重组人 B 型利钠肽治疗扩张型心肌病心力衰竭患者临床疗效观察

摘要

目的：评价重组人 B 型利钠肽（rhBNP）对扩张型心肌病心力衰竭治疗的近期临床疗效。方法入选扩张型心肌病心力衰竭患者121例，心功能Ⅲ～Ⅳ级，分为常规治疗组（对照组，n＝61）和 rhBNP 治疗组（rhBNP 组，n＝60），记录病史，并观察两组治疗前、后临床症状、心脏彩超、心功能状态、血浆 N 末端 B 型钠尿肽原（NT‐proBNP）水平和肾功能变化。结果治疗72 h后，rhBNP 组 NT‐proBNP 水平显著低于对照组（P ＜0．01）；治疗1周时，rhBNP 组 LVEDd 显著小于对照组（P ＝0．033），两组LVEF 均升高，rhBNP 组升高更显著（P＜0．01）；治疗1周后 rhBNP 组的总有效率（91．6％）与对照组（72．1％）比较，差异有统计学意义（P＝0．005）；rhBNP 组平均住院时间也明显短于对照组（P＝0．041）；两组患者出现主要不良心血管事件（MACE）的比例比较，差异无统计学意义（P＝0．492）。结论 rhBNP 治疗扩张型心肌病急性失代偿期患者是安全有效的。%Objective To evaluate the short term clinical efficacy of recombinant human B‐type natriuretic peptide(rhBNP) in the treatment of dilated cardiomyopathy complicating heart failure .Methods 121 patients with dilated cardiomyopathy complicating heart failure were selected ,the cardiac function grade Ⅲ - Ⅳ ,and randomly divided into the conventional treatment group(control group ,n= 61) and the rhBNP treatment group(rhBNP group ,n = 60) .The disease history was recorded and clinical symptoms , heart color echocardiography ,cardiac function ,renal function and plasma NT‐proBNP levels were observed before and after treat‐ment .Results The NT‐proBNP level after 72 h treament in the rhBNP group was significantly lower than that in the control group (P< 0 .01) ;LVEDd after 1 week treatment in the rhBNP group was significantly lower than that in the control group ( P =0 .033) ;LVEF was increased in the both groups ,but the increase in the rhBNP group was more significant compared with the con‐trol group (P< 0 .01) .The total effective rate was 91 .6% in the rhBNP group and 72 .1% in the control group with statistical dif‐fernece between the two groups(P= 0 .005) ;the average hospital stay time in the rhBNP group was significantly shorter than that in the control group(P= 0 .041) .The proportion of the major adverse cardiovascular events(MACE) occurrence had no statistical difference between the two groups(P= 0 .492) .Conclusion rhBNP is safe and effective in treating the acute decompensation of di‐lated cardiomyopathy .