重组人生长激素对老年心力衰竭合并贫血患者肾功能及氨基末端B型利钠肽前体的影响

Effects of Recombinant human growth hormone on renal function and level of N-terminal pro-B-type natriuretic peptide in elderly patients with chronic heart failure and anemia

目的观察重组人生长激素（rhGH）对老年慢性心力衰竭（CHF）合并贫血患者心功能、肾功能、血红蛋白的影响。方法将87例心功能Ⅱ～Ⅳ级（NYHA）的慢性心力衰竭患者随机分为治疗组（44例）及对照组（43例）。在慢性心力衰竭常规治疗基础上，对照组给予口服铁剂，治疗组给予口服铁剂加皮下注射重组人生长激素。治疗4周后，观察两组血红蛋白、血肌酐、肌酐清除率、心功能、氨基末端B型利钠肽前体（NT-proBNP）变化。结果与治疗前相比，治疗后治疗组血红蛋白明显升高[（111．2±3．3）g／L比（99．3＋4-3）g／L，P〈0．05]，血清肌酐水平明显降低[（161．4±39．7）μmol／L比（198．2±41．7）μmol／L，P〈0．05]，肌酐清除率增加[（43．8±7．1）ml／min比（39．0±8．8）ml／L，P〈0．05]，心功能分级明显改善[（3．1±0．7）比（2．3±0．5）]，血浆biT—proBNP显著下降[（11236．1＋430．7）ng／L比（2215．3±950．2）ng／L，P〈0．05]。对照组上述参数均有所改善，但差异无统计学意义。结论老年慢性心力衰竭合并贫血患者应用rhGH和口服铁剂治疗，在改善心功能的基础上，可进一步纠正贫血，改善肾功能，降低血浆NT—proBNP水平。

Objective To investigate the effects of Recombinant human growth hormone （rhGH） on hemoglobin, cardiac and renal function of elderly patients with congestive heart failure （CHF） and anemia. Meth- ods Eighty-seven patients CHF （NYHA Ⅱ-Ⅳ ） and anemia were randomized into treatment group （n=44） and control group （n=43）. All patients accepted the standard treatment of heart failure. Patients in treatment group re-ceived rhGH and oral iron preparation daily. The patients in control group were given only oral iron preparation. After four-week treatment, the levels of Hb, serum creatinine, creatinine clearance, plasma NT-proBNP and car- diac function were examined. ＇ Results In treatment group, there was significant increase of Hb[（ 111.2±3.3 ）g/L vs （99.3±4.3）g/L, P〈0.05], significant deduction of serum creatinine [（161.4±39.7 ）μmol/L vs （198.2±41.7）μmol/ L, P〈0.05], increase of creattinine clearance [（43.8±7.1）ml/min vs （39.0±8.8）ml/L, P〈0.05], significant im- provement of NYHA functional class[（3.1 ±0.7 ） vs （2.3 ±0.5 ）] and significant fall of plasma NT-proBNP[（ 1236.1 ± 430.7）ng/L vs （2215.3±950.2）ng/L, P〈0.05], after treatment compared with baseline. In control group, there was no significant change in any of the above parameters. Conclusion The treatment with rhGH and oral iron prepa- ration can improve not only the cardiac functions but also the renal function, and it can also increase the level of Hb and reduce the level of plasma NT-proBNP in elderly patients with CHF and anemia.