重组人脑钠肽治疗急性左心衰竭的疗效和安全性研究

摘要

Objective To investigate the efficacy and safety of recombinant human brain natriuretic peptite(rhBNP) on acute left heart failure.Methods Sixty-five patients with acute left heart failure selected from January 2010 to June 2012 were divided into control group (40 cases) and treatment group (25 cases).According to the random number,the two groups were given basic standard treatment and treatment group was added with rhBNP.The clinical symptoms of two groups of patients with remission,endogenous plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP) level,hemodynamic changes and adverse event were observed.Results After 4 d and 1 week of treatment,the NT-proBNP levels in treatment group were significantly lower than those in the control group; the difference was statistically significant[(5 472 ± 422)μg/L,(3 892 ± 225)μg/L vs (7 627 ± 276) μg/L,(5 983 ± 399)μg/L,P ＜ 0.05].After 1 week of treatment,the effective rate of control group[60％ (24/40)] was lower than that in the treatment group[84％ (21/25)],the difference was statistically significant (x2 =13.29,P =0.024).After 4 d and 1 week of treatment,the left ventricular ejection fraction of treatment group was higher than that in the control group [(45.9 ± 5.9) ％,(52.2 ± 6.2) ％ vs (35.9 ± 3.8) ％,(40.1 ± 3.2) ％] ; the central venous pressure of treatment group was lower than that in the control group; the difference was statistically significant[(8.8 ± 1.9),(6.6 ± 1.2) cmH2O vs (11.4 ± 2.0),(9.3 ± 2.1) cmH2O,P ＜0.05].After 1 year of follow-up,the incidence rate of adverse reaction in control group[37.5％ (11/40)] was higher than that in the treatment group[20％ (4/25)] ; the difference was statistically significant(x2 =11.20,P=0.029).Conclusion rhBNP can effectively improve the cardiac function in patients with heart failure and reduce the incidence of adverse events.%目的 探讨重组人脑钠肽(rhBNP)对急性左心衰竭的疗效及安全性.方法 选取2010年1月至2012年6月江苏省常熟市第一人民医院收治的65例急性左心衰竭患者,按随机数字表法分为对照组(40例)和治疗组(25例),2组患者均先给予标准的基础治疗,治疗组加用rhBNP,观察2组患者的内源性血浆N末端B型利钠肽前体(NT-proBNP)水平、治疗效果、血流动力学变化及不良反应发生情况.结果 治疗后4d及1周治疗组NT-proBNP水平[(5 472 ±422) 、(3 892 ±225) μg/L]明显低于对照组[(7 627±276)、(5 983±399) μg/L],差异有统计学意义(P＜0.05).对照组治疗后1周有效率[60.0％(24/40)]低于治疗组[84.0％ (21/25)],差异有统计学意义(x2=13.29,P =0.024).治疗后4d及1周治疗组左心室射血分数[(45.9±5.9)％、(52.2±6.2)％]高于对照组[(35.9±3.8)％、(40.1±3.2)％,中心静脉压[(8.8±1.9)、(6.6±1.2) cmH2O,(1 cmH2O=0.098 kPa)]低于对照组[(1 1.4±2.0)、(9.3 ±2.1)cmH2O],差异均有统计学意义(均P＜0.05).对照组随访1年内不良反应发生率[37.5％ (11/40)]高于治疗组[20.0％(4/25)],差异有统计学意义(x2=1 1.20,P=0.029).结论 rhBNP可有效改善心力衰竭患者的心功能,降低不良反应发生率.