环磷腺苷葡甲胺联合重组人脑利钠肽治疗冠心病心衰疗效评价

Evaluation of curative effect of meglumine cyclic adenylate combined with recombinant human brain natriuretic peptide in treatment of coronary artery disease patients with heart failure

目的:观察环磷腺苷葡甲胺(MCA)联合重组人脑利钠肽(rhBNP)治疗冠心病心力衰竭(心衰)患者的临床疗效及血流动力学和血浆BNP浓度的变化。方法:将54例心功能(NA)Ⅲ-Ⅳ级的冠心病患者随机分为3组,每组各18例。Ⅰ组用常规治疗,Ⅱ组用常规治疗+MCA,Ⅲ组用常规治疗+MCA+rhBNP。结果:①临床疗效,Ⅰ组、Ⅱ组及Ⅲ组的总有效率分别为61.1%、77.8%和88.9%;Ⅱ和Ⅲ组的总有效率均优于Ⅰ组,且Ⅲ组的总有效率明显优于Ⅰ组(P<0.05)。②血流动力学变化,3组治疗后每搏输出量(SV)、心输出量(CO)、心脏作功指数(CⅠ)、左室射血分数(LVEF)均升高,但以Ⅱ、Ⅲ组升高显著(均P<0.01);与Ⅱ组比较,Ⅲ组明显升高(P<0.05,P<0.01)。治疗后Ⅱ、Ⅲ组二尖瓣血流舒张早期最大流速与心房收缩期最大流速的比值(E/A)均明显升高(均P<0.01);与Ⅱ组比较,Ⅲ组明显升高(P<0.05)。③血浆BNP浓度的变化,3组治疗后BNP浓度均降低,但以Ⅱ、Ⅲ组降低显著(P<0.01,P<0.001);与Ⅱ组比较,Ⅲ组明显降低(P<0.01)。结论:MCA联合rhBNP治疗冠心病心衰有效、安全,两者具有协同作用。

Objective To investigate the curative effect of meglumine cyclic adenylate（MCA） combined with recombinant human brain natriuretic peptide（rhBNP） in treatment of coronary artery disease patients with heart failure,and the changes of hemodynamics and the BNP concentration.Methods Fifty-four patients with coronary atherosclerotic heart disease whose heart function was Ⅲ-Ⅳ grade were divided into three groups（n=18）：groupⅠ,conventional therapy;group Ⅱ：conventional therapy plus MCA;group Ⅲ,conventional therapy plus MCA combined with rhBNP.Results ① Clinical curative effect：the total effective rates of group Ⅱ（77.8%） and group Ⅲ（88.9%） were higher than that of group Ⅰ（61.1%）,but the total effectively rate of group Ⅲ was obviously higher than that of groupⅠ（P〈0.05）.② The changes of hemodynamics：after treatment,the stroke volume（SV）,cardiac output（CO）,cardiac index（CI） and left ventricle ejection fraction（LVEF） were increased in groupⅠ,Ⅱ,Ⅲ;they were significanthy increased in groupⅡ and group Ⅲ（P〈0.01）;compared with group Ⅱ,they were significanthy increased in group Ⅲ（P〈0.05,P〈0.01）.The ratios of the peak flow rate of bicuspid blood current diastolic phase to atrial systole period（E/A） in group Ⅱand group Ⅲ were increased（P〈0.01）;compared with group Ⅱ,the E/A in group Ⅲ was significanthy increased（P〈0.05）.③ The changes of BNP concentration：after treatment,the BNP concentrations were decreased in three groups,especially in group Ⅱ（P〈0.01） and group Ⅲ（P〈0.001）;compared with group Ⅱ,it was significant decreased in group Ⅲ（P〈0.01）.Conclusion MCA combined with rhBNP has utility,safety and synergistic effect in treatment of coronary artery disease patients with heart failure.