摘要
目的:探讨左卡尼汀(LC)联合沙库巴曲缬沙坦治疗心力衰竭(HF)合并肾功能不全患者的临床疗效及安全性,以及对血清鸢尾素(Irisin)、可溶性生长刺激表达基因2蛋白(sST2)、N末端脑钠肽前体(NT-proBNP)水平的影响.方法:选择2018年1月～2020年12月南宁市第一人民医院收治的150例HF合并肾功能不全患者,随机分为对照组(沙库巴曲缬沙坦治疗)和联合治疗组(LC联合沙库巴曲缬沙坦治疗),各75例.两组均在常规治疗的基础上采取相应的治疗方案.持续治疗4周后比较两组临床疗效、安全性以及肾功能、心功能、血气、血清Irisin、sST2及NT-proBNP水平.结果:联合治疗组患者治疗总有效率显著高于对照组(97.33％比86.67％,P=0.016).治疗后,与对照组比较,联合治疗组患者左室射血分数(LVEF)[(42.70±1.49)％比(45.12±1.68)％]和 Irisin[(406.36±20.05)ng/L 比(426.19±15.58)ng/L]、动脉氧分压(PaO2)[(78.94±2.71)mmHg 比(88.87±2.24)mmHg]均显著提高(P 均＜0.001);左室收缩末期内径(LVESd)[(41.17±1.34)mm 比(33.88±1.13)mm]、左室舒张末期内径(LVEDd)[(50.54±2.12)mm 比(43.04±2.08)mm]均显著减小,NT-proBNP[(1939.15±186.14)ng/L 比(1344.42±145.85)ng/L]、血肌酐(Scr)[(273.61±13.24)μmol/L 比(242.38±9.57)μmol/L]、尿素氮(BUN)[(14.16±1.16)μmol/L 比(10.01±1.26)μmol/L]、动脉二氧化碳分压(PCO2)[(37.61±2.27)mmHg 比(31.76±1.40)mmHg]及 sST2[(44.35±4.65)μg/L比(38.52±3.66)μg/L]均显著降低(P均＜0.001).两组不良反应发生率无显著差异(P=0.716).结论:左卡尼汀联合沙库巴曲缬沙坦治疗心力衰竭合并肾功能不全患者疗效和安全性均较高,能有效降低患者NT-proBNP及sST2水平,改善患者肾功能及心功能.
Abstract
Objective:This study aims to investigate therapeutic effect and safety of L-carnitine(LC)combined with sacubitril valsartan in patients with heart failure(HF)and renal insufficiency,and their influence on serum lev-els of Irisin,soluble growth stimulation expressed gene 2(sST2)and N terminal pro brain natriuretic peptide(NT-proBNP).Methods:This randomized control study enrolled 150 HF patients with renal insufficiency admitted in First People's Hospital of Nanning between January 2018 and December 2020.The patients were divided into control group(n=75,sacubitril valsartan therapy)and combined treatment group(n=75,LC combined sacubitril valsartan therapy),each group received corresponding therapy based on routine treatment.After 4-week continuous treat-ment,clinical therapeutic effect,safety,kidney function,cardiac function,blood gas,serum levels of Irisin,sST2 and NT-proBNP were compared between two groups.Results:Total effective rate of combined treatment group was significantly higher than that of control group(97.33％vs.86.67％,P=0.016).Compared with patients in control group after treatment,those in combined treatment group had significant higher left ventricular ejection fraction(LVEF)[(42.70±1.49)％vs.(45.12±1.68)％],Irisin[(406.36±20.05)ng/L vs.(426.19±15.58)ng/L]and arterial partial pressure of oxygen(PaO2)[(78.94±2.71)mmHg vs.(88.87±2.24)mmHg](P＜0.001 all),and significant lower left ventricular end-systolic diameter(LVESd)[(41.17±1.34)mm vs.(33.88±1.13)mm],left ventricular end-diastolic diameter(LVEDd)[(50.54±2.12)mm vs.(43.04±2.08)mm],NT-proBNP[(1939.15±186.14)ng/L vs.(1344.42±145.85)ng/L],serum creatinine(Scr)[(273.61±13.24)μmol/L vs.(242.38±9.57)μmol/L],blood urea nitrogen(BUN)[(14.16±1.16)μmol/L vs.(10.01±1.26)μmol/L],arterial partial pressure of carbon dioxide(PCO2)[(37.61±2.27)mmHg vs.(31.76±1.40)mmHg]and sST2[(44.35±4.65)μg/L vs.(38.52±3.66)μg/L](P＜0.001 all).We detected no significant difference in incidence of adverse reactions between two groups(P=0.716).Conclusion:L-carnitine combined with sacubitril valsartan has good efficacy and safety in the treatment of HF patients with renal insufficiency,which can effectively reduce the levels of NT-proBNP and sST2,and improve renal function and cardiac function.
维普
万方数据