重组脑钠肽静脉注射对失代偿心力衰竭患者肾功能、肾素活性和血醛固酮的影响

Effect of Nesiritide,Glycerol Trinitrate,Dobutamine on Plasma Renin Activity and Aldosterone in Patients With Intractable Heart Failure

目的观察在应用新活素(重组脑钠肽rhBNP)、硝酸甘油、多巴酚丁胺治疗失代偿心力衰竭伴轻度肾功能不全时对肾功能、肾素、血管紧张素、醛固酮系统(RAS)的影响。方法42例患者分成三组:甲组应用rhBNP;乙组应用硝酸甘油;丙组应用多巴酚丁胺静脉注射,同时检测血浆肾素活性(PRA)、血管紧张素II(AT-II)、血浆醛固酮(ALD)浓度,并在24、48h再次复查上述指标,复查左室射血分数(EF%),进行比较。结果发现静脉应用rhBNP后患者的血浆PRA明显下降(3.58±0.72vs1.83±0.41vs1.23±0.33,P<0.01);ALD也明显下降(145.6±31vs93.6±25vs77.2±22,P<0.01);而硝酸甘油组和多巴酚丁胺组的PRA、ALD则无明显变化,P>0.05。三组比较有明显统计学差异,P<0.05。结论在失代偿心力衰竭时应用rhBNP静脉注射能快速、有效地降低PRA和ALD血浆浓度,而硝酸甘油和多巴酚丁胺在短期内对PRA和ALD变化影响不大。

Objective To observe the effect of nesiritide glycerol trinitrate, dobutamine on renin and aldosterone in patients with intractable heart failure. Methods 42 cases of intractable heart failure were dividedinto 3 groups, and received intravenous infusion of nesiritide（ 12 cases）, glycerol trinitrate（ 15 cases）, and dobutamine（15 cases） respectively. Plasma rennin activity（PRA）, aldosterone（ALD） and angiotensin Ⅱ （AT-Ⅱ） were measured before and after infusion in 24h and 48h. LVEF was recorded by UCG. Results PRA and ALD obviously descended in the rhBNP group（ 3.58 ± 0.72 vs 1.83 ±0. 41 vs 1.23 ± 0.33） P 〈 0. 01 ; （145.6 ±31 vs 93.6 ±25 vs 77.2 ±22）P 〈0.01, respectively. LVEF raised, blood pressure had no obvious change. But there are no obvious changes of PRA and ALD in glycerol trinitrate group and dobutamine group. Conclusion Infusion of recombinant BNP can decrease PRA and ALD quickly and efficiently in patients with intractable heart failure, so it can be used to treat intractable heart failure effectively.