重组人脑钠肽治疗顽固性心力衰竭的临床研究

摘要

Objective To investigate the clinical effects of the recombinant human brain natriuretic pep-tide ( rhBNP) on intractable heart failure .Methods Sixty-one patients with intractable heart failure were random-ly divided into two groups:rhBNP group ( 30 patients ) was treated with rhBNP combined with conventional anti-heart failure therapy and the control group (31 patients) was treated with conventional anti-heart failure therapy . Therapeutic efficacy was observed and plasma N-terminal pro-brain natriuretic peptide ( NT-proBNP ) levels were measured;cardiac function was detected by ultrasound before and one week after treatment .Results The total ef-fective rate was 93.3%(28/30) in rhBNP group and 67.7%(21/31) in control group.There were significant differences on NT-proBNP level between rhBNP group treated before and after treatment [ ( 1 918 ±466 ) ng/L vs (590 ±81) ng/L, P <0.01].There were significant differences in the left ventricular end diastolic diameter ( LVDD) and left ventricular ejection fraction ( LVEF) between the two groups before and after treatment:[ rhBNP group LVDD:(68 ±8) mm vs (59 ±7)mm, control group LVDD:(66 ±8)mm vs (61 ±8)mm, rhBNP group LVEF:(34 ±7)%vs (45 ±7)%, control group LVEF:(35 ±7)%vs (40 ±8)%].However, there were no differences between rhBNP group and control group regarding LVDD after treatment (P>0.05).Conclusion The study shows that rhBNP can reduce plasma NT-proBNP level significantly .%目的：研究重组人脑钠肽（ rhBNP）治疗顽固性心力衰竭的临床效果。方法选择2010年1月至2012年12月顽固性心力衰竭住院患者61例，完全随机分为rhBNP组（30例）和对照组（31例）。2组患者均给予常规治疗，rhBNP组另加用rhBNP，给药方法为rhBNP按1．5μg/kg静脉负荷量后，继之以7．5～10．0 ng/（kg・ min）持续泵入48 h。治疗后1周观察疗效，检测血浆N末端脑钠肽原（NT-proBNP）水平及心脏功能并与治疗前比较。结果 rhBNP组和对照组总有效率分别为93．3％（28/30）和67．7％（21/31），组间差异有统计学意义（P＜0．05）。 rhBNP组患者治疗前后NT-proBNP水平分别为（1918±466）、（590±81）ng/L，对照组患者治疗前后NT-proBNP水平分别为（1803±603）、（990±99）ng/L，2组治疗后明显低于本组治疗前（均P＜0．01）， rhBNP组治疗后1周NT-proBNP水平明显低于对照组治疗后（P＜0．01）。2组治疗后左心室舒张末期内径（LVDD）均低于本组治疗前，左心室射血分数（LVEF）均高于本组治疗前[rhBNP组治疗前后LVDD：（68±8）、（59±7）mm，对照组治疗前后LVDD：（66±8）、（61±8）mm，rhBNP组治疗前后LVEF：（34±7）％、（45±7）％，对照组治疗前后LVEF：（35±7）％、（40±8）％]，治疗前后差异均有统计学意义（均P＜0．01）；治疗后2组间LVEF的差异有统计学意义（P＜0．05）。结论 rhBNP可明显降低顽固性心力衰竭患者的NT-proBNP水平，治疗顽固性心力衰竭具有较好的临床效果。