血浆B型脑利钠肽指导心衰患者袢利尿剂的使用对于肾功能的作用观察

摘要

目的:了解血浆B型脑利钠肽(BNP)指导袢利尿剂的使用是否有利于心衰患者肾功能的保护.方法:100例入选患者随机分为两组,袢利尿剂的使用分别依据NYHA心功能分级加测量体重(N+W组)及血浆BNP浓度加测量体重(B + W组).定期测量血肌酐、血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血浆BNP,并进行动态观察、分析.结果:基线时两组血浆BNP、肌酐浓度及NGAL浓度比较,P值分别为0.122、0.08、0.082.以最低有效剂量维持时N + W组血浆BNP、肌酐浓度及NGAL浓度均高于B + W组,P 值分别为0.042、0.036、0.025.维持治疗1个月后N + W组血浆BNP、肌酐浓度及NGAL浓度均高于B + W 组,P 值分别为< 0.001、0.02、< 0.001.基线至最低有效剂量维持治疗前N + W组8例心衰复发,B + W组10例心衰反复发作,P ＝ 0.795;维持治疗1个月内N + W组9例心衰复发,B + W组1例心衰复发,P ＝ 0.016.结论:血浆BNP指导袢利尿剂的使用可以减少心衰复发,更有利于心衰患者肾功能的保护.%Objective This study is aimed to investigate whether usage of loop diuretics, according to serum BNP level, in patients with heart failure is more useful for renal function protection. Method One hundred patients with heart failure were randomly divided into two groups. The diuretics usage is based on the NYHA classification plus measuring of weight (N + W) , or plasma BNP level plus measuring of weight (B + W) , respectively. Serum creatinine (CR), blood neutrophils gelatin enzyme related lipid carrier protein (NGAL) and plasma B-type brain natriuretic peptide (BNP) were regularly measured and analyzed dynamically. Result At baseline, the plasma level of BNP, creatinine and NGAL had no difference between two groups (P = 0.122, 0.08 and 0.082 respectively). After giving the minimum effective dose, the plasma level of BNP, creatinine and NGAL in group (N + W) was higher than that in group (B + W) (P = 0.042, 0.036 and 0.025 respectively). After one-month maintenance therapy, the plasma level of BNP, creatinine and NGAL in group (N + W) was much higher than that in group (B + W) (P < 0.001, P = 0.02 and P < 0.001 respectively). From baseline to the minimum effective dose, eight patients experienced recurrence of heart failure in group (N + W), 10 in group (B + W) (P = 0.795) ; After one month maintenance therapy, 9 patients experienced recurrence of heart failure in group (N+W), only 1 in group (B + W) (P = 0.016). Conclusion According to serum BNP level, loop diuretics usage in patients with heart failure could reduce the recurrence of heart failure, and could be more conducive for renal function protection.