沙库巴曲/缬沙坦治疗慢性肾脏病合并慢性心力衰竭患者的疗效分析

Efficacy Analysis of Sacubitril/Valsartan in the Treatment of Patients with Chronic Kidney Disease and Chronic Heart Failure

摘要: 目的：观察沙库巴曲/缬沙坦治疗慢性肾脏病合并慢性心力衰竭的临床疗效。方法：回顾性收集2019年9月至2021年10月青岛大学附属医院收治的90例慢性心力衰竭合并慢性肾脏病患者的临床资料，根据其治疗方法将其分为观察组(45例，沙库巴曲/缬沙坦治疗组)，对照组(45例，非沙库巴曲/缬沙坦治疗组)，收集两组患者的一般资料及治疗前后的数据资料，通过统计学方法分析诺欣妥对慢性心力衰竭合并慢性肾脏病患者的心功能及肾功能的影响及临床疗效。结果：1) 治疗后观察组的SBP、DBP和MAP水平较对照相比明显下降，两组之间存在统计学差异(P < 0.05)。2) 治疗后，两组患者的LVEF水平较前升高，且观察组升高水平大于对照组，两组之间存在统计学差异(P < 0.05)，两组患者的LVEDD、LVESD水平均较前降低，且观察组降低水平较对照组更为显著，两组之间存在统计学差异(P < 0.05)。3) 治疗后观察组的NT-proBNP水平较对照相比明显下降，两组之间存在统计学差异(P < 0.05)。4) 治疗前后观察组与对照组的肝肾功能水平无明显差异(P > 0.05)。5) 治疗后观察组患者的心功能分级改善较对照组更加显著，两组患者总有效率分别为80.0%和95.6%，两组之间存在统计学差异(P < 0.05)。结论：对于已经启动肾脏替代治疗的慢性心力衰竭合并慢性肾脏病患者，沙库巴曲/缬沙坦治疗可以显著降低患者血压，同时可以改善患者心功能，改善心肌重构，并且对于患者的肝肾功能水平无明显加重，若患者耐受可给予酌情加用沙库巴曲/缬沙坦治疗。

Abstract: Objective: To observe the clinical efficacy of sacubitril/valsartan in the treatment of chronic kidney disease complicated with chronic heart failure. Methods: This study retrospectively collected the clinical data of 90 patients with chronic heart failure combined with chronic kidney disease who were admitted to the Affiliated Hospital of Qingdao University from September 2019 to October 2021 according to the inclusion and exclusion criteria. They were divided into observation group (45 cases, sacubitril/valsartan treatment group) and control group (45 cases, non-sacubitril/valsartan treatment group) according to their treatment methods. The general in-formation and data before and after treatment of the two groups of patients were collected. Statis-tical analysis was used to analyze the effect and clinical curative effect of sacubitril/valsartan on the cardiac function and renal function in patients with chronic heart failure complicated with chronic kidney disease. Result: 1) After treatment, the levels of SBP, DBP and MAP in the observation group were significantly lower than those in the control group, and there was a statistical difference be-tween the two groups (P < 0.05). 2) After treatment, the levels of LVEF in the two groups were high-er than before, and the elevated level in the observation group was greater than that in the control group, and there was a statistical difference between the two groups (P < 0.05); and the decrease level in the observation group was more significant than that in the control group, and there was a statistical difference between the two groups (P < 0.05). 3) After treatment, the NT-proBNP level of the observation group was significantly lower than that of the control group, and there was a statis-tical difference between the two groups (P < 0.05). 4) There was no significant difference in the lev-els of liver and kidney function between the observation group and the control group before and after treatment (P > 0.05). 5) After treatment, the improvement of cardiac function classification in the observation group was more significant than that in the control group. The total effective rates of the two groups were 80.0% and 95.6%, respectively, and there was a statistical difference be-tween the two groups (P < 0.05). Conclusion: For patients with chronic heart failure and chronic kidney disease who have started renal replacement therapy, sacubitril/valsartan treatment can significantly reduce blood pressure, improve cardiac function, and improve myocardial remodeling. There was no significant increase in the level of renal function, and if the patient tolerated it, sacu-bitril/valsartan could be added as appropriate.