【作者】 吴倩；

【导师】 刘盈盈；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:本研究旨在评估沙库巴曲/缬沙坦在临床实践中治疗终末期肾脏病规律血液透析合并心衰的临床疗效,为其治疗肾衰合并心衰患者提供理论依据和数据支持。方法:搜集2020年6月至2022年12月在吉林大学中日联谊医院及吉林大学白求恩第二医院就诊的慢性肾脏病规律血液透析合并心衰的患者。研究分为两组(沙库巴曲/缬沙坦组和对照组),沙库巴曲/缬沙坦组为规律血液透析并应用沙库巴曲/缬沙坦治疗的患者,共纳入44例,沙库巴曲/缬沙坦剂量50mg日1起始,耐受情况下2-3天增加至50mg日2或100mg日1;对照组为规律血液透析的未应用沙库巴曲/缬沙坦的患者共纳入63例。两组常规治疗(利尿、强心、扩血管等)相同。在治疗前及治疗12周后评估左心室射血分数(Left ventricular ejection fraction,LVEF)、左心室宽度(Left ventricular width,LVD)、氨基末端脑钠肽前体(N terminal pro b type natriuretic Peptide,NT-pro BNP)、血红蛋白(Hemoglobin,Hb)、红细胞体积分布宽度(Redcelldistributionwidth,RDW)、血小板体积分布宽度(Platelet volume distribution width,PDW)等指标,两组之间进行组间差异性分析,同时两组分别在治疗前、治疗12周后之间进行组内差异性分析。结果:1.治疗12周后血压变化:两组在治疗之前以及治疗12周后收缩压均无显著性差异(p>0.05);与对照组相比,治疗12周后沙库巴曲/缬沙坦组收缩压显著下降,差异具有统计学意义(p<0.05);沙库巴曲/缬沙坦组收缩压治疗之前与治疗12周后相比差异显著(p<0.05),而对照组收缩压治疗之前与治疗12周后相比差异不显著(p>0.05)。两组在治疗前以及治疗12周后舒张压无显著性差异(p>0.05);两组舒张压增减无显著差异(p>0.05);两组的舒张压治疗之前与治疗12周后相比无显著性差异(p>0.05)。2.治疗12周后NT-pro BNP变化:治疗前两组的NT-pro BNP无显著性差异(p>0.05);治疗12周后两组的NT-pro BNP差异显著(p<0.05);治疗12周后,沙库巴曲/缬沙坦组的NT-pro BNP较治疗前下降,对照组的NT-pro BNP较治疗前增加,两组NT-pro BNP变化差异显著(p<0.05);两组治疗之前与治疗12周后NT-pro BNP相比均差异显著(p<0.05)。3.治疗12周后左室射血分数变化:两组在治疗前以及治疗12周后左室射血分数无显著性差异(p>0.05);在治疗12周后沙库巴曲/缬沙坦组左室射血分数较治疗前有所升高,而对照组左室射血分数较治疗前有所下降,左室射血分数变化差异显著,具有统计学意义(p<0.05);两组治疗12周后左室射血分数与治疗前相比均差异不显著(p>0.05)。4.治疗后12周后左心室宽度变化:两组在治疗前以及治疗12周后左心室宽度无显著性差异(p>0.05)。两组治疗12周后较治疗前左心室宽度增减无显著差异(p>0.05);在治疗12周后沙库巴曲/缬沙坦组左心室宽度较治疗前略减少,但与治疗前相比差异性不显著(p>0.05);在治疗12周后对照组左心室宽度较治疗前略增加,但与治疗前相比差异性不显著(p>0.05)。5.治疗后12周后血红蛋白变化:两组在治疗前以及治疗12周后血红蛋白无显著性差异(p>0.05);两组治疗12周后较治疗前血红蛋白增减无显著差异(p>0.05);在治疗12周后两组血红蛋白与治疗前相比无显著性变化(p>0.05)。6.治疗后12周后红细胞体积分布宽度变化:在治疗前以及治疗12周后两组红细胞体积分布宽度无显著性差异(p>0.05);在治疗12周后两组红细胞体积分布宽度均较治疗前有所增加,但对照组增加更显著(p<0.05);与治疗前相比,治疗12周后对照组红细胞体积分布宽度显著增加,而沙库比曲/缬沙坦组差异不显著(p>0.05)。7.治疗后12周后血小板体积分布宽度变化:两组在治疗前以及治疗12周后血小板体积分布宽度无显著性差异(p>0.05);两组治疗12周后较治疗前血小板体积分布宽度增减无显著差异(p>0.05);治疗12周后两组血小板体积分布宽度较治疗之前无显著性差异(p>0.05)。结论:1.沙库巴曲/缬沙坦可有效降低终末期肾脏病血液透析合并心衰患者的NT-pro BNP水平。2.沙库巴曲/缬沙坦可有效降低终末期肾脏病血液透析合并心衰患者的收缩压。3.沙库巴曲/缬沙坦可有效延缓终末期肾脏病血液透析合并心衰患者的红细胞体积分布宽度升高。4.沙库巴曲/缬沙坦对终末期肾脏病规律血液透析合并心衰的患者心肾有益。更多还原

【Abstract】 Objective:This study was designed to evaluate the clinical efficacy of sacubitril/valsartan in the treatment of end-stage renal disease patients with regular hemodialysis and heart failure in clinical practice,and to provide theoretical basis and data support for the treatment of renal failure patients with heart failure.Methods:From June 2020 to December 2022,patients with chronic kidney disease complicated with heart failure who were treated in The China-Japan Union Hospital Of Ji Lin University and The Second Bethune Hospital Of Ji Lin University were selected.The study was divided into two groups(the sarcubacil/valsartan group and the control group).The sarcubacil/valsartan group was a group of patients who underwent regular hemodialysis and received sarcubacil/valsartan treatment.A total of44 patients were included.The dose of sarcubacil/valsartan started at 50 mg daily and increased to 50 mg daily or 100 mg daily under tolerance for 2-3 days;The control group consisted of 63 patients who did not receive regular hemodialysis and were not treated with sarcubacil/valsartan.The two sets of routine treatments(diuresis,cardiac strengthening,vasodilation,etc.)are the same.Left ventricular ejection fraction(LVEF),left ventricular width(LVD),N-terminal pro-brain natriuretic peptide(NT-pro BNP),hemoglobin(Hb),red blood cell distribution width(RDW),platelet distribution width(PDW)and other indicators were evaluated before treatment and after 12 weeks of treatment.Inter-group difference analysis was performed between the two groups,and intra-group difference analysis was performed between the two groups before treatment and after 12 weeks of treatment.Results:1.Changes of blood pressure after 12 weeks of treatment: there was no significant difference in systolic blood pressure between the two groups before and after 12 weeks of treatment(p>0.05);Compared with the control group,the systolic blood pressure of sacubitril/valsartan group decreased significantly after 12 weeks of treatment(p<0.05).The systolic blood pressure of sacubitril/valsartan group before treatment