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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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

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

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