重组人脑利钠肽治疗急性心力衰竭的疗效评价及预后影响因素分析

摘要

Objectiye To evaluate the efficacy and safety of recombinant human brain natriuretic peptide(rhBNP)in acute heart failure patients,and analysis the risk factors for prognosis. Methods Based on 2: 1 ratio,59 severe heart failure patients in our hospital were divided randomly into rhBNP group(n = 19)and control group(n = 40). The patients of control group received standard treatment for heart failure,and rhBNP was also infused in those in rhBNP group. Compare the change of pulmonary dyspnea rate and major adverse cardiac event(MACE). Fur-thermore,we used the receptor - operating characteristic(ROC)curves to evaluate prognostic factors for MACE. Results Basic characteristics, such as age,male rate,hypertension,diabetes,previous myocardial infarction and heart function,and renal function were comparable between the two groups( P > 0. 05). After 1 - week treatment,patients in the rhBNP group were associated with significantly improved dyspnea,heart rate and BNP compared with control group( P 0. 05). Logistic regression analyses demonstrated that age(OR 1. 67,95%CI,1. 06 ~ 2. 83,P = 0. 04)and IABP re - implantation(OR 3. 11,95% CI,2. 46 ~ 6. 69,P = 0. 04)were all independent risk factors for 1- year MACE. Conclusion For acute heart failure patients,rhBNP treatment can improve the dyspnea,cardiac function and heart failure associ-ated rehospitalization. Age and BNP are the risk factors for prognosis.%目的：评价重组人脑利钠肽（rhBNP）对急性心力衰竭患者的疗效，并分析影响预后的危险因素。方法选取2013年1月到2015年1月住院治疗的急性心力衰竭的患者59例，依据随机数字表法按照2：1比例将患者分为脑利钠肽组（19例）和对照组（40例）。对照组患者均给予常规抗心衰治疗；脑利钠肽组患者在对照组基础上输注 rhB-NP，比较两组患者的呼吸困难和心功能变化情况，并随访观察1年内主要不良心血管事件（MACE）发生率。应用 Logis-tic 回归分析 MACE 的危险因素，应用受试者工作特征性（ROC）曲线和约登指数评估危险因素对 MACE 的最佳预测阈值和相应的敏感度和特异度。结果两组患者的基础年龄、性别比例、高血压、糖尿病、陈旧心肌梗死、房颤、基础心、肾功能等无显著差异（ P ＞0.05）。治疗1周后，脑钠肽组和对照组患者的血 BNP、CK - MB 和心率均治疗前显著降低（ P <0.05），脑利钠肽组患者的△BNP 治疗前后变化值、△心率治疗前后变化值和呼吸困难均较对照组有显著改善（ P <0.05）。随访1年后，脑利钠肽组患者的心力衰竭再入院率和 MACE 发生率均较对照组有所降低，但差异无统计学意义（ P ＞0.05）。Logistic 回归分析证实年龄（OR 1.67，95% CI：1.06~2.83，P =0.04）和 BNP（OR 3.11，95% CI：2.46~6.69，P =0.04）为预测 MACE 发生的危险因素。结论重组人脑利钠肽能改善急性心衰患者的呼吸困难症状，改善短期的心功能，部分降低心力衰竭再住院率。年龄和 BNP 是影响预后的重要因素。