ARNI联合SGLT2i对缺血性心肌病患者早期肾功能保护作用及炎症影响的研究

doi:10.3969/j.issn.1006-6233.2025.02.031

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摘要 目的: 探究血管紧张素受体脑啡肽酶抑制剂(ARNI)联合钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)对缺血性心肌病(ICM)患者早期肾功能保护作用及炎症的影响。方法: 选取2022年12月至2024年2月期间本院收治的128例ICM患者作为研究对象,采用计算机随机分组法分为对照组(常规药物治疗,n=32)、ARNI组(采用ARNI治疗,n=32)、SGLT2i组(采用SGLT2i治疗,n=32)、联合组(采用ARNI联合SGLT2i治疗,n=32)。比较四组治疗前后肾功能指标[尿微量白蛋白(mALB)、血清胱抑素C(CysC)]、脑钠肽(BNP)、6min步行测试(6MWT)结果、炎症指标[白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)],记录不良反应发生情况。结果: 治疗后对照组、ARNI组、SGLT2i组、联合组肾功能指标mALB、CysC水平均下降,且ARNI组、SGLT2i组、联合组mALB、CysC下降幅度高于对照组,联合组mALB、CysC下降幅度高于ARNI组、SGLT2i组,差异有统计学意义(P<0.05);治疗后对照组、ARNI组、SGLT2i组、联合组BNP水平下降、6MWT上升,且ARNI组、SGLT2i组、联合组BNP水平下降幅度高于对照组、6MWT均上升幅度长于对照组,联合组BNP水平下降幅度高于ARNI组、SGLT2i组,6MWT上升幅度长于ARNI组、SGLT2i组,差异有统计学意义(P<0.05);治疗后对照组、ARNI组、SGLT2i组、联合组炎症指标TNF-α、IL-6、CRP、IL-1β水平下降,且ARNI组、SGLT2i组、联合组炎症指标水平下降幅度均高于对照组,联合组炎症指标水平下降幅度均高于ARNI组、SGLT2i组,差异有统计学意义(P<0.05);治疗后对照组、ARNI组、SGLT2i组、联合组不良反应总计发生率比较差异无统计学意义(P>0.05)。结论: ARNI联合SGLT2i治疗ICM较各抑制剂单独应用效果更佳,能够有效保护早期肾功能,增强血管扩张能力和运动耐力,改善机体炎症状态,且安全性良好,具推广应用价值。

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关键词 ：血管紧张素受体脑啡肽酶抑制剂, 钠-葡萄糖协同转运蛋白2抑制剂, 缺血性心肌病, 肾功能, 炎症

Abstract：Objective: To explore the early renal function protective effect and inflammatory impact of angiotensin receptor neprilysin inhibitor (ARNI) combined with sodium-glucose co-transporter 2 inhibitor (SGLT2i) in patients with ischemic cardiomyopathy (ICM). Methods: A total of 128 ICM patients who were admitted to our hospital between December 2022 and February 2024 were selected as the study subjects and randomly divided into four groups: control group (standard medication, n=32), ARNI group (ARNI treatment, n=32), SGLT2i group (SGLT2i treatment, n=32), and combined group (ARNI + SGLT2i treatment, n=32). Kidney function indicators [urinary microalbumin (mALB), serum cystatin C (CysC)], brain natriuretic peptide (BNP), 6-minute walk test (6MWT), and inflammatory markers [interleukin (IL)-1β, IL-6, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α)] were compared before and after treatment, and adverse reaction incidence was recorded. Results: After treatment, kidney function indicators (mALB and CysC) decreased in all groups, with the ARNI, SGLT2i, and combined groups showing a greater reduction in mALB and CysC compared to the control group, and the combined group showing the greatest reduction compared to the ARNI and SGLT2i groups (P<0.05). After treatment, BNP levels decreased and 6MWT improved in all groups, with the ARNI, SGLT2i, and combined groups showing a greater decrease in BNP and greater improvement in 6MWT than the control group, and the combined group showing the greatest decrease in BNP and the greatest improvement in 6MWT compared to the ARNI and SGLT2i groups (P<0.05). After treatment, inflammatory markers (TNF-α, IL-6, CRP, IL-1β) decreased in all groups, with the ARNI, SGLT2i, and combined groups showing a greater decrease in inflammatory markers than the control group, and the combined group showing the greatest reduction in inflammatory markers compared to the ARNI and SGLT2i groups (P<0.05). There were no significant differences in the overall incidence of adverse reactions among the four groups (P>0.05). Conclusion: ARNI combined with SGLT2i is more effective than monotherapy in treating ICM, effectively protecting early renal function, enhancing vasodilation ability and exercise tolerance, improving systemic inflammation, and showing good safety, with great potential for broader application.

