沙库巴曲缬沙坦钠片联合百令胶囊治疗慢性左心衰竭合并肾功能不全的临床观察

目的:研究沙库巴曲缬沙坦钠片联合百令胶囊治疗慢性左心衰竭合并肾功能不全患者的疗效及安全性,为临床用药提供参考。方法:将2018年11月至2019年11月于四川省人民医院就诊的96例慢性左心衰竭合并肾功能不全患者根据随机数字表法分为A、B、C组,每组32例。A组患者给予常规抗心力衰竭治疗和百令胶囊(每次2 g,每日3次),B组患者给予常规抗心力衰竭治疗和沙库巴曲缬沙坦钠片(每次50 mg,每日2次)治疗,C组患者给予抗心力衰竭治疗和沙库巴曲缬沙坦钠片(每次50 mg,每日2次)+百令胶囊(每次2 g,每日3次);3组患者均连续治疗6个月。比较各组患者的临床有效率,检测治疗前后的左心功能指标左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]、血清学指标白细胞介素1(IL-1)、IL-6、N末端脑钠肽前体水平和肾小球滤过率(GFR)],观察并记录其不良反应发生情况。结果:共有脱落患者6例,最终90例完成本研究,其中A组29例、B组30例、C组31例。治疗前,3组患者的左心功能和血清学指标比较,差异均无统计学意义(P>0.05)。治疗6个月后,C组的临床有效率显著高于A组和B组(P<0.05)。与同组治疗前比较,3组患者治疗后的LVEDD、LVESD和血清学指标水平均显著降低(P<0.05),LVEF、GFR均显著升高(P<0.05),且C组患者上述指标(血清IL-1水平除外)的变化显著优于A组和B组、B组患者上述指标(GFR除外)的变化显著优于A组(P<0.05)。3组患者均未见明显不良反应发生。结论:沙库巴曲缬沙坦钠片联合百令胶囊可显著降低慢性左心衰竭合并肾功能不全患者血清中炎症因子水平,改善其心肾功能,且安全性较高。

Clinical Observation of Sacubitril Valsartan Sodium Tablets Combined with Bailing Capsules in the Treatment of Chronic Left Heart Failure with Renal Insufficiency

OBJECTIVE:To study the efficacy and safety of sacubitril valsartan sodium tablets combined with Bailing capsules in the treatment of chronic left heart failure with renal insufficiency,and to provide reference for clinical drug use.METHODS:Totally 96 patients with chronic left heart failure with renal insufficiency who sought medical care in our hospital from Nov.2018 to Nov.2019 were divided into group A,B and C according to table of random numbers,with 32 cases in each group.Group A received conventional heart failure treatment and and Bailing capsules(2 g each time,3 times a day);group B received conventional heart failure treatment and Sacubitril valsartan sodium tablets(50 mg each time,twice a day);group C was given with heart failure treatment and Sacubitril valsartan sodium tablets(50 mg each time,twice a day)and Bailing capsules(2 g each time,3 times a day).3 groups received consecutive 6 months of treatment.Clinical response rates of 3 groups were compared.Left heart function indexesleft ventricular end systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)]and serological indexesinterleukin 1(IL-1),IL-6,N terminal brain natriuretic peptide precursor,glomerular filtration rate(GFR)]were detected before and after treatment.The occurrence of ADR were observed and recorded.RESULTS:During this study,a total of 6 patients fell off,and eventually 90 patients completed the study,including 29 cases in group A,30 cases in group B and 31 cases in group C.Before treatment,there was no statistical significance in left heart function indexes or serological indexes among 3 groups(P>0.05).After 6 months of treatment,clinical response rate of group C was significantly higher than those of group A and B(P<0.05).Compared with before treatment,LVEDD,LVESD and serological indexes of 3 groups were decreased significantly after treatment(P<0.05),while LVEF and GFRwere increased significantly(P<0.05);the changes of above indexes(except for IL-1 level in serum)in group C were significantly better than group A and B,the changes of above indexes in group B(except for GFR)were significantly better than group A(P<0.05).No significant ADR were observed in 3 groups.CONCLUSIONS:Sacubitril valsartan sodium tablets combined with Bailing capsules can significantly decrease the level of serum inflammation factors,and improve cardiac and renal function in patients with chronic left heart failure with renal insufficiency,with good safety.