重组人脑利钠肽治疗急性心力衰竭的效果及对肿瘤坏死因子样弱凋亡诱导物的影响

摘要

Objective To assess the alteration of soluble human tumor necrosis factor-like weak inducer of ap-optosis ( TWEAK) in patients with acute heart failure ( AHF) .To investigate the safety and efficacy of recombinant hu-man brain natriuretic peptide ( rhBNP) in the treatment of AHF and its effect on TWEAK.Methods A total of 66 pa-tients with AHF and 22 healthy subjects were enrolled in the AHF group and the control group, respectively.Level of TWEAK was compared between groups.The AHF group was further divided into 2 sub-groups ( Group1, 2 ) .Both Group 1 and Group 2 received standard treatment of heart failure and underlying diseases, and 3-day rhBNP was further applied in Group 1.Results Before treatment, the TWEAK level in AHF group was significantly higher than control group, and there was no difference between Group 1 and Group 2.After treatment for 3 days, the TWEAK level in Group 1 was significantly lower than in Group 2.Statistically significant differences were demonstrated in the improvement of clin-ical symptoms, brain natriuretic peptide ( BNP) level and central venous pressure ( CVP) between the 2 subgroups.Ser-um creatinine level improved in both subgroups with no statistically significant difference between subgroups.Left ventricu-lar end-diastolic diameter ( LVDD) and ejection fraction ( EF) were not statistically significantly different between Group 1 and 2.Conclusion TWEAK may contribute to the development of AHF.Administration of rhBNP can improve the clinical symptoms and laboratory outcomes of AHF patients, and promote elimination of TWEAK without causing malignant arrhythmia and kidney function decline.%目的：观察急性心力衰竭（ AHF）患者的肿瘤坏死因子样弱凋亡诱导物（ TWEAK）的变化，评价重组人脑利钠肽（ rhBNP）治疗AHF的临床效果及其对TWEAK的影响。方法66例AHF患者及22例健康人分别归入AHF组和对照组，观察两组的TWEAK差异。 AHF组又分为2个亚组（ rhBNP组33例、常规组33例），2个亚组均正规抗心力衰竭及基础病治疗，此外rhBNP组额外使用 rhBNP 治疗3 d。结果未使用药物前 AHF组的TWEAK浓度与对照组差异有统计学意义，rhBNP组与常规组之间差异无统计学意义。治疗3 d后，rhBNP组与常规组之间循环TWEAK浓度差异有统计学意义，rhBNP组循环TWEAK浓度明显降低。 rhBNP组的临床疗效及脑利钠肽、中心静脉压改善与常规组相比差异有统计学意义。2个亚组的肌酐均有改善但组间差异无统计学意义。左室舒张末期横径、射血分数治疗前后及两个亚组间差异均无统计学意义。结论 TWEAK可能在AHF的进展中起一定作用。 rhBNP能明显改善AHF患者的症状及实验室指标，并促进TWEAK的清除，且不引起严重恶性心律失常及肾功能恶化。