Objective To investigate the effect of recombinant human brain natriuretic peptide ( rhBNP) in patients with resistance of diuretics and chronic heart failure and its mechanism .Methods Select from August 2014 to April 2015 , 62 cases of chronic heart failure patients with diuretics resistant , depending on admission sequence of ,they were randomly divid -ed into control group ( n =34 ) and observation group ( n =28 ) .Basic treatment and basic treatment plus rhBNP treatment were given respectively , the 2 groups of patients'vital signs ,electrolytes , daily morning body mass and liquid volume were re-corded,observe the improvement of heart function .The left ventricular ejection fraction (LVEF), left ventricular end-systol-ic/diastolic diameter ( LVESD/LVEDD) were measured by cardiac color Doppler .The levels of serum vascular nervous angio-tensin II ( Ang II), aldosterone ( ALD), norepinephrine ( NE), serum N-terminal pro brain natriuretic peptide precursor (NT-proBNP) and antidiuretic hormone( ADH) were determined.The rate of re-entry in 3 months were followed-up .Results After treatment, the total effective rate of observation group was82 .1 % higher than the control group (35.3%,χ2 =13.709, P <0.01).After treatment,compared with before treatment ,2 groups'LVEF,HR significantly improved ( P <0.05),and the observation group's LVEF, HR improved more obviously ( P <0.05).LVEDD and LVESD changes before and after treatment were not significant ( P >0.05), but still showed a decreasing trend .Observation group from begins of treatment , the urine volume increased significantly , and gradually diuretic effect became more obvious , to 4-5 days,the effect reached the steady state , but still maintain a good diuretic effect , while the control group patients with limited diuretic effect .Curative effect in observed group is better than control group ( t 1d=9.853, t2d =8.426, t 3d=10.646, t 4d =10.166, t 5d=8.580, P <0.01).After treatment, observe groups of patients with body mass decreased more markedly , better than the control group, until 4 to 5 days still shows better body quality decline trend ( t 1d =4.897, t 2d =7.837, t 3d =7.030, t 4d=7.800, t5d =6.981, P <0.01).After treatment, 2 groups of blood urea nitrogen, serum creatinine, serum sodium indexes were com-pared with those before treatment showed significantly improvement ( P <0.05), and observation of blood urea nitrogen (BUN), blood creatinine compared with the control group showed better therapeutic effect ( P <0.01).The 2 groups had little change in serum potassium ( P >0.05).Compared with before treatment, after treatment in control group, serum ALD and NT-proBNP significantly decreased ( P <0 .01 ) , and the observation group's nerve endocrine factor 4 was significantly decreased ( P <0.01).Compared with the control group , the observation group significantly decreased of the serum Ang II , NE, and NT proBNP level ( P <0.01).Patients were discharged after a follow-up of 3 months, the control group's re-hospi-talization were 14 cases (41.2%), which were higher than in the observation group of 5 cases (17.9%) (χ2 =3.929, P <0.05).Conclusion Recombinant human brain natriuretic peptide can rapidly improve the symptoms of heart failure , reduce the retention of water and sodium , alleviate diuretic resistance , lower readmission rate and its mechanism may be related to its diuretic collaborative function and neurohormonal antagonism .%目的：探讨重组人脑利钠肽（ rhBNP）对慢性心力衰竭利尿剂抵抗患者的治疗效果及其作用机制。方法选取2014年8月—2015年4月慢性心力衰竭利尿剂抵抗患者62例，按入院顺序随机分为观察组（ n ＝28）与对照组（ n ＝34）。2组分别予以基础治疗、基础治疗加rhBNP治疗，记录2组患者的生命体征、电解质、每日清晨体质量及液体出入量，观察心功能的改善情况。心脏彩色多普勒测定左室射血分数（ LVEF ）、左室收缩／舒张末内径（LVESD／LVEDD）。测定血清血管紧张素II（AngII）、醛固酮（ALD）、去甲肾上腺素（NE）、血清氨基末端脑钠肽前体（NT－proBNP）水平及抗利尿激素（ADH）水平。随访患者3个月内的再入院率。结果治疗后，观察组总有效率82．1％高于对照组的35．3％（χ2＝13．709， P ＜0．01）。治疗后，2组LVEF、HR均较治疗前明显好转（ P ＜0．05），而观察组LVEF、HR改善更明显（ P ＜0．05）。 LVEDD、LVESD在治疗前后变化不大（ P ＞0．05），但仍显现出一定的下降趋势。观察组从治疗当天开始，患者尿量明显增多，随着时间的推延，利尿效果更加明显，至第4～5天时达到稳定状态，但仍能保持较好的利尿效果；而对照组患者利尿收益有限，观察组效果优于对照组（ t 1d ＝9．853、t 2d ＝8．426、t3d ＝10．646、t 4d ＝10．166、t 5d ＝8．580， P ＜0．01）。治疗后，观察组患者体质量降低较为明显改善，优于对照组，至第4～5天时仍显示出较好的体质量下降趋势（ t 1d＝4．897、t 2d ＝7．837、t 3d ＝7．030、t 4d ＝7．800、 t 5d ＝6．981， P ＜0．01）。治疗后，2组血尿素氮、血肌酐、血清钠等指标上均较治疗前明显好转（ P ＜0．05），且观察组血尿素氮、血肌酐较对照组显现出更好的治疗效果（ P ＜0．01）。而血清钾2组均变化不大（ P ＞0．05）。与治疗前比较，治疗后对照组患者血清ALD及NT－proBNP下降明显（ P ＜0．01），而观察组神经内分泌因子4项均明显下降（ P ＜0．01）。与对照组比较，观察组明显降低血清AngⅡ、NE及NT－proBNP水平（ P ＜0．01）。患者出院后3个月随访，对照组再住院14例（41．2％）高于观察组的5例（17．9％）（χ2＝3．929， P ＜0．05）。结论重组人脑利钠肽可迅速改善心力衰竭症状、减少水钠潴留、缓解利尿剂抵抗、降低再入院率，其作用机制可能与其利尿协同作用及神经内分泌因子拮抗作用相关。
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