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沙库巴曲缬沙坦对原发性高血压患者肾功能的影响
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| 篇名： | 沙库巴曲缬沙坦对原发性高血压患者肾功能的影响 |
| TITLE： | Effects of sacubitril/valsartan on renal function in patients with primary hypertension |
| 摘要： | 目的 探讨沙库巴曲缬沙坦对原发性高血压患者肾功能的影响。方法回顾性纳入2018年1月至2023年6月战略支援部队特色医学中心收治的原发性高血压患者，根据用药情况分为沙库巴曲缬沙坦组和缬沙坦组，采用倾向性评分匹配方法来均衡两组患者的一般资料数据。两组均在改善患者生活方式的基础上联合降压药物治疗；沙库巴曲缬沙坦组患者加用沙库巴曲缬沙坦片200mg，口服，每日1次；缬沙坦组患者加用缬沙坦胶囊80mg，口服，每日1次。比较两组患者治疗后2个月、治疗后6个月血肌酐水平较基线升高（以下简称“血肌酐升高”）幅度、血肌酐升高＞30%～50%或＞50%的患者比例、高钾血症（血钾≥5.5mmol/L）患者比例，以及治疗前（基线水平）、治疗后2个月、治疗后6个月3个时间点患者的血肌酐水平、血钾水平及估算肾小球滤过率（eGFR）变化趋势。结果倾向性评分匹配后，沙库巴曲缬沙坦组62例患者，缬沙坦组61例患者，两组患者治疗前的一般资料比较，差异均无统计学意义（P＞0.05），具有可比性。治疗后6个月，沙库巴曲缬沙坦组患者血肌酐升高幅度显著低于缬沙坦组（P＝0.003）；沙库巴曲缬沙坦组患者血肌酐升高＞30%～50%的患者比例显著低于缬沙坦组（P＝0.045）。治疗后2个月和治疗后6个月，两组患者均未出现高钾血症事件。重复测量方差分析显示，治疗后6个月内，两组患者血肌酐、eGFR的变化趋势差异有统计学意义（P＜0.001）；服用缬沙坦的患者血肌酐持续上升，eGFR持续下降，而随着治疗时间的延长，服用沙库巴曲缬沙坦的患者血肌酐水平先升高后下降，eGFR先下降后升高。结论原发性高血压患者服用沙库巴曲缬沙坦可延缓甚至逆转肾功能水平的下降，对肾功能恶化具有限制作用，且不增加高钾血症的发生风险。 |
| ABSTRACT： | OBJECTIVE To investigate the effects of sacubitril/valsartan on renal function in patients with primary hypertension. METHODS A retrospective study was conducted among patients with primary hypertension who were admitted to PLA Strategic Support Force Characteristic Medical Center from January 2018 to June 2023. Based on their medication， they were divided into two groups： sacubitril/valsartan group and valsartan group. Propensity score matching was used to match baseline data between the two groups. Patients were treated with antihypertensive drugs based on improving their lifestyle. Sacubitril/valsartan group additionally received oral administration of 200 mg Sacubitril/valsartan tablets once daily， while valsartan group additionally received oral administration of 80 mg Valsartan capsules once daily. The increase amplitude of serum creatinine from baseline， the proportion of patients with elevated serum creatinine ＞30%-50% or ＞50%， and the proportion of patients with hyperkalemia （serum potassium ≥5.5 mmol/L） were compared between two groups at 2 months and 6 months after treatment. The trends of changes in serum creatinine， serum potassium and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment （at baseline）， 2 months and 6 months after treatment. RESULTS After propensity score matching， there were 62 patients in sacubitril/valsartan group and 61 patients in valsartan group； there were no significant differences in baseline characteristics between the two groups before treatment （P＞0.05）， indicating comparability. After 6 months of treatment， the increase of serum creatinine in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.003）； the proportion of patients with elevated serum creatinine ＞30%-50% in the sacubitril/valsartan group was significantly lower than that in the valsartan group （P＝0.045）. None of the patients experienced hyperkalemia events after 2 months and 6 months of treatment. Repeated measures analysis of variance showed significantly statistical differences in serum creatinine and eGFR between the two groups within 6 months of treatment （P＜0.001）. Patients taking valsartan experienced a continuous increase in serum creatinine levels and a decrease in eGFR， while patients taking sacubitril/valsartan showed a first increase and then a decrease in serum creatinine levels， and a first decrease and then an increase in eGFR with a prolonged duration of medication. CONCLUSIONS Sacubitril/valsartan can delay or even reverse the decline in renal function levels， and limit the deterioration of renal function in patients with primary hypertension， without increasing the risk of hyperkalemia. |
| 期刊： | 2024年第35卷第14期 |
| 作者： | 谢雅君；赵蓓；冯雪瑶；李世兴；李晓晔；史宁 |
| AUTHORS： | XIE Yajun，ZHAO Bei，FENG Xueyao，LI Shixing，LI Xiaoye，SHI Ning |
| 关键字： | 沙库巴曲缬沙坦；原发性高血压；肾功能；血肌酐；血钾；估算肾小球滤过率 |
| KEYWORDS： | sacubitril/valsartan； primary hypertension； renal function； serum creatinine； serum potassium； eGFR |
| 阅读数： | 12 次 |
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