Key words： Angiotensin receptor neprilysin inhibitor Sodium-glucose cotransporter 2 inhibitor Ischemic cardiomyopathy Renal function Inflammation

基金资助:山西省医学重点科研项目(重点攻关专项),(编号:2022XM34)

通讯作者: 苗鹏飞

引用本文:

吴振华, 苗鹏飞, 唐建花, 褚鸽子, 王哲, 史生金, 赵玉霞, 郭莉青. ARNI联合SGLT2i对缺血性心肌病患者早期肾功能保护作用及炎症影响的研究[J]. 河北医学, 2025, 31(2): 344-349.
WU Zhenhua, MIAO Pengfei, TANG Jianhua, et al. Study on the Early Renal Function Protective Effect and Inflammatory Impact of ARNI Combined with SGLT2i in Patients with Ischemic Cardiomyopathy. HeBei Med, 2025, 31(2): 344-349.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.02.031 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I2/344

[1] Pastena P,Frye JT,Ho C,et al.Ischemic cardiomyopathy:epidemiology,pathophysiology,outcomes,and therapeutic options[J].Heart Fail Rev,2024,29(1):287-299.
[2] Tsukamoto S,Uehara T,Azushima K,et al.Updates for cardio-kidney protective effects by angiotensin receptor-neprilysin inhibitor:requirement for additional evidence of kidney protection[J].Am Heart Assoc,2023,12(8):29565.
[3] Cho IJ,Kang SM.Angiotensin receptor-neprilysin inhibitor in patients with heart failure and chronic kidney disease[J].Kidney Res Clin Pract,2021,40(4):555-565.
[4] Andreea MM,Surabhi S,Razvan-Ionut P,et al.Sodium-glucose cotransporter 2 (SGLT2i) inhibitors:harms or unexpected benefits[J].Medicina (Kaunas),2023,59(4):742.
[5] Towbin JA,McKenna WJ,Abrams DJ,et al.2019 HRS expert consensus statement on evaluation,risk stratification,and management of arrhythmogenic cardiomyopathy[J].Heart Rhythm,2019,16(11):301-372.
[6] 姜洋.沙库巴曲缬沙坦对缺血性心肌病与扩张型心肌病心力衰竭患者疗效及安全性的比较[J].中国冶金工业医学杂志,2022,39(5):590-592.
[7] 李静,边云飞.SGLT2抑制剂治疗射血分数保留的心力衰竭作用机制的研究进展[J].中西医结合心脑血管病杂志,2023,21(17):3193-3196.
[8] 李志家,李佩仪.血管紧张素受体脑啡肽酶抑制剂和血管紧张素转化酶抑制剂在老年缺血性心肌病患者中的效果分析[J].中国社区医师,2021,37(19):23-24.
[9] Bozkurt B,Nair AP,Misra A,et al.Neprilysin inhibitors in heart failure:the science,mechanism of action,clinical studies,and unanswered questions[J].JACC Basic Transl Sci,2022,8(1):88-105.
[10] Iordan L,Gaita L,Timar R,et al.The renoprotective mechanisms of sodium-glucose cotransporter-2 inhibitors (SGLT2i)-A narrative review[J].Int Mol Sci,2024,25(13):7057.
[11] Lee YC,Lin JK,Ko D,et al.Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction[J].Am Geriatr Soc,2023,71(10):3110-3121.
[12] Chen Y,He Q,Mo DC,et al.The angiotensin receptor and neprilysin inhibitor,LCZ696,in heart failure:a meta-analysis of randomized controlled trials[J].Medicine (Baltimore),2022,101(41):30904.