【摘要】 目的探讨慢性心力衰竭(CHF)失代偿期急性发作患者给予重组人B型利钠肽(rh BNP)治疗的可行性与安全性。方法选取桂林市第二人民医院心血管内科2012年6月至2015年6月确诊并收治的CHF失代偿期患者78例,依照随机数字表法将所有患者分为对照组与观察组,每组各39例,两组患者均接受吸氧、利尿、强心、营养心肌等常规抗心衰治疗,观察组在此基础上追加rh BNP治疗,两组均以72 h为一个疗程。治疗结束后7 d比较两组患者的临床疗效、心功能指标、相关生化指标等差异,并评估治疗的安全性。结果观察组患者的临床总有效率为94.9%(37/39),明显高于对照组的71.8%(28/39),差异有统计学意义(P<0.05);观察组患者治疗前的左室射血分数(LVEF)、左室短轴缩短率(LVSF)、左室收缩末期直径(LVESD)与左室舒张末期直径(LVEDD)分别为(40.2±4.6)%、(44.4±5.1)%、(48.1±6.1)mm、(60.3±6.7)mm,对照组分别为(40.9±4.8)%、(44.6±5.0)%、(48.7±6.2)mm、(60.5±7.1)mm,两组患者治疗前的心功能指标比较差异均无统计学意义(P>0.05);观察组患者治疗后的LVEF、LVSF、LVESD和LVEDD分别为(48.5±5.2)%、(51.3±5.2)%、(42.3±5.2)mm、(53.8±5.3)mm,对照组分别为(45.8±4.4)%、(48.1±5.5)%、(46.2±5.8)mm、(57.4±6.2)mm;治疗后两组患者的LVEF、LVSF明显升高,LVESD、LVEDD明显降低,差异均有统计学意义(P<0.05),与对照组比较,观察组的升高与降低幅度更为明显,差异均有统计学意义(P<0.05)。观察组治疗前的N端脑钠肽前体(NT-pro BNP)、血清胱抑素C(Cys C)、血浆转化生长因子-β(TGF-β)分别为(933.2±312.2)μg/L、(1.85±0.41)mg/L、(362.7±80.3)μg/L,治疗后相应指标分别为(324.5±109.3)μg/L、(1.02±0.23)mg/L、(165.4±33.2)μg/L。对照组治疗前的NT-pro BNP、Cys C、TGF-β分别为(935.6±321.2)μg/L、(1.86±0.42)mg/L、(361.8±83.2)μg/L,治疗后相应指标分别为(537.3±189.3)μg/L、(1.39±0.30)mg/L、(244.3±44.2)μg/L,两组患者的上述三项指标治疗前比较差异均无统计学意义(P>0.05),治疗后均有所降低(P>0.05),而观察组的降低幅度更明显,差异均有统计学意义(P<0.05)。对照组与观察组不良反应发生率分别为17.9%(7/39)、10.3%(4/39),差异无统计学意义(P>0.05)。结论在常规抗心衰治疗基础上追加重组人B型利钠肽治疗CHF急性发作失代偿期有助于迅速纠正心衰症状,改善患者心功能,增加心输出量,且不良反应轻微,总体疗效确切,具较高的临床推广价值。更多还原

【Abstract】 Objective To evaluate the feasibility and safety of recombinant human B type natriuretic peptide(rh BNP) in treating patients of chronic heart failure in acute decompensated period. Methods Seventy-eight patients with chronic heart failure in acute decompensated period treated in Cardiovascular Department in the Second People’s Hospital of Guilin were randomly divided into control group and observation group, with 39 patients in each group(with hospitalized time limited from June 2012 to June 2015). Patients in both groups were given conventional anti-heart failure treatment, including oxygen uptake, diureses, cardiac, myocardial nutrition. Besides, patients in the observation group were given rh BNP treatment. The course of treatment was 72 h for both groups. Seven days after the treatment, the clinical effects, indexes of heart functions, related biochemical indexes were compared, and the safety of treatment was evaluated. Results The clinical total effective rate in the observation was significantly higher than that in the control group [(94.9%(37/39) vs 71.8%(28/39), P<0.05]. Before treatment, the left ventricular ejection fraction(LVEF), left ventricular short axis shortening rate(LVSF), left ventricular end systolic diameter(LVESD), left ventricular end diastolic diameter(LVEDD) were(40.2±4.6)%,(44.4±5.1)%,(48.1±6.1) mm,(60.3±6.7) mm, respectively in the observation group, and(40.9±4.8)%, [(44.6±5.0)%,(48.7±6.2) mm,(60.5±7.1) mm, respectively in the control group, with no significant difference between the two groups(P<0.05). After treatment, the LVEF, LVSF, LVESD, LVEDD were(48.5±5.2)%,(51.3±5.2)%,(42.3±5.2) mm,(53.8±5.3) mm, respectively in the observation group, and(45.8±4.4) %,(48.1±5.5) %,(46.2±5.8) mm,(57.4±6.2) mm, respectively in the control group. After treatment, both groups’ LVEF and LVSF were significantly increased and the LVESD and LVEDD were significantly decreased(P<0.05). The increased or decreased ranges in the observation group were more significant than the control group(P<0.05). In the observation group, the NT-pro BNP, cystatin C(Cys C) and transforming growth factor-β(TGF-β) were(933.2±312.2) μg/L,(1.85±0.41) mg/L,(362.7±80.3) μg/L, respectively before treatment, and(324.5±109.3) μg/L,(1.02±0.23) mg/L,(165.4±33.2) μg/L, respectively after treatment. In the control group, the NT-pro BNP, Cys C and TGF-β were(935.6±321.2) μg/L,(1.86±0.42) mg/L,(361.8±83.2) μg/L, respectively before treatment, and(537.3±189.3) μg/L,(1.39±0.30) mg/L,(244.3±44.2) μg/L, respectively after treatment. The three indexes of before treatment showed no significant difference(P>0.05), and the indexes were all significantly decreased after treatment(P<0.05). The decreased range in the observation group was significantly more than that in the control group(P<0.05). The adverse reaction rate in the control group and observation group were17.9%(7/39) and 10.3%(4/39), respectively, with no statistically significant difference(P<0.05). Conclusion Conventional anti-heart failure treatment combined with rh BNP in treating patients of chronic heart failure in acute decompensated period helps rapidly correct the heart failure symptoms, improve patients’ heart functions, and increase the cardiac output,with little adverse reactions and accurate curative effects. Thus, this therapeutic method deserves to be widely promoted.更多还原