静脉注射重组人脑利钠肽对急性冠脉综合征患者心室重构的影响

目的观察静脉滴注重组人脑利钠肽（recombinant human brain natriuretic peptide,rhBNP）对急性冠脉综合征患者神经内分泌及心功能的影响,以探讨其对ACS患者心室重构的作用。方法选择我院住院的急性冠脉综合征患者70例,随机分为rhBNP组对照组：常规治疗。测定2组治疗前、后血浆脑利钠肽及肾素、血管紧张素II、醛固酮水平;检测治疗前、后左心室形态学参数和舒缩功能的变化。结果治疗后48h、5d、7d两组BNP水平较治疗前均有显著下降,5d时2组BNP水平均有所回升,形成第二峰,但rhBNP组峰值显著低于对照组（P〈0.05）。治疗后36h rhBNP组血浆肾素、血管紧张素II、醛固酮水平较治疗前分别下降26.8%、19.6%、17.3%,显著大于对照组（P〈0.05）,2组治疗后5d、7d、14d心脏射血分数（EF值）较治疗前均有改善,rhBNP组明显优于对照组（P〈0.05）;14d时均有增加,rhBNP组显著小于对照组（P〈0.05）。结论静脉注射rhBNP可以降低血浆肾素、血管紧张素Ⅱ、醛固酮、BNP水平,提高心脏射血分数,在一定程度上抑制左心室舒张末期内径的增长,可以阻抑急性冠脉综合征后的心室重构。

Effects of intravenous injection with recombinant human brain natriuretic peptide on ventricular remodeling in patients with acute coronary syndrome

Objective To observe the effects of intravenous injection with recombinant human brain natriuretic peptide（rhBNP）on neuroendocrine and heart function in patients with acute coronary syndrome（ACS）,and to estimate the effect of intravenous rhBNP on ventricular remodeling in patients with ACS.Methods The 70 patients with ACS were randomly divided into two groups,rhBNP group（n=35）and control group（n=35）.The patients in control group were treated by routine therapy（nitroglycerin）,however,the patients in rhBNP group were treated by rhBNP.The levels of plasma B-type natriuretic peptide（BNP）,renin,angiotensinII and aldosterone were detected before and after treatment.The changes of left ventricular morphology and function were detected by two-dimensional,M-mode and Doppler ultrasound examination.Results which was significantly decreased after 48 hours,5 days,7days in both groups（P〈0.05）.The levels of plasma BNP in rhBNP group were significantly lower than those in control group（P〈0.05）.The levels of plasma BNP were increased after 5 days and showed the second peak,but the peak-amplitude in rhBNP group was significantly lower than that of control group（P〈0.05）.The levels of plasma renin,angiotensinII and aldosterone in rhBNP group were significantly reduced by 26.8%,19.6%,17.3% respectively at 36 hours after treatment（P〈0.05）.The ejection fraction was significantly increased in rhBNP group,as compared with that in control group（P〈0.05）.The LVEDd was increased in both groups at 14days,which in rhBNP group was significantly lower than that in control group（P〈0.05）.Conclusion The intravenous injection with recombinant human brain natriuretic peptide can reduce the levels of renin,angiotensinⅡ,aldosterone and BNP,enhance cardiac ejection fraction,inhibit the increment LVEDd at some extent.The exogenous BNP can inhibit the ventricular remodeling in patients with AC.