2023 年第 3 期 第 18 卷

托伐普坦联合贝那普利对急性左心衰竭患者心肾功能的影响

The effect of tolvaptan combined with benazepril on cardiac and renal function in patients with acute left heart failure

作者：夏洪娟何建

英文作者：Xia Hongjuan He Jian

单位：海军军医大学第三附属医院急诊科，上海200438

英文单位：Department of Emergency Third Affiliated Hospital of Naval Medical University Shanghai 200438 China

关键词：

英文关键词：cuteleftheartfailure;Tolvaptan;Benazepril;Cardiacandrenalfunction

• 摘要：

• 目的 探讨托伐普坦联合贝那普利对急性左心衰竭患者心肾功能的影响。方法 选取海军军医大学第三附属医院急诊科2019年1月至2020年12月诊治的急性左心衰竭患者，采用随机数字表法分为观察组（53例）和对照组（53例）进行前瞻性研究。2组均给予吸氧、镇静、控制心律失常、利尿、强心、扩张血管以及纠正水电解质紊乱等干预。对照组在此基础上予以盐酸贝那普利10 mg/次，1次/d口服治疗。观察组在对照组的基础上予以托伐普坦片15 mg/次，1 d后改为7.5 mg/次，1次/d口服治疗。2组均治疗7 d。比较2组临床疗效、心功能指标、N末端B型脑钠肽前体（NT-proBNP）、胱抑素C及心肌肌钙蛋白I（cTnI）水平、心脏不良事件、肾功能指标及药物不良反应。结果 治疗后，观察组总有效率高于对照组［92.5%(49/53)比75.5%(40/53)］，差异有统计学意义（P=0.017）。治疗后，2组患者左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）均低于治疗前，左心室射血分数（LVEF）均高于治疗前，且观察组LVEDD、LVESD均低于对照组，LVEF高于对照组，差异均有统计学意义（均P＜0.05）。治疗后，2组患者血清NT-proBNP、胱抑素C及cTnI水平均低于治疗前，且观察组患者血清NT-proBNP、胱抑素C及cTnI水平均低于对照组（均P＜0.05）。观察组心脏不良事件发生率低于对照组，差异有统计学意义（P=0.038）。2组患者治疗后血尿素氮、血肌酐、尿白蛋白排泄率(UARE)水平均低于治疗前，估算肾小球滤过率（eGFR）水平均高于治疗前，且观察组血尿素氮、血肌酐、UARE水平均低于对照组，eGFR水平高于对照组（均P＜0.05）。2组治疗期间不良反应发生率比较，差异无统计学意义（P=0.566）。结论 托伐普坦联合贝那普利应用于急性左心衰竭患者能提高疗效，改善心功能，降低血清NT-proBNP、胱抑素C及cTnI水平，保护肾功能，安全性较高。

• Objective  To investigate the effect of tolvaptan combined with benazepril on cardiac and renal function in patients with acute left heart failure. Methods  From January 2019 to December 2020， patients with acute left heart failure admitted to Department of Emergency, Third Affiliated Hospital of Naval Medical University were selected and divided into observation group(53 cases) and control group (53 cases) according to the random number table method for prospective study. Two groups were given interventions of oxygen inhalation, sedation, control of arrhythmia, diuresis, cardiac strengthening, dilatation of blood vessels and correction of water and electrolyte disorders. On this basis, the control group was treated with benazepril hydrochloride orally 10 mg once a day. On the basis of the control group, the observation group was given 15 mg of tolvaptan tablets orally for 1 d, then changed to 7.5 mg once a day. Both groups were treated for 7 d. The clinical efficacy, cardiac function indexes, N-terminal pro-brain natriuretic peptide (NT-proBNP), cystatin C and cardiac troponin I (cTnI) levels, adverse cardiac events, renal function indexes and adverse drug reactions were compared between the two groups. Results  After treatment, the total effective rate in the observation group was higher than that in the control group ［92.5%(49/53) vs 75.5%(40/53)］(P=0.017). After treatment, left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) in both groups were lower than those before treatment, left ventricular ejection fraction(LVEF) in both groups were higher than those before treatment, LVEDD and LVESD  in the observation group were lower than those in the control group, and LVEF in the observation group was higher than that in the control group (all P＜0.05). After treatment, serum levels of NT-proBNP, cystatin C and cTnI in both groups were lower than those before treatment, and the levels in the observation group were lower than those in the control group (all P＜0.05). The incidence of adverse cardiac events in the observation group was lower than that in the control group (P=0.038). After treatment, levels of blood urea nitrogen, serum creatinine and urinary albumin excretion rate (UARE) in both groups were lower than those before treatment, the estimated glomerular filtration rate (eGFR) in both groups were higher than that before treatment, levels of blood urea nitrogen, serum creatinine and UARE in the observation group were lower than those in the control group, and eGFR in the observation group was higher than that in the control group (all P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment (P=0.566). Conclusions  Tolvaptan combined with benazepril can improve the efficacy and cardiac function in patients with acute left heart failure, reduce serum levels of NT-proBNP, cystatin C and cTnI, and protect renal function, with high safety.