重组人脑利钠肽对急性冠脉综合征伴心力衰竭患者神经内分泌激素和心功能的影响

摘要

目的：观察重组人脑利钠肽（rhBNP）用于急性冠脉综合征（ACS）伴急性心力衰竭（AHF）治疗神经内分泌激素水平及心功能的影响。方法将76例住院治疗的 ACS － AHF 患者随机分为 rhBNP 组（37例）和硝酸甘油（NIT）组（39例）。两组在常规治疗基础上，rhBNP组给予 rhBNP 连续静脉滴注72 h，NIT 组给予硝酸甘油连续使用72 h。两组患者治疗前及停药后6 h 分别抽血检测 NT － proBNP 及肾上腺素、去甲肾上腺素、肾素、血管紧张素Ⅱ、醛固酮水平，于住院期间及出院后1个月行心脏超声检查，比较两组住院期间及出院后1个月左心室舒张末期容积，左心室收缩末期容积及左心室射血分数。分别测试比较两组患者出院前及停药后1个月，6分钟步行距离及出院6个月内主要心脏不良事件（MACE，包括心源性死亡、再发严重心力衰竭、恶性心律失常）的发生情况。结果停药后 rhBNP 组较NIT 组的 NT － proBNP 及肾上腺素、去甲肾上腺素、肾素、血管紧张素Ⅱ、醛固酮水平显著降低，可显著改善心脏功能。两组停药后1个月与出院前相比，6分钟步行距离均明显增加（ P ﹤0.05），且 rhBNP 组较 NIT 组更显著（ P ﹤0.05）。随访6个月内两组间 MACE 发生率比较，rhBNP 组低于 NIT 组（ P ﹤0.05）。结论对 ACS － AHF 患者静脉内注射 rhBNP，较 NIT 可显著抑制血浆中 NT － proBNP 及肾上腺素、去甲肾上腺素、肾素、血管紧张素Ⅱ、醛固酮等神经内分泌激素水平，对 ACS － AHF 患者尽早应用 rhBNP 能更好地改善患者的心功能及预后。%Objective To evaluate the effects of recombinant human brain natriuretic peptide (rhBNP) on the neuroendocrine hormone levels and heart function in acute coronary syndrome (ACS ) complicating acute heart failure(AHF). Methods 76 cases of ACS com-plicating AHF in our hospital were enrolled and randomly divided into the rhBNP group ( n = 37) and the nitroglycerin(NIT) group ( n = 39 ) . On the basis of the same conventional therapy, the rhBNP group was given rhBNP by continuous intravenous injection for 72 h and the NIT group was given nitroglycerin for successive 72 h. The blood samples in the two groups were collected before treat-ment and at 6 h after drug withdrawal for detecting NT - proBNP, epinephrine, norepinephrine, rennin, angiotensinⅡ and aldosterone. The left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular ejection fraction (LVEF) during hospitalization and at 1 month after discharge from hospital were compared between the two groups. The 6 min walking distance before discharge and after drug withdrawal was measured and compared between the two groups. The occurrence situation of the major adverse cardiac events (MACE, including cardiac death, recurrent severe heart failure, malignant arrhythmia, etc. ) was compared between the two groups. Results The levels of plasma NT - proBNP after drug withdrawal in the rhBNP group were significantly lower than those in the NIT group ( P ﹤ 0. 05) . The levels of plasma epinephrine, norepinephrine, renin, angiotensinⅡ and aldosterone in the rhBNP group were significantly reduced compared with those in the NIT group, the heart function was significantly improved. The 6 min walking distance at 1 month after drug withdrawal was obviously increased compared with before discharge( P ﹤ 0. 05 ), moreover the rhBNP group was more obvious in the curative effect than the NIT group( P ﹤ 0. 05) . The occurrence rate of MACE within 6 - month follow up period in the rhBNP group was lower than that in the control group( P ﹤ 0. 05). Conclusion Intravenous injection of rhBNP can significantly inhibit plasma NT - proBNP and the neuroendocrine hormone levels of epinephrine, norepinephrine, rennin, angiotensinⅡand aldosterone in the patients with ACS complicating AHF. Applying rhBNP as early as possible can better improve the heart function and prognosis in the patients with ACS complicating AHF.