【摘要】 目的观察沙库巴曲缬沙坦在血液透析患者中治疗心力衰竭的有效性和安全性。方法纳入血液透析合并慢性心功能不全患者,以用药前为基线,加用沙库巴曲缬沙坦后随访3个月。期间监测心力衰竭生物标记物及生化指标,体质成分分析评估容量,超声评价心脏结构及功能。结果纳入受试者17例,4例因药物不良反应、1例因肾移植退出。随访终点左心室射血分数(left ventricular ejection fraction,LVEF)(62.7%±10.1%)较基线(54.2%±15.8%)改善(t=-4.429,P=0.001);基线LVEF减低者(<55%)改善更明显(t=-6.204,P=0.003),伴随左心室收缩末容积[基线(109.0±62.7)ml,终点(79.4±52.1)ml,t=4.725,P=0.009]下降。LVEF正常者左心室后壁厚度[基线(1.08±0.27)cm,终点(0.99±0.16)cm,t=3.176,P=0.025]下降。随访终点时血肌酐(t=-2.856,P=0.016),尿素(t=-3.149,P=0.009)及甲状旁腺激素(t=-2.230,P=0.048)水平较基线升高。结论沙库巴曲缬沙坦可改善血液透析患者的心脏收缩功能,在LVEF正常者中减轻左心室肥厚。治疗中可引起肌酐、尿素及甲状旁腺激素水平上调。更多还原

【Abstract】 Objective To observe the efficacy and safety of sacubitril/valsartan for the treatment of heart failure in maintenance hemodialysis patients. Methods Patients on hemodialysis complicated with chronic cardiac insufficiency and with stably controlled volume status were enrolled. They were treated with sacubitril/valsartan and followed up for 3 months. Before treatment with sacubitril/valsartan(baseline) and during follow-up, biomarkers of heart failure were tested, and volume status was assessed by body composition monitor(BCM). Changes of cardiac structure and function were examined by echocardiography. Results A total of17 patients were included, while 4 patients withdrew due to drug-related adverse reactions and one due to renal transplantation during follow-up. Left ventricular ejection fraction(LVEF) increased from baseline 54.2±15.8% to endpoint 62.7±10.1%(t=-4.429, P=0.001) and greater improvement was found in patients with declined baseline LVEF(≤55%; t=-6.204, P=0.003), in line with a significant reduction in left ventricular end systolic volume(baseline 109.0±62.7 ml vs. endpoint 79.4±52.1 ml; t=4.725, P=0.009). In patients with normal LVEF, left ventricular posterior wall thickness decreased significantly(baseline 1.08 ± 0.27 cm vs. endpoint0.99 ± 0.16 cm; t=3.176, P=0.025). The endpoints of serum creatinine(t=-2.856, P=0.016), urea(t=-3.149,P=0.009) and parathyroid hormone(baseline 328±161 pg/ml vs. endpoint 409±191 pg/ml; t=-2.230, P=0.048)elevated significantly as compared with the baseline values. Conclusion Sacubitril/valsartan significantly improves cardiac systolic function in hemodialysis patients with heart failure and reduces ventricular wall thickness in patients with normal LVEF. However, this treatment may also induce the increase of creatinine, urea and parathyroid hormone levels.更多还原