血管素受体和尼普利辛抑制剂在慢性病中:机会还是担忧?
Antonio De Pascalis1, Alessandro Tomassetti2, Daniele Vetrano2
1Nephrology, Dialysis, and Renal Transplantation Unit, Vito Fazzi Hospital, Lecce, Italy.
Kidney360
|January 7, 2026
概括
ангиотензин受体 - 尼普利辛抑制剂 (ARNI) 对慢性病 (CKD) 患者显示有前途. 虽然ARNIs并非绝对具有脏保护作用,但它们证明了脏安全性,并减少蛋白尿,特别是在心脏病中.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- ангиотензин受体 - 尼普利辛抑制剂 (ARNI) 正在改变心力衰竭的护理.
- 人们对其脏应用越来越感兴趣,特别是在慢性脏病 (CKD) 中.
研究的目的:
- 为了探索 neprilysin 的功能.
- 批判性地审查在CKD患者中ARNI使用的临床前和临床证据.
- 采用"从长椅到床边"的方法.
主要方法:
- 关于抑制 neprilysin 的实验数据的审查.
- 对心力衰竭患者随机临床试验 (RCT) 的分析 (PARADIGM-HF,PARAGON-HF,PARAGLIDE-HF).
- 英国HARP-III试验 (初级结局RCT) 和现实世界的数据的评估.
主要成果:
- 实验数据表明,尼普利辛的抑制可以改善蛋白尿,纤维化和内皮功能,特别是在RAAS阻塞的情况下.
- 心力衰竭患者的RCT显示安全性;二级终点表明潜在的益处.
- 英国HARP-III试验证实了耐受性和蛋白尿减少,但没有观察到明显的脏保护作用.
- 现实世界的数据表明RNAI具有可接受的风险概况,与Renin-Angiotensin-Aldosterone系统阻断剂相当,益处超过风险.
结论:
- 萨库比特里尔/瓦尔萨坦 (Sac/Val) 可能是脏病学中一个有前途的治疗选择,特别是在心脏病中.
- 需要进行进一步的试验,以充分定义RNAI在CKD管理中的作用.
- 目前的证据支持使用ARNI进行适当的监测,平衡好处与不良影响.
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