沙库巴曲缬沙坦钠对射血分数减低型心力衰竭患者肾功能、血压及血清电解质的影响

目的探究沙库巴曲缬沙坦对射血分数减低型心力衰竭(HFrEF)患者的肾功能、血压及电解质的影响并分析造成肾功能恶化(WRF)的相关危险因素。方法选取2019年10月至2020年1月于徐州医科大学附属医院心内科就诊的HFrEF患者104例,根据用药不同分为两组,其中观察组为接受沙库巴曲缬沙坦钠治疗者54例(ARNI组),对照组为接受盐酸贝那普利治疗者50例(ACEI组),分别对两组患者进行6个月的随访,观察治疗前后两组患者血清尿素氮(BUN)、肌酐(SCr)、胱抑素C(CysC)、尿酸(UA)、收缩压(SBP)、舒张压(DBP)及血电解质的变化,分析造成WRF的相关危险因素。结果随访6个月后,两组患者SCr水平较用药前均明显升高(P<0.05),但ARNI组SCr水平增加幅度明显低于ACEI组(5.76μmol/L vs.14.54μmol/L,P<0.05),且WRF发生率(16.7%)低于ACEI组(22.0%),而两组间BUN、CysC及UA的变化无明显差异(P>0.05)。ARNI组患者血压较基线平均降低12.11/4.68 mmHg(1 mmHg=0.133kPa),ACEI组患者血压较基线平均降低6.63/3.04 mmHg,两组相比,ARNI组SBP下降幅度更大(P<0.05),而DBP的下降幅度组间无明显差异(P>0.05)。治疗前后,ARNI组及ACEI组血钾、血钠、血钙及血磷水平无显著改变(P>0.05),组间也无明显差异。通过单因素及多因素Logistic回归分析发现,年龄≥75岁是造成WRF的重要危险因素。结论与ACEI相比,ARNI能延缓HFrEF患者肾功能进展,降压效果较强。

Influence of sacubitril/valsartan on kidney function,blood pressure and serum electrolytes in patients with heart failure with reduced ejection fraction

Objective To investigate the influence of sacubitril/valsartan on kidney function,blood pressure(BP)and serum electrolytes in patients with heart failure with reduced ejection fraction(HFrEF),and analyze the risk factors related to worsening renal function(WRF).Methods HFrEF patients(n=104)were chosen from Department of Cardiology in the Affiliated Hospital of Xuzhou Medical University from Oct.2019 to Jan.2020,and divided into 2 groups:observation group treated with ARNI(ARNI group,n=54)and control group treated with ACEI(ACEI group,n=50).A follow-up for 6 months was carried out in 2 groups,and changes of blood urea nitrogen(BUN),serum creatinine(SCr),serum cystatin C(CysC),uric acid(UA),systolic blood pressure(SBP),diastolic blood pressure(DBP)and serum electrolytes were observed.The risk factors related to WRF were analyzed.Results After followed up for 6 months,SCr level increased significantly in 2 groups(P<0.05),while the increase of SCr level was significantly smaller in ARNI group than that in ACEI group(5.76μmol/L vs.14.54μmol/L,P<0.05).The incidence rate of WRF was lower in ARNI group(16.7%)than that in ACEI group(22.0%),and BUN,CysC and UA had no significant difference between 2 groups(P>0.05).Compared with baseline,BP decreased averagely by 12.11/4.68 mmHg in ARNI group,and decreased averagely by 6.63/3.04 mmHg in ACEI group.SBP had larger decrease in ARNI group(P<0.05),and DBP decrease had no significant difference between 2 groups(P>0.05).The levels of blood potassium,blood sodium,blood calcium and blood phosphorus had no significant changes in 2 groups before and after treatment(P>0.05),and had significant difference between 2 groups.The results of single-factor and multi-factor Logistic regression analyses showed that age≥75 was an important risk factor of WRF.Conclusion ARNI can delay WRF process and has higher anti-hypertension effect compared with ACEI in HFrEF patients.