冻干重组人脑钠肽对慢性心力衰竭患者稀释性低钠血症的治疗观察

Therapeutic effect of lyophilized recombinant human brain natriuretic peptide on dilutional hyponatremia in patients with chronic heart failure

目的:观察新活素(冻干重组人脑钠肽)对慢性心力衰竭患者稀释性低钠血症的治疗作用。方法:伴稀释性低钠血症的慢性心力衰竭患者65例按就诊顺序被随机分常规治疗组(32例,进行限水、利尿、高渗盐水等基础治疗),新活素组(33例,另加用新活素,负荷量为1.5g/kg静脉注射,然后以0.0075g·kg-1·min-1连续静脉点滴72h)。监测比较两组血钠、尿钠水平,24h尿量及体质量指数(BMI)变化。结果:治疗后2组血钠水平升高,平均24h尿量增多,BMI降低,均有统计学意义(P<0.01)。优效性检验显示:与常规治疗组比较,新活素组血钠升高幅度[(12.9±1.5)mmol/L比(14.1±1.5)mmol/L]、平均24h尿量增加幅度[(0.33±0.02)L/d比(0.35±0.03)L/d]及BMI降低幅度[(2.2±0.4)kg/m2比(3.6±0.6)kg/m2]显著增加,差异有统计学意义(P均<0.01)。结论:冻干重组人脑钠肽可显著改善慢性心力衰竭患者的低钠及水负荷状态,值得临床推荐。

Objective：To observe the therapeutic effects of Xinhuosu （lyophilized recombinant human brain natriuretic peptide,rh-BNP） on dilutional hyponatremia in patients with chronic heart failure （CHF）.Methods：A total of 65 CHF patients with dilutional hyponatremia were randomly divided into routine treatment group （n =32,received basic treatment such as water restriction,diuresis and hypertonic saline solution etc） and rh-BNP group （n =33,received rh-BNP additionally,the loading dose was 1.5 g/kg by introvenous injection,then 0.0075 g · kg-1 ·min-1 by intravenous infusion for continuous 72h） according to number table.Changes of blood sodium and urinary sodium levels,24h urinary volume and body mass index （BMI） were monitored and compared between two groups.Results：Compared with before treatment,there were significant increase in blood sodium level and mean 24h urinary volume,and significant decrease in BMI in two groups after treatment （P〈0.01）.Superiority test indicated that compared with routine treatment group,there were significant increase in blood sodium [（12.9 ± 1.5） mmol/L vs.（14.1 ± 1.5） mmol/L],mean 24h urinary volume [（0.33 ± 0.02） L/d vs.（0.35 ± 0.03） L/d] and decrease in BMI [（2.2± 0.4） kg/m2 vs.（3.6± 0.6） kg/m2] in rh-BNP group,P〈0.01 all.Conclusion：Lyophilized recombinant human brain natriuretic peptide can significantly improve hyponatremic and water load status in patients with chronic heart failure,and should be recommended in clinic.