血浆脑钠肽指导心力衰竭患者应用袢利尿剂的作用

Application of loop diuretics in patients with heart failure according to plasma brain natriuretic peptide level

目的了解血浆脑钠肽指导心力衰竭患者应用袢利尿剂是否能减少副作用。方法100例入选患者分为两组:N+W组袢利尿剂的使用依据患者纽约心脏协会心功能分级加测量体质量;B+W组依据血浆脑钠肽浓度加测量体质量。定期测量两组血浆B型脑钠肽、血肌酐、血脂、尿酸、电解质浓度和血压,并进行动态观察、分析。结果 (1)基线时,两组血浆脑钠肽、血肌酐、总胆固醇、血钾、血钠、血氯、血尿酸浓度及血压比较,差异无统计学意义(P=0.122、0.08、0.07、0.577、0.645、0.81、0.091、0.21);N+W组血浆甘油三酯高于B+W组,差异有统计学意义(P=0.01)。(2)利尿剂以最低有效剂量维持时,两组血浆脑钠肽、血肌酐、总胆固醇、甘油三酯浓度及血压比较,差异均有统计学意义(P=0.042、0.036、0.02、0.03、0.03);两组血钾、血钠、血氯、血尿酸浓度比较,差异无统计学意义(P=1、0.088、0.387、0.067)。(3)维持治疗1个月后两组血浆脑钠肽、血肌酐、甘油三酯、血钾、血钠、血氯、血尿酸浓度及血压比较,差异有统计学意义(P<0.001,P=0.02、0.01、0.017、0.001、0.001、0.01、0.007);两组血总胆固醇浓度比较,差异无统计学意义(P=0.06)。(4)基线至最低有效剂量维持治疗前,N+W组8例(16%)心力衰竭复发,B+W组10例(20%)心力衰竭反复发作,两组发生率比较差异无统计学意义(P=0.795);维持治疗1个月内N+W组9例(18%)心力衰竭复发,B+W组1例(2%)心力衰竭复发,两组发生率比较差异有统计学意义(P=0.016)。结论血浆脑钠肽指导攀利尿剂的使用可以减少心力衰竭复发,减少利尿剂副作用的发生率。

Objectives To investigate the use of loop diuretics guided by plasma brain natriuretic peptide （BNP） level in reducing side effects in patients with heart failure. Methods Totally 100 patients with heart failure were randomly divided into 2 groups. The use of loop diuretics was based on the NYHA classification plus weight （N＋W group） and plasma BNP level plus weight （B＋W group） respectively. Plasma B-type BNP, serum creatinine （CR）, blood fat, blood uric acid, blood electrolyte and blood pressure were regularly measured and analyzed dynamically. Results （ 1 ） At baseline, plasma concentrations of BNP, creatinine, total cholesterol and blood potassium, blood sodium, serum chloride, blood uric acid level, blood pressure were not significantly different between the two groups （P=0.122, 0.08, 0.07, 0.577, 0.645, 0.81, 0.091, and 0.21, respectively）. Blood triglyceride level in N＋W group was higher than that in B＋W group （P=0.01）. （2）During the retain of minimal effective dose of diuretics, plasma BNP level, creatinine, blood total cholesterol, blood triglyceride and blood pressure were significantly different between the two groups （P=0.042, 0.036, 0.02, 0.03, and 0.03, respectively）; meanwhile, blood potassium, blood sodium,serum chloride and blood uric acid level were not significantly different （P=l, 0.088, 0.387 and 0.067, respectively）. （3） After 1 month＇s therapy, plasma BNP level, creatinine, blood triglyeeride, blood uric acid, blood pressure and blood potassium, blood sodium,serum chloride were significantly different between the two groups （P〈0.001, P=0.02, 0.01, 0.01, 0.007, 0.017, 0.001 and 0.001, respectively）; whereas blood total cholesterol was not significantly different （P=0.06）. （4）From baseline to treatment of minimal effective dose, 8 patients （16%） showed recurrence of heart failure in N＋W group and 10 cases （20%） in B＋W group （P=0.795）. After 1 month＇s maintenance therapy, 9 patients（18%） showed recurrence of heart failure in N＋W group and only 1 case（2%）in B＋W group （P=O.016）. Conclusions Use of loop diuretics guided by plasma BNP level can reduce the recurrence of heart failure and side effects of diuretics in patients with heart failure.