基础血浆B型利钠肽水平对心力衰竭患者应用重组人B型利钠肽短期临床疗效的预测价值

摘要

目的 评价基础血浆B型利钠肽(BNP)水平对心力衰竭患者应用重组人B型利钠肽(rhBNP)短期临床疗效的预测价值.方法 选取2012年12月至2013年12月在河北医科大学第二医院心内科住院的心力衰竭患者共46例,其中男性24例,女性22例,入院后在常规抗心力衰竭治疗基础上加用rhBNP,分别计量静脉应用rhBNP前24 h、后第1、2和3个24 h液体出入量,计算每日净出量,分别将用药后每日净出量减去用药前净出量计为患者应用rhBNP后连续3个24 h的利尿效果,结合患者用药后整体临床状况改善程度评估rhBNP的短期临床疗效.基础血浆BNP值于应用rhBNP之前测定,依据其四分位数进行分组,比较血浆BNP不同水平组间rhBNP利尿效果及整体临床状况改善程度.采用双变量相关分析评价rhBNP利尿效果与基础血浆BNP水平之间的相关性.结果 所有患者基础血浆BNP值380~5000 pg/ml[1225 pg/ml(1689 pg/ml)].依据基础血浆BNP水平四分位数进行分组,基础血浆BNP不同水平组间应用rhBNP后第1个24 h的利尿效果差异有统计学意义(F=3.132,P=0.035).应用rhBNP泵点后第1个24 h利尿效果与基础血浆BNP值呈负相关(r=-0.412,P<0.01);第2个24 h利尿效果与基础血浆BNP值呈负相关趋势(r=-0.059,P=0.69);第3个24 h利尿效果与基础血浆BNP值呈负相关(r=-0.292,P=0.049).基础血浆BNP不同水平组间患者整体临床情况改善程度差异有统计学意义(χ2=18.815,P=0.03).结论 基础血浆BNP水平高的心力衰竭患者较BNP水平低的患者应用rhBNP的短期临床效果欠佳;心力衰竭患者应用rhBNP的短期利尿效果与基础血浆BNP水平呈负相关;基础血浆BNP水平对心力衰竭患者应用rhBNP的短期治疗效果具有一定预测价值.%Objective To evaluate the predictive values of baseline plasma B?type natriuretic peptide( BNP) levels for short?term clinical efficacy of recombinant human brain natriuretic peptide( rhBNP) in patients with heart failure. Methods A total of 46 heart failure patients including 24 males and 22 females were selected between December 2012 and December 2013. For these patients rhBNP was used subsequent to appropriate conventional therapies for heart failure. 24 hours fluid input and output were recorded before and the first, second, third 24 hours after drug used. The difference value of 24?hour output day 1, day 2, day 3 after rhBNP and 24?hour output before rhBNP was defined as primary endpoint. The degree of improvement in overall clinical condition was also recorded after drug used. Baseline plasma concentrations of BNP were measured before rhBNP administration. According to the plasma BNP quartile to compare diuretic effect and degree of improvement in overall clinical status. Bivariate correlation was used to analyze the relationship between baseline BNP levels and the diuretic effect. Results The baseline BNP concentrations ranged from 380 pg/ml to 5000 pg/ml, with a median of 1225 pg/ml. According to the plasma BNP quartile, diuretic effect of the first 24 hours after drug administration showed a significant difference among four groups(F=3. 132, P=0. 035). There was a significant negative correlation between baseline BNP levels and the diuretic effect of the first 24 hours ( r = -0. 412, P <0. 01 ) . A negative correlation trend was found between baseline BNP value and the diuretic effect of the second 24 hours( r=-0. 059, P =0. 69 ) . The diuretic effect of the third 24 hours and baseline plasma BNP values were negatively correlated(r= -0. 292, P=0. 049). The degree of improvement in overall clinical status was statistically significant among the BNP groups(χ2 =18. 815, P=0. 03). Conclusions The heart failure patients with higher BNP levels have a poor short?term clinical efficacy after rhBNP administration than the patients with lower BNP levels. The short?term diuretic effect of rhBNP is negatively correlated with baseline plasma BNP levels. Baseline BNP levels can be used to predict the short?term clinical efficacy of rhBNP in heart failure patients.