was significantly different from that after 12 weeks of treatment(p<0.05),while that of control group before treatment was not significantly different from that after 12 weeks of treatment(p<0.05).There was no significant difference in diastolic blood pressure between the two groups before and 12 weeks after treatment(p>0.05)There was no significant difference in diastolic blood pressure between the two groups(p>0.05).There was no significant difference in diastolic blood pressure between the two groups before treatment and after 12 weeks of treatment(p>0.05).2.The change of NT-pro BNP after 12 weeks of treatment: there was no significant difference between the two groups before treatment(p>0.05);After 12 weeks of treatment,there was significant difference in NT-pro BNP between the two groups(p<0.05);After 12 weeks of treatment,NT-pro BNP in sacubitril/valsartan group decreased compared with that before treatment,while NT-pro BNP in control group increased compared with that before treatment,and there was significant difference in NT-pro BNP change between the two groups(p<0.05);There was significant difference in NT-pro BNP between the two groups before treatment and after 12 weeks of treatment(p<0.05).3.The change of LVEF after 12 weeks of treatment: There was no significant difference in LVEF between the two groups before and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,LVEF in sacubitril/valsartan group was higher than that before treatment,while LVEF in control group was lower than that before treatment,and the difference of LVEF change was significant(p<0.05).There was no significant difference in left ventricular ejection fraction between the two groups after12 weeks of treatment(p>0.05).4.Changes of left ventricular width after 12 weeks of treatment: There was no significant difference in left ventricular width between the two groups before treatment and after 12 weeks of treatment(p>0.05).After 12 weeks of treatment,the left ventricular width of sacubitril/valsartan group was slightly decreased,but the difference was not significant(p>0.05).After 12 weeks of treatment,the left ventricular width of the control group increased slightly,but the difference was not significant(p>0.05).5.Hemoglobin changes after 12 weeks of treatment: There was no significant difference in hemoglobin between the two groups before treatment and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,there was no significant difference in hemoglobin between the two groups(p> 0.05).6.Changes of red cell volume distribution width after 12 weeks of treatment:There was no significant difference in red cell volume distribution width between the two groups before and after 12 weeks of treatment(p>0.05);After 12 weeks of treatment,the volume distribution width of red blood cells in both groups increased,but the increase in the control group was more significant(p<0.05).After 12 weeks of treatment,the red cell volume distribution width was significantly increased in the control group compared with that before treatment,while the difference was not significant in the sacubitril/valsartan group(p>0.05).7.Changes of platelet volume distribution width after 12 weeks of treatment:There was no significant difference between the two groups before and after 12 weeks of treatment(p>0.05);There was no significant difference in the increase or decrease of platelet volume distribution width between the two groups after 12 weeks of treatment(p>0.05).After 12 weeks of treatment,there was no significant difference between the two groups(p>0.05).Conclusion:1.Sacubitril/valsartan can effectively reduce NT-pro BNP levels in hemodialysis patients with end-stage renal disease and heart failure.2.Sacubitril/valsartan is effective in reducing systolic pressure in patients with end-stage renal disease on hemodialysis and heart failure.3.Sacubitril/valsartan effectively delays the increase in red cell volume distribution width in end-stage renal disease hemodialysis patients with heart failure.4.Sacubitril/valsartan is beneficial for the heart and kidney in patients with end-stage renal disease and hemodialysis complicated with heart failure.更多还原