重组人脑利钠肽治疗难治性心力衰竭的临床研究

目的研究重组人脑利钠肽(rhBNP)治疗难治性心力衰竭(RHF)的临床疗效。方法选择心功能分级(NYHA)Ⅲ～Ⅳ级的RHF患者60例,分为rhBNP组(rhBNP治疗)和对照组(硝普钠治疗)各30例,观察两组患者治疗前后生命体征、相关心功能指标和氨基末端脑钠肽前体(NT-proBNP)浓度的变化。所有患者均知情同意。结果 (1)与治疗前比较,rhBNP组治疗后左心室射血分数(LVEF)升高(38.5%±7.3%比28.4%±6.0%),24 h尿量增多[(920.0±320.0)ml比(500.0±120.0)ml],心率[(91.0±6.5)次/min比(112.0±1.3)次/min]、血肌酐[(86.0±17.2)μmol/L比(101.6±18.5)μmol/L]下降,差异均有统计学意义(均为P<0.05);(2)两组治疗后,rh-BNP组LVEF高于对照组(31.7%±8.9%),24 h尿量多于对照组[(740.0±140.0)ml],心率低于对照组[(107.0±7.7)次/min],肌酐低于对照组[(101.4±15.6)μmol/L],差异均有统计学意义(均为P<0.05);(3)两组治疗前后,NT-proBNP、收缩压(SBP)和左心室舒张末期内径(LVDd)差异均无统计学意义(P>0.05)。结论 rhBNP可明显改善RHF患者的心功能,其近期效果优于硝普钠治疗。

Effect of recombinant human brain natriuretic peptide(rhBNP)on patients with refractory heart failure

Objective To study the effect of recombinant human brain natriuretic peptide （rhBNP） on patients with refractory heart 1allure （RHF）. Methods Sixty refractory heart failure patients with New York Heart Association （NYHA） class Ⅲ or Ⅳ were randomly divided into rhBNP group （n = 30, rhBNP 1.5 μg/kg intravenously and then 0. 0075 μg·kg^-1·min^-1 infused intravenously for 48 hours） and sodium nitroprusside group （ n = 30, infused intravenously from 5 μg/min and titrated to 150 μg/min for 48 hours）. All the patients accepted other conventional therapy for heart failure, Heart function and plasma NT-proBNP level after treatment were compared between two groups. A written informed consent form was signed by each participant before enrollment. Results （ 1 ） In rhBNP group, left ventricle ejection fraction （LVEF） increased from （28.4%± 6. 0% ） to （38. 5%±7.3% ） and heart rate（fIR） decreased from （ 112. 0 -＋ 1.3） beats/rain to （91.0±6.5 ） beats/min after rhBNP therapy （all P 〈0. 05）. （2） Patients in rhBNP group had better l,VEFand H Rthan in sodium nitroprussidegroup [LVEF （38.5%±7.3%） vs. （31.7%±8.9%）, HR （91.0±6.5） vs. （ 107.0±7.7） beats/rain, all P 〈0. 05 ]. （3） Plasma NT-proBNP level and LVDd remained unchanged after rhBNP or sodium nitroprusside therapy （ P 〉 0. 05）. Conclusions rhBNP can improve heart function of patients with refractory heart fallure significantly, and the short-term effect is better than sodium nitroprusside.