重组人脑利钠肽对中重度心力衰竭患者自主神经功能的影响

目的:探讨重组人脑利钠肽(rhBNP)对慢性心力衰竭(CHF)患者窦性心率震荡(HRT),心率变异性(HRV)的影响。方法:治疗组(16例)加用rhBNP,首次负荷剂量2.0μg/kg静脉注射后,持续0.01μg.kg-1.min-1连用48h;对照组(16例)则灌注硝酸甘油10μg.kg-1.min-1。用药前后测定血清BNP浓度,HRT和HRV变化。结果:治疗组血清BNP浓度显著低于对照组[(735±485)ng/ml∶(1 544±677)ng/ml,P<0.05]。治疗组平均RR间期(SDNN),5min RR均值标准差(SDANN),相邻正常RR间期差值的均方根值(rMSSD),相邻RR间期之差大于50ms的心搏次数占总心搏次数的百分比(PNN50)以及震荡斜率(TS)显著高于对照组,而震荡起始(TO)则显著低于对照组。结论:静脉灌注rhBNP可有益地调节心力衰竭患者自主神经功能,对中重度心力衰竭者具有较好的保护作用。

Impact of recombinant human B-type natriuretic peptide on autonomic nervous function in patients with moderate and severe heart failure

Objective:To investigate the effects of recombinant human B-type natriuretic peptide(rhBNP) compared with nitroglycerin on heart rate variability(HRV) and heart rate turbulence(HRT) in patients with moderate and severe chronic heart failure(CHF).Method:32 patients with CHF were divided randomly into rhBNP treatment group(0.01 μg·kg-1·min-1,n=16) or nitroglycerin treatment group(10 μg·kg-1·min-1,n=16).HRV and HRT indices were obtained from 24-hour Holter,serum BNP concentration was assayed by ELISA.Result:Compared with nitroglycerin group,serum BNP was higher significantly in rhBNP group after rhBNP was used intravenously.[(735±485)ng/ml∶(1 544±677)ng/ml,P<0.05].Also,there were obvious increase in standard deviation of the R-R intervals over a 24-hour period(SDNN),standard deviation of all 5-minute mean R-R intervals(SDANN),and the percentage of R-R intervals with >50 ms variation(PNN50) in rhBNP group,compared with nitroglycerin intervention group(all P<0.05).However,there was a smaller turbulence onset(TO) in rhBNP group than in nitroglycerin group.Conclusion:rhBNP therapy improves autonomic nervous function and has a protective effect on patients with moderate and severe CHF.