脑钠肽治疗慢性心力衰竭并肾功能不全的疗效观察

Clinical Observation on Brain Natriuretic Peptide in Treating Patients with Chronic Congestive Heart Failure Combined with Renal Dysfunction

目的观察脑钠肽治疗慢性心力衰竭并肾功能不全的有效性。方法将哈励逊国际和平医院在2010年1月至2012年12月收治的慢性心力衰竭并肾功能不全、符合美国纽约心脏病学会分级Ⅲ～Ⅳ级的患者200例,随机分为硝普钠组98例和脑钠肽组102例。观察患者两组治疗前后的心力衰竭症状改善情况,如血浆脑钠肽、左心室射血分数的变化,同时观察治疗前后肾功能变化,观察治疗过程中的低血压反应、食欲情况、心绞痛和心力衰竭情况。结果治疗后的组间左心室射血分数比较,硝普钠组为(36.5±7.6)%,低于脑钠肽组的(42.9±8.1)%(P<0.05);血浆脑钠肽水平硝普钠组为(4379±1110)ng/L,高于脑钠肽组的(2327±1120)ng/L(P<0.05),脑钠肽组左心室射血分数明显好转,血浆脑钠肽水平显著下降。药物相关的不良反应在脑钠肽组更少。脑钠肽组治疗有效率为89%,硝普钠组治疗有效率为60%,脑钠肽组疗效显著优于硝普钠组(P<0.05)。硝普钠组和脑钠肽组的治疗前后组内和组间比较血浆肌酐、尿素氮和尿酸的水平,差异均无统计学意义(P>0.05)。结论脑钠肽治疗慢性心力衰竭并肾功能不全疗效显著、安全。

Objective To evaluate efficacy of brain natriuretic peptide in treatment of chronic congestive heart failure（CHF） combined with renal dysfuntion.Methods Two hundred patients of congestive heart failure based on NYHA Ⅲ-Ⅳ classification,combined with renal dysfunction,were enrolled in this study.The patients were randomly allocated to brain natriuretic peptide group of 102 cases and sodium nitroprusside group of 98 cases.Heart failure symptoms improvement,such as brain natriuretic peptide,changes in left ventricular ejection fraction（LVEF） were observed,changes in renal function before and after treatment were observed,hypotension,appetite,angina and heart failure were also observed.Results LVEF of the sodium nitroprusside group and the brain natriuretic peptide group after treatment：（36.5 ± 7.6） % vs（42.9 ± 8.1%）（P 0.05）;the plasma BNP level：（4379 ± 1110） ng/L vs（2327 ± 1120） ng/L（P 0.05）.（Drug-related adverse events in brain natriuretic peptidegroup was significantly lower than that in sodium nitroprusside groupEffective rate in brain natriuretic peptide group and the sodium nitroprusside group was 89% and 60% respectively,the former obviously higher than the latter（P 0.05）.Plasma creatinine,urea nitrogen and uric acid of the two groups before and after treatment had no statistically significant difference（P 0.05）.Conclusion Brain natriuretic peptide is effective and safe as treatment for chronic heart failure combined with renal dysfunction.