Kashiwagi Yusuke, Nagoshi Tomohisa, Tanaka Yoshiro, Oi Yuhei, Kimura Haruka, Ogawa Kazuo, Kawai Makoto, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Sci Rep. 2024 Jul 17;14(1):16493. doi: 10.1038/s41598-024-67524-6.
Recently, a mild elevation of the blood ketone levels was found to exert multifaceted cardioprotective effects. To investigate the effect of angiotensin receptor neprilysin inhibitors (ARNIs) on the blood ketone body levels, 46 stable pre-heart failure (HF)/HF patients were studied, including 23 who switched from angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to ARNIs (ARNI group) and 23 who continued treatment with ACE inhibitors or ARBs (control group). At baseline, there were no significant differences in the total ketone body (TKB) levels between the two groups. Three months later, the TKB levels in the ARNI group were higher than the baseline values (baseline to 3 months: 71 [51, 122] to 92 [61, 270] μmol/L, P < 0.01). In the control group, no significant change was observed between the baseline and 3 months later. A multiple regression analysis demonstrated that the initiation of ARNI and an increase in the blood non-esterified fatty acid (NEFA) levels at 3 months increased the percentage changes in the TKB levels from baseline to 3 months (%ΔTKB level) (initiation of ARNI: P = 0.017, NEFA level at 3 months: P < 0.001). These results indicate that ARNI administration induces a mild elevation of the blood TKB levels in pre-HF/HF patients.
最近，人们发现血液酮水平的轻度升高具有多方面的心脏保护作用。为了研究血管紧张素受体脑啡肽酶抑制剂（ARNI）对血液酮体水平的影响，对46例稳定的心力衰竭前（HF）/HF患者进行了研究，其中23例从血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）转换为ARNI（ARNI组），23例继续接受ACE抑制剂或ARB治疗（对照组）。基线时，两组的总酮体（TKB）水平无显著差异。三个月后，ARNI组的TKB水平高于基线值（基线至3个月：71[51,122]至92[61,270]μmol/L，P<0.01）。在对照组中，基线和三个月后未观察到显著变化。多元回归分析表明，ARNI的起始使用和3个月时血液非酯化脂肪酸（NEFA）水平的升高增加了TKB水平从基线到3个月的百分比变化（%ΔTKB水平）（ARNI的起始使用：P=0.017，3个月时的NEFA水平：P<0.001）。这些结果表明，在心力衰竭前/心力衰竭患者中，给予ARNI会导致血液TKB水平轻度升高。
