B型利钠肽治疗充血性心力衰竭随机对照试验的分析

Effects of congestive heart failure treatment with human-b-type natriuretic peptide

目的:了解B型利钠肽(BNP)治疗对心衰患者血流动力学的效应及其安全性和耐受性。方法:以充血性心衰为主题词,B-typenatriureticpeptide和nesiritide分别为文本词,对Medline数据库检索临床随机对照试验(RCT),对各试验的方法学和结果等进行评价。结果:8个临床随机对照试验被纳入,结果是BNP的人工合成制剂nesiritide使肺毛细血管楔压(PCWP)平均降低4.06mmHg,95%CI[-4.79,-3.33],P<0.00001,心脏指数(CI)增加0.08L/min·m2,95%CI[0.02,0.15],P=0.01,低血压发生率增加,RR=3.36[2.15,5.26],P=0.01,心动过缓发生高于对照,RR=4.99[1.70,14.60],P=0.003,而室性心律失常两组相似。结论:BNP能有效改善心衰患者血流动力学,改善近期预后,呈剂依赖;明显降低严重心衰患者且危险因素≥4个患者的远期死亡率;Nesiritide治疗虽存在低血压等诸多副作用,但一般患者均能耐受。

Objective：To assess the beneficial and harmful effects of congestive heart failure （CHF） treatment with human-b-type natriuretic peptide and the tolerance of patients. Methods： Searched the randomized controlled trials （RCTs） in Medline database with congestive heart failure as McSH and B-type natriuretic peptide （BNP）, nesiritide as text words. Their objects, researches methodologies and results were evaluated. Results： A total of 8 clinical RCTs were included. Nesiritide （artificial agent of BNP） averagely reduced PCWP 4.06 mmHg, 95% CI [=4.79, - 3. 33], P〈0. 000 01, raised cardiac index 0.08 L/min ·m^2 , 95% CI [0.02, 0. 15], P〈0.01; Increased incidence of hypotension, RR=3.36 [2.15, 5.26], P=0. 01; Bradycardia is more often frequent in treatment group, RR=4.99 [1.70, 14.60], P= 0. 003, but incidence of ventricular arrhythmia was similar in the both group. Conclusion ：Hemodynamics can be improved by BNP in heart failure. Its dosage-relative effects lead to improvement of prognosis in short term duration. BNP can also reduce long-germ mortality of severe CHF in patients with more than 4 risk factors. Although nesiritide can cause side-effect such as hypotension etc. but it is safely toleranted.