重组人 BNP 联合黄芪注射液对 AMI PCI 术后心力衰竭患者心功能及血清炎症因子的影响

摘要

目的 探讨重组人脑利钠肽(rhBNP )联合黄芪注射液对急性心肌梗死(AMI )经皮冠脉内介入治疗(PCI)术后心力衰竭患者心功能及血清炎症因子水平的影响.方法 选择96例AMI行 PCI术后心力衰竭患者,随机均分为rhBNP组(在常规治疗基础上给予 rhBNP治疗)和联合治疗组(在 rhBNP组基础上联用黄芪注射液) ,治疗14d ,观察两组临床疗效,治疗前后心功能、血清N末端B型脑钠肽前体(NT‐proBNP) 、肿瘤坏死因子‐α (TNF‐α) 、 hsCRP 、基质金属蛋白酶‐9 (MMP‐9) 、髓过氧化物酶(MPO)水平变化,及不良反应发生率.结果 治疗后,联合治疗组临床总有效率显著高于 rhBNP组(91.67% 比72. 92%, P＝0.016) ;与 rhBNP组比较,联合治疗组 LVEF [ (44.26 ± 7.39 )% 比(49.67 ± 7.46 )%]增加更显著, LVEDV [ (129. 27 ± 8.71 ) ml比(117.39 ± 7.59) ml] 、 LVESV [ (78.10 ± 6.22) ml比(66. 74 ± 5. 96) ml]减小更显著, NT‐proBNP [ (968. 43 ± 172.49) ng／L比(796. 30 ± 158. 24) ng／L] 、 TNF‐α [ (118.67 ± 23.59) ng／L比(97.73 ± 18. 48) ng／L] 、 hsCRP [ (4.19 ± 0.85) mg／L比(3. 38 ± 0. 57) mg／L] 、 MMP‐9 [ (82.47 ± 14. 28) ng／ml比(60.92 ± 11.45) ng／ml] 、MPO [ (497.52 ± 64. 32) mg／L比(452. 82 ± 60.57) mg／L]水平下降更显著(P均＝0.001) .两组不良反应发生率无显著差异(P＝0. 584) .结论 rhBNP联合黄芪注射液治疗AMI行PCI术后心力衰竭患者可显著改善心功能,减轻炎症反应,且安全,值得推广.%To explore influence of recombinant human B type natriuretic peptide (rhBNP) combined As‐tragalus injection on heart function and serum levels of inflammatory factors in AMI patients with post‐percutaneous coronary intervention (PCI) heart failure .Methods : A total of 96 AMI patients with post‐PCI heart failure were randomly and equally divided into rhBNP group (received rhBNP based on routine treatment ) and combined treat‐ment group (received Astragalus injection based on rhBNP group ) , both groups were treated for 14d.Clinical thera‐peutic effect , heart function , serum levels of N terminal pro BNP (NT‐proBNP) , tumor necrosis factor (TNF)‐α , hsCRP , matrix metalloproteinase (MMP)‐9 and myeloperoxidase (MPO) before and after treatment , and inci‐dence of adverse reactions were observed in two groups .Results : After treatment , total effective rate of combined treatment group was significantly higher than that of rhBNP group (91.67% vs .72.92%, P＝0. 016).Compared with rhBNP group after treatment , there was significant rise in LVEF [ (44.26 ± 7.39)% vs.(49. 67 ± 7.46)%] , and significant reductions in LVEDV [ (129.27 ± 8.71) ml vs .(117.39 ± 7.59) ml] , LVESV [ (78.10 ± 6.22) ml vs.(66. 74 ± 5.96) ml] , serum levels of NT‐proBNP [ (968.43 ± 172.49 ) ng／L vs.(796. 30 ± 158. 24 ) ng／L ] , TNF‐α [(118. 67 ± 23.59) ng／L vs.(97.73 ± 18.48) ng／L] , hsCRP [(4. 19 ± 0. 85) mg／L vs.(3. 38 ± 0. 57) mg／L] , MMP‐9 [ (82.47 ± 14. 28) ng／ml vs .(60. 92 ± 11. 45) ng／ml] and MPO [ (497. 52 ± 64.32) mg／L vs.(452. 82 ± 60.57) mg／L] in combined treatment group , P＝0.001 all.There was no significant difference in incidence rate of adverse reactions between two groups , P＝0.584. Conclusion : RhBNP combined Astragalus injection can signifi‐ cantly improve heart function , relieve inflammatory reactions with safety in AMI patients with post‐CI heart fail‐ure , which is worth extending .