沙库巴曲缬沙坦对慢性心衰患者贫血的影响及相关因素分析

摘要/Abstract

摘要： 目的本研究旨在通过前瞻性试验,探讨血管紧张素受体脑啡肽酶抑制剂（ARNI）沙库巴曲缬沙坦与慢性心力衰竭（CHF）患者发生贫血之间的关系,并探讨其中可能存在的相关影响因素。方法选取2021年1月—2023年6月临沂市人民医院和临沂市中医医院的406例符合纳入标准和排除标准的CHF患者作为研究对象。采用随机数表法将研究对象按1:1的比例分为ARNI组和ARB组。入组初期两组均行常规治疗,在此基础上,ARB组203例给予缬沙坦治疗,ARNI组203例则给予沙库巴曲缬沙坦治疗。在治疗前和治疗12个月后检测两组患者的血红蛋白含量、铁蛋白水平、血清铁水平、促红细胞生成素（EPO）、维生素B₁₂、叶酸水平以及炎症指标（IL-6）水平,分析两组患者在治疗12个月后的贫血发生率和贫血程度的差异,二元logistic回归分析贫血发生的相关影响因素,并对有意义的因素做进一步比较分析。结果治疗12个月后,两组贫血患者EPO水平、铁蛋白水平、IL-6均较治疗前升高,ARNI组非贫血患者在治疗后铁蛋白水平呈降低趋势,而ARB组呈升高趋势,两组非贫血组患者炎症指标IL-6均呈降低趋势,差异均有统计学意义（P<0.05）;ARNI组的贫血发生率低于ARB组,并且ARNI组患者贫血程度较ARB组要轻,差异有统计学意义（P<0.05）;二元logistic回归分析提示较高的EPO水平、铁蛋白水平升高、高炎性状态是两组患者贫血发生的共同预测因素;高龄（≥65岁）、较差的心功能分级仅是ARB组贫血发生的危险因素;ARNI组贫血患者治疗前后EPO升高水平较ARB组显著,而ARB组贫血患者治疗前后铁蛋白、炎症指标升高水平较ARNI组显著,差异有统计学意义（P<0.05）。结论沙库巴曲缬沙坦与缬沙坦均有引起CHF患者发生贫血的风险,但沙库巴曲缬沙坦引起的贫血发生率与贫血程度要低。较高的EPO水平、铁蛋白水平升高、高炎性状态是两种药物引发CHF患者贫血的共有预测因素,但高龄、较差的心功能分级仅是口服缬沙坦引起贫血的危险因素。这种差异可能归因于沙库巴曲缬沙坦能影响EPO的分泌、铁的吸收利用以及对CHF患者炎症的抑制作用。

关键词: 沙库巴曲缬沙坦, 慢性心力衰竭, 贫血, 因素分析

Abstract: Objective This study aims to investigate the relationship between the angiotensin receptor enkepriliase inhibitor Sacubitril/Valsartan and the occurrence of anemia in patients with chronic heart failure (CHF) through a prospective trial, and Explore the possible influencing factors. Methods A total of 406 CHF patients who met the inclusion and exclusion criteria from Linyi People's Hospital and Linyi Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were selected as the research subjects. According to the random number table method the research subjects were randomly divided into the ARNI group and the ARB group at a 1:1 ratio. At the beginning of enrollment, both groups received conventional treatment. On this basis, 203 cases in the ARB group were treated with valsartan, and 203 cases in the ARNI group were treated with sacubitril/valsartan. Before treatment and 12 months after treatment, the levels of hemoglobin content, serum ferritin, serum iron and other anemia and iron metabolism-related indicators, as well as erythropoietin (EPO), vitamin B₁₂, folic acid levels and inflammatory indicators (IL-6) were detected in both groups. The differences in the incidence and degree of anemia in the two groups 12 months after treatment were analyzed. Binary logistic regression was used to analyze the related influencing factors of anemia occurrence, and further comparative analysis was conducted on the meaningful factors. Results After 12 months of treatment, the levels of EPO, ferritin, and IL-6 in the anemic patients in both groups were all increased compared with those before treatment. In the non-anemic patients in the ARNI group, the ferritin level showed a decreasing trend after treatment, while in the ARB group, it showed an increasing trend. The inflammatory indicator IL-6 in the non-anemic groups of both groups showed a decreasing trend. All the above differences were statistically significant (P<0.05). The incidence of anemia in the ARNI group was lower than that in the ARB group, and the degree of anemia in the ARNI group was milder than that in the ARB group, with statistically significant differences (P<0.05). Binary logistic regression analysis indicated that higher EPO levels, increased ferritin levels, and a high inflammatory state were common predictive factors for the occurrence of anemia in patients in both groups. While advanced age (≥65 years old) and poorer cardiac function classification were only risk factors for the occurrence of anemia in the ARB group. The increase level of EPO before and after treatment in anemic patients in the ARNI group was significantly higher than that in the ARB group, while the increase levels of ferritin and inflammatory indicators before and after treatment in anemic patients in the ARB group were significantly higher than those in the ARNI group, with statistically significant differences (P<0.05). Conclusion Both sacubitril/valsartan and valsartan have the risk of causing anemia in patients with chronic heart failure, but the incidence and degree of anemia caused by sacubitril/valsartan are lower. Higher EPO level, increased ferritin level, and high inflammatory state are common predictive factors for anemia in patients with chronic heart failure caused by the two drugs, but advanced age and poorer cardiac function classification are only risk factors for anemia caused by taking valsartan orally. This difference may be attributed to the fact that sacubitril/valsartan can affect the secretion of EPO, the absorption and utilization of iron, and the inhibition of inflammation in patients with heart failure.

Key words: sacubitril/valsartan, chronic heart failure, anemia, factor analysis

中图分类号:

R541.6

尹聪聪, 王娟, 樊荣. 沙库巴曲缬沙坦对慢性心衰患者贫血的影响及相关因素分析[J]. 中华养生保健, 2025, 43(11): 46-51.

Yin Cong-cong, Wang Juan, Fan Rong. Analysis of the Effect of Sacubitril/Valsartan on Anemia in Patients[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(11): 46-51.

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