重组人脑利钠肽治疗慢性心力衰竭对醛固酮及内皮素-1的影响

目的:评价重组人脑利钠肽(rhBNP)治疗慢性心力衰竭的疗效及对血浆醛固酮和内皮素-1水平的影响。方法:对35例入选患者进行随机、开放、对照临床试验。其中实验组18例,给予rhBNP治疗;对照组17例,给予硝酸甘油治疗;观察两组用药前后血流动力学指标及血浆K 、Na 、醛固酮(ALD)和内皮素-1(ET-1)水平的变化,来探讨rhBNP治疗慢性心力衰竭的疗效及作用机制。结果:实验组在降低患者肺毛细血管楔压和肺动脉压方面、降低血浆醛固酮和内皮素-1浓度方面、升高K 浓度、降低Na 浓度方面与对照组比较均有统计学差异(P均<0．05-0．01)。结论:rhBNP治疗慢性心力衰竭疗效显著,其作用机制可能与拮抗肾素-血管紧张素-醛固酮系统的过度激活,抑制内皮素-1的释放有关,是一种既可以改善血流动力学指标,又可以拮抗神经体液因子过度激活的药物。

Effects of Recombinant Human Brain Natriuretic Peptide on Aldosterone and Endothelin-1 in Treatment of Heart Failure

Objective: To study the efficacy and the effects of recombinant human brain natriuretic peptide(rhBNP) on aldosterone and endothelin-1 in the treatment of congestive heart failure(CHF). Methods: A randomized, open, controlled clinical trail was conducted in 35 patients with CHF. Eighteen received rhBNP and 17 were treated with nitroglycerin as controls. The changes hemodynamic indexes, the plasma concentrations of K , Na , aldosterone (ALD) and endothelin-1 ( ET-1) in order to examine the efficacy and mechanism of rhBNP . Results: Between experiment and control groups significant differences were found in the decreasing of PCWP, PAP and plasma concentration of Na , ALD, ET-1, and in the increasing of plasma concentration of K (P < 0. 05 - 0. 01). Conclusion; The mechanism of rhBNP may be associated witlh the overactivation of renin-angiotension-aldosterone system, and the inhibited production of endothelin-1.