【摘要】 目的：分析沙庫巴曲缬沙坦治疗射血分数降低心力衰竭（HFrEF）患者对心肾功能及安全性的影响。方法：选择2019年1月-2021年1月于本院治疗的HFrEF患者110例作为研究对象，根据治疗方法不同，将患者分为换药组（n=50）与对照组（n=60）。对照组给予包括依那普利在内的常规治疗，换药组则给予沙库巴曲缬沙坦代替依那普利治疗。治疗6个月后随访，记录比较两组治疗前后心肾功能及安全性指标，包括N末端前体脑利钠肽（NT-proBNP）、美国纽约心脏病学会（NYHA）分级、静息心率（RHR）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、血清肌酐（Cr）、尿素氮（BUN）水平、估算肾小球滤过率（eGFR）、心源性死亡、心力衰竭再住院及不良反应发生情况。结果：治疗前，两组各项心肾功能指标比较，差异均无统计学意义（P>0.05）。治疗6个月后，两组NT-proBNP、NYHA分级、RHR均低于治疗前，且换药组较对照组更低（P<0.05）;两组LVEF高于治疗前，换药组高于对照组（P<0.05）。治疗6个月后，换药组LVEDD优于治疗前（P<0.05）。治疗6个月后，两组肾功能指标比较，差异均无统计学意义（P>0.05），两组Cr、BUN均低于治疗前，eGFR高于治疗前（P<0.05）。两组治疗随访期间均无心源性死亡发生，心力衰竭再住院率及不良反应发生率比较，差异均无统计学意义（P>0.05）。结论：对于HFrEF患者，沙库巴曲缬沙坦可有效改善患者心肾功能，与依那普利相比对心功能改善更明显，未增加不良反应发生率，安全性较高。

【关键词】 沙库巴曲缬沙坦 依那普利 心力衰竭 射血分数 心肾功能

Effect and Safety Analysis of Sacubitril/Valsartan on Cardiac and Renal Function in Patients with Heart Failure with Reduced Ejection Fraction/KONG Xiangjiang. //Medical Innovation of China， 2021， 18（34）： 0-076

[Abstract] Objective： To analyze the effects of Sacubitril/Valsartan on cardiac and renal function and safety in patients with heart failure with reduced ejection fraction （HFrEF）. Method： A total of 110 HFrEF patients treated in our hospital from January 2019 to January 2021 were selected as the research object. According to different treatment methods， the patients were divided into drug change group （n=50） and control group （n=60）. The control group was given routine treatment including Enalapril， and the drug change group was treated with Sacubitril/Valsartan instead of Enalapril. After 6 months of treatment， the cardiac and renal function and safety indexes of the two groups were recorded and compared before and after treatment， including N-terminal precursor brain natriuretic peptide （NT-proBNP）， NYHA grade， resting heart rate （RHR）， left ventricular ejection fraction （LVEF）， left ventricular end diastolic diameter （LVEDD）， serum creatinine （Cr）， blood urea nitrogen （BUN）， estimated glomerular filtration rate （eGFR）， cardiac death， heart failure rehospitalization and adverse reactions. Result： Before treatment， there were no significant differences in cardiac and renal function between the two groups （P>0.05）. After 6 months of treatment， NT-proBNP， NYHA grade and RHR in the two groups were lower than those before treatment， and those of the drug change group were lower than those in the control group （P<0.05）; LVEF in the two groups were higher than those before treatment， and that in the drug change group was higher than that in the control group （P<0.05）. After 6 months of treatment， LVEDD in the drug change group was better than that before treatment （P<0.05）. After 6 months of treatment， there was no significant difference in renal function between the two groups （P>0.05）. Cr and BUN in the two groups were lower than those before treatment， and eGFR was higher than that before treatment （P<0.05）. There was no cardiac death between the two groups during the follow-up period. There were no significant differences in the rehospitalization rate of heart failure and the incidence of adverse reactions between the two groups （P>0.05）. Conclusion： For patients with HFrEF， Sacubitril/Valsartan can effectively improve the cardiac and renal function of patients. Compared with enalapril， Sacubitril/Valsartan can significantly improve the cardiac function without increasing the incidence of adverse reactions and has high safety.

[Key words] Sacubitril/Valsartan Enalapril Heart failure Ejection fraction Heart and kidney function

First-author’s address： Shenyang 245 Hospital， Shenyang 110042， China

doi：10.3969/j.issn.1674-4985.2021.34.017

心力衰竭（HF）作为一种全球性疾病影响了全世界2600万人口的健康，在我国心力衰竭患病人数达450万，5年死亡率达45%～60%[1-3]。……