究沙库巴曲缬沙坦治疗慢性肾脏病(CKD)合并高血压非心力衰竭患者的疗效及对炎症因子影响。方法:收集2021年1月至2023年6月华中阜外医院肾内科CKD 1~4期合并高血压非心力衰竭患者,在常规治疗基础上,对照组加用缬沙坦(n=30),治疗组加用沙库巴曲缬沙坦(n=30)。在治疗前及治疗6月后检测心肾相关指标、炎症因子水平,评估肾功能恶化[估算的肾小球滤过率(eGFR)下降超过基线20%]及不良反应发生率。结果:共纳入60例患者,CKD 3~4期占76.7%,治疗组及对照组基线数据无差异。(1)与基线比较,两组患者治疗后血压均下降,治疗组下降幅度更大(P<0.05);对照组血尿素氮,血清肌酐(SCr)较基线上升,eGFR较基线下降(均P<0.05);治疗组SCr、24 h尿蛋白定量及N末端前B型利钠肽(NT-proBNP)较基线下降,eGFR,左心室射血分数(LVEF)及血白蛋白较基线上升(均P<0.05);两组SCr、eGFR、NT-ProBNP及LVEF等指标治疗后变化比例有统计学差异。(2)对照组炎症因子治疗后无明显变化,治疗组白细胞介素(IL)-1β、IL-6、IL-8、IL-2R等指标较基线下降(均P<0.05),两组IL-6治疗后变化比例有统计学差异。(3)肾功能恶化的发生率治疗组低于对照组(3.3%vs 33.3%,P<0.05)。多因素二元Logistic回归分析提示,沙库巴曲缬沙坦治疗(OR=0.013,95%CI 0.000~0.562)及基线24 h尿蛋白定量(OR=2.268,95%CI 1.313~3.919)是肾功能恶化的独立影响因素。(4)两组高钾血症发生率差异无统计学意义(10%vs 6.7%,P>0.05),治疗过程中均未出现明显的低血压、咳嗽、血管神经性水肿等不良反应。结论:沙库巴曲缬沙坦能有效控制CKD 1~4期合并高血压非心力衰竭患者血压,降低蛋白尿,减轻炎症状态,同时能改善其心功能,延缓肾功能恶化。

Objective:To observe the efficacy of sacubactril valsartan and the change of inflammatory factors in chronic kidney disease(CKD)complicated with hypertension and non-heart failure.Methodology:CKD patients with hypertension and non-heart failure in our hospital from January 2021 to June 2023 were collected.The control group was treated with Valsartan,and the treatment group was treated with sacubactril valsartan.The cardiac indicators,renal indicators and inflammatory cytokines,early deterioration of renal function(eGFR decreased by more than 20%from baseline)were followed up after 6 months.Results:A total of 60 CKD(the percentage of CKD 3~4 stage is 76.7%)patients were included.(1)There was no significant difference of the clinical data,cardiac and renal parameters between the treatment group(n=30)and the control group(n=30)before treatment(P>0.05).(2)Compared with baseline,the blood pressure of both groups decreased,and the decline was even greater in treatment group(P<0.05).Compared with baseline,24-hour urinary protein,serum creatinine and N-terminal pro-B-type natriuretic peptide(NT-proBNP)decreased;estimated glomeruar filtration rate(eGFR),left ventricular ejection fraction(LVEF)and serum albumin increased in the treatment group(P<0.05),While serum creatinine increased and eGFR decreased after 6 months of Valsartan treatment(P<0.05).The change percentage of serum creatinine,eGFR,NT-proBNP and LVEF between two groups have statistical significance(P<0.05).(3)In the treatment group,IL-1β,IL-2R,IL-6 and IL-8 decreased(P<0.05),while IL-10 and TNF-αhad no change(P>0.05).The above inflammatory factors had no significant difference after treatment in the control group.(4)The renal function deterioration incidence of renal function of treatment group was significantly lower than that control group(3.3%vs 33.3%,P<0.05).Sacubactril valsartan treatment(OR=0.01395%CI 0.000,0.562)and the baseline 24-hour urinary protein quantity(OR=2.268,95%CI 1.313,3.919)were independent influencing factors for renal function deterioration events.(5)There was no significant difference in the incidence of hyperkalemia between two groups(10%vs 6.7%,P>0.05).No obvious adverse reactions such as hypotension,cough and angioneurotic edema occured in both groups.Conclusion:Sacubactril valsartan can effectively induce blood pressure,proteinuria and inflammation,improve the cardiac function,renal function and renal prognosis in CKD 1~4 stage with hypertension and non-heart failure patients.