重组人脑利钠肽与多巴酚丁胺对心力衰竭患者疗效的影响

Therapeutic efficacy of recombinant human brain natriuretic peptide versus dobutamine on decompensated heart failure patients with different blood BNP levels

目的:比较重组人脑利钠肽(rhBNP)与多巴酚丁胺对不同血浆BNP水平心力衰竭(心衰)患者的疗效。方法:将左室射血分数(LVEF)<40%的心衰患者随机分为高BNP组(BNP≤3 000pg·ml-1)和极高BNP组(BNP>3 000pg·ml-1)。每组又根据选用rhBNP或多巴酚丁胺的不同再分为rhBNP亚组和多巴酚丁胺亚组,分别连续静滴24～72h。评估治疗前及治疗后第5天患者临床症状改善情况、血浆BNP水平、左室舒张末内径(LVEDD)及LVEF;观察住院时间;分析药物对血压、心率和血肌酐的影响以及心血管不良事件的发生率。结果:在高BNP组,与多巴酚丁胺相比,rhBNP能更有效地提高患者心功能分级(NYHA)(P<0.05),降低血浆BNP水平(P<0.05),提高LVEF(P<0.05),缩短患者住院时间(P<0.05)。在极高BNP组,rhBNP的疗效并不优于多巴酚丁胺。两种治疗对患者心率及血肌酐水平无显著影响(P>0.05)。rhBNP治疗后,患者收缩压和舒张压水平均有所下降(P<0.01),多巴酚丁胺治疗对血压无明显影响(P>0.05)。两种治疗引发心血管不良事件的发生率无统计学差异(P>0.05)。结论:在BNP升高≤3 000pg·ml-1的心衰患者,rhBNP改善心功能的疗效明显优于多巴酚丁胺。而在BNP极度升高患者,rhBNP疗效并不优于多巴酚丁胺。

Objective：To determine the therapeutic efficacy of recombinant human brain natriuretic peptide（rhBNP）versus dobutamine on decompensated heart failure（DHF）patients with different blood BNP levels.Method：Patients with DHF whose left ventricular ejection fraction（LVEF）was 40% were divided into high BNP group（BNP≤3 000pg·ml-1）or extra-high BNP group（BNP3 000pg·ml-1）depending on their plasma BNP levels.Each group was then subdivided into rhBNP or dobutamine subgroups according to intravenous administration with either rhBNP or dobutamine.Clinical symptoms,plasma BNP concentration,left ventricular end-diastolic dimension（LVEDD）and LVEF were assessed before and after 5days of treatment.Hospital length of stay（LOS）,the influence of the study drug on blood pressure,heart rate,plasma creatinine and cardiovascular adverse events were analyzed.Result：In the high BNP group,rhBNP was more efficient than dobutamine in improving NYHA classification（P0.05）,decreasing plasma BNP level（P0.05）,increasing LVEF（P0.05）and reducing LOS（P0.05）.However,rhBNP displayed no superior therapeutic efficacy to dobutamine in the extrahigh BNP group.Both of them had no remarkable impact on heart rate and plasma creatinine（P0.05）.Blood pressure was decreased in subjects treated with rhBNP（P0.01）,while no marked changes were observed when treated with dobutamine（P0.05）.The cardiovascular adverse events occurred in subjects treated with rhBNP were similar to those with dobutamine（P0.05）.Conclusion：rhBNP is more efficient than dobutamine in improving heart function in patients with DHF when plasma BNP is≤3 000 pg·ml-1.However,rhBNP treatment show no advantages over dobutamine when plasma BNP reachs extremely high levels（3 000pg·ml-1）.