重组人脑利钠肽治疗CHF急性发作患者的疗效

Efficacy of recombinant human brain natriuretic peptide in patients with acute exacerbation of CHF

目的研究重组人脑利钠肽辅助治疗慢性心力衰竭(CHF)急性发作患者的疗效及作用机制。方法以2020年1月-2022年5月本院收治的78例CHF急性发作患者随机分为左西孟旦组(39例)和重组人脑利钠肽组(39例)。两组均进行常规治疗,在此基础上,左西孟旦组采用左西孟旦进行治疗,重组人脑利钠肽组在左西孟旦组的基础上采用重组人脑利钠肽进行治疗,两组均治疗3 d。比较两组疗效、心肌损伤指标、细胞因子水平、肾功能指标及心功能。结果治疗后,重组人脑利钠肽组总有效率高于左西孟旦组(P<0.05)。治疗后与治疗前比较,两组血清脑钠肽(BNP)、乳酸盐脱氢酶(LDH)、肌酸激酶(CK)、肌钙蛋白T(cTnT)、胱抑素C(Cys-C)、醛固酮(ALD)、去甲肾上腺素(NE)、尿素氮(BUN)、血肌酐(SCr)水平及左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)降低,左西孟旦组高于重组人脑利钠肽组(P<0.05)。治疗后与治疗前比较,两组血清类胰岛素生长因子-1(IGF-1)水平、24 h尿量、肾小球滤过率(eGFR)、左室射血分数(LVEF)、每搏输出量(SV)升高,左西孟旦组低于重组人脑利钠肽组(P<0.05)。结论重组人脑利钠肽辅助治疗CHF急性发作患者,可有效改善患者细胞因子水平、肾功能及心功能,可能与其可有效改善患者心肌能量代谢有关,具有较好的治疗效果。

Objective To investigate the efficacy and mechanism of recombinant human brain natriuretic peptide in the adjuvant treatment of acute exacerbation of chronic heart failure(CHF).Methods A total of 78 patients with acute exacerbation of CHF admitted to our hospital from January 2020 to May 2022 were randomly divided into levosimendan group(39 cases)and recombinant human brain natriuretic peptide group(39 cases).On basis of conventional therapy,the levosimendan group was treated with levosimendan,while the recombinant human brain natriuretic peptide group was treated with recombinant human brain natriuretic peptide on the basis of the levosimendan group.Both groups were treated for 3 d.The efficacy,myocardial injury index,cytokine level,renal function index and cardiac function were compared between two groups.Results After treatment,the total effective rate of the recombinant human brain natriuretic peptide group was higher than that of the levosimendan group(P<0.05).After treatment compared with before treatment,the serum levels of brain natriuretic peptide(BNP),lactate dehydrogenase(LDH),creatine kinase(CK),troponin T(cTnT),cystatin C(Cys-C),aldosterone(ALD),norepinephrine(NE),urea nitrogen(BUN),serum creatinine(SCr),LVEDD,LVESD of the two groups decreased,and all those indexes in the recombinant human brain natriuretic peptide group were lower than those in the levosimendan group(P<0.05).After treatment,compared with before treatment,serum levels of insulin-like growth factor-1(IGF-1),urine output in 24 hours,glomerular filtration rate(eGFR),left ventricular ejection fraction(LVEF)and stroke volume(SV)in the recombinant human brain natriuretic peptide group increased higher than those in the levosimendan group(P<0.05).Conclusion The adjuvant therapy of recombinant human brain natriuretic peptide can effectively improve the level of cytokines,renal function and cardiac function in patients with acute exacerbation of CHF,which may be related to the effective improvement of myocardial energy metabolism in patients,and has a good therapeutic effect.