沙库巴曲缬沙坦钠治疗慢性心衰合并肾功能不全的效果

摘要] 目的：观察常规抗心衰药物基础上换用沙库巴曲缬沙坦钠（Sacubitril/Valsartan，LCZ696）对慢性心力衰竭合并肾功能不全患者的临床疗效。方法：回顾性分析2018年9月至2020年9月在复旦大学附属闵行医院心内科治疗的射血分数降低型心力衰竭（HFrEF）合并肾功能不全患者196例，所有患者均接受指南导向药物治疗(GDMT),患者在抗心衰标准药物治疗基础上将ACEI/ARB替换为LCZ696治疗，平均观察（9.3±3.6）个月。比较患者治疗前后纽约心功能分级（NYHA），生活质量评分的变化，左心室射血分数（LVEF）、左心室舒张末内径（LVEDD）、血浆N-端脑钠肽前体（NT-proBNP）水平、eGFR及血钾的变化。结果：治疗后LVEF较治疗前显著升高，LVEDD较治疗前明显降低（P＜0.001），NYHA分级明显改善（P＜0.001）； NT-ProBNP较治疗前明显降低（P＜0.001）。治疗后躯体、情绪、其他领域及总分均较治疗前明显降低（P＜0.05）。诊室日间收缩压和家庭自测夜间收缩压与治疗前相比均显著降低（P＜0.05；P＜0.01），eGFR较治疗前明显升高（P＜0.01），血钾无明显变化（P＞0.05）。结论：HFrEF合并肾功能不全患者在标准抗心衰药物治疗基础上换用LCZ696能明显改善NYHA分级、肾功能和生活质量评分，降低NT-ProBNP，对血钾无明显影响。符合适应症的慢性心衰合并肾功能不全患者应用沙库巴曲缬沙坦钠安全有效。

Effects of sacubitril/valsartan on patients with chronic heart failure complicated with renal insufficiency

Abstract] Objective: To observe the clinical efficacy of Sacubitril/Valsartan (LCZ696) in patients with chronic heart failure complicated with renal insufficiency.Methods:196 patients with reduced ejection fraction heart failure (HFrEF) complicated with renal insufficiency treated in the Department of Cardiology, Minhang Hospital, Fudan University from September 2018 to September 2020 were retrospectively analyzed. All patients received guided-oriented drug therapy (GDMT), in which patients were treated with LCZ696 instead of ACEI/ARB in addition to standard antiheart failure therapy, for a mean of (9.3±3.6) months. The changes of New York Heart function grading (NYHA), quality of life score, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, eGFR and serum potassium were compared before and after treatment. Results: After treatment, LVEF was significantly higher than before treatment, LVEDD was significantly lower than before treatment (P < 0.001), NYHA grade was significantly improved (P < 0.001).NT-proBNP was significantly lower than that before treatment (P < 0.001).After treatment, somatic, emotional, other areas and total scores were significantly lower than those before treatment (P < 0.05).The systolic blood pressure in the clinic day and at night was significantly lower than that before treatment (P < 0.05;P < 0.01), eGFR was significantly higher than before treatment (P < 0.01), serum potassium had no significant change (P > 0.05).Conclusion: In HFrEF patients with renal insufficiency based on standard anti-heart failure drug therapy, LCZ696 can significantly improve NYHA grading, renal function and quality of life score, reduce NT-proBNP, and have no significant effect on blood potassium. Sacubitril/Valsartan is safe and effective for patients with chronic heart failure complicated with renal insufficiency.