左西孟旦或重组人脑利钠肽对急性失代偿性心力衰竭患者心肾功能影响的对比研究

Comparison of clinical outcomes between levosimendan and recombinant B-type natriuretic peptide for heart and renal function in acute decompensated heart failure patients

目的探讨静脉滴注左西孟旦(Levo)或重组人脑利钠肽(rhBNP)对急性失代偿性心力衰竭(ADHF)患者心肾功能的影响。方法 50例ADHF患者(纽约心脏病学会心功能分级Ⅲ或Ⅳ级)纳入研究,随机分入Levo组(静脉滴注Levo 0.1μg·kg-1·min-1)和rhBNP组(静脉滴注rhBNP 0.01μg·kg-1·min-1),每组25例。观察两组治疗后24h的24h尿量、收缩压的变化,治疗后48h的血清肌酐(sCr)水平、估算的肾小球滤过率(eGFR)的变化,治疗后7d的左心室射血分数(LVEF)、血浆脑利钠肽(BNP)水平的变化。进一步比较治疗前收缩压≤95mmHg(1mmHg=0.133kPa)且LVEF<0.35的患者治疗前后的收缩压和LVEF。结果两组在治疗后24、48、72h的24h尿量均较同组治疗前显著增多(P值均<0.01)。两组在治疗后24h的收缩压与同组治疗前的差异均无统计学意义(P值均>0.05)。两组在治疗后24、48、72h和7d的sCr水平均较同组治疗前显著下降(P值均<0.01),eGFR均较同组治疗前显著升高(P值均<0.01)。两组在治疗后7d的血浆BNP水平均较同组治疗前显著降低(P值均<0.01),LVEF均较同组治疗前显著改善(P值均<0.05)。两组间治疗后各时间的24h尿量、收缩压、eGFR和sCr、血浆BNP水平的差异均无统计学意义(P值均>0.05),Levo组在治疗后7d的LVEF显著高于rhBNP组同时间(P<0.01)。Levo组中治疗前收缩压≤95mmHg且LVEF<0.35的ADHF患者(12例)治疗前后收缩压的差异无统计学意义(P>0.05),治疗后7d的LVEF较治疗前显著提高(P<0.01);rhBNP组中治疗前收缩压≤95mmHg且LVEF<0.35的ADHF患者(9例)治疗前后的收缩压和LVEF与治疗前的差异均无统计学意义(P值均>0.05)。结论 ADHF患者静脉滴注Levo较rhBNP能更好地改善左心室的收缩功能,两者均具有肾脏保护作用。对于低心排量伴收缩压降低的患者更倾向于选择Levo。

Objective To compare the effects between levosimendan （Levo） and recombinant human B- type natriuretic peptide （rhBNP） on heart and renal function in patients suffered from acute decompensated heart failure （ADHF）. Methods Fifty patients with ADHF （New York Heart Association heart function classification standard 11[ or ]V） were enrolled in this study and randomly divided into Levo group （n=25, 0. 1μg·kg-1·min-1 Levo was intravenously given） and rhBNP group （n = 25, 0.01 μg·kg-1·min-1 rhBNP was intravenously given）. Urine volume, systolic blood pressure （SBP）, serum creatinine （sCr）, estimated glomerular filtration rate （eGFR）, left ventricular ejection fraction （LVEF） and serum BNP were measured before and after treatment. Subgroup analyses were performed for patients with LVEF^0.35 and SBP^95 mmHg （1 mmHg = 0. 133 kPa）. Results Compared with the parameters before treatment, 24 h urine volume, eGFR and LVEF were significantly increased, while sCr and BNP were significantly decreased after treatment （P〈0.01 or P〈0.05）. There was nosignificant difference between preoperative and postoperative SBP in all patients （P〉0.05）. After treatment, there was no significant difference in terms of 24 h urine volume, SBP, sOr, eGFR or BNP between two groups （all P〉0.05）. LVEF in Levo group was significantly higher than that in rhBNP group on day 7 after surgery （P〈 0.01）. Subgroup analysis showed that SBP level was not significantly decreased （P〉0. 05） and LVEF was significantly increased after treatment （P〈0.05） in Levo group, while there was no significant difference in SBP or LVEF in rhBNP group （both P〉0.05）. Conclusion Compared with rhBNP therapy, intravenous Levo therapy may effectively improve LVEF in ADHF patients. Both Levo and rhBNP can protect renal function. Therefore, it is prone to choose Levo in patients those with low-output heart failure, especially those with low blood pressure.