重组人脑钠肽治疗急性心力衰竭合并肾功能不全的近期疗效观察

Efficacy of recombinant human brain natriuretic peptide on acute heart failure with renal function insufficiency

目的 观察重组人脑钠肽（rhBNP）治疗心力衰竭合并肾功能不全的近期疗效.方法 回顾性分析心力衰竭合并肾功能不全的患者105例,根据不同治疗分为2组,常规治疗组50例,给予常规治疗;rhBNP组55例,常规治疗的基础上加用rhBNP.rhBNP按0.007 5 μg/（kg·min）微量泵静脉泵入,1次/d,每次持续约10 h,7d为1个疗程.记录2组患者治疗前、治疗后7d及3个月的血浆氨基末端脑钠肽前体（NT-proBNP）、左心室射血分数、左心室舒张末期容积、左心室收缩末期容积、24h尿量、尿素氮、血清肌酐、血清胱抑素C、肌酐清除率检测结果.结果 rhBNP组与常规治疗组比较,治疗后7 d NT-proBNP[（1 516±432） ng/L比（4 951±1 314）ng/L],左心室射血分数[（46.9±6.8）％比（30.6±2.5）％],左心室舒张末内径[（50±3）mm比（57±5）mm],左心室收缩末内径[（35±6）mm比（43±3）mm],24 h尿量[（975±172） ml比（786±143）ml],尿素氮[（7.3 ±2.3）mmol/L比（12.9±3.2） mmol/L],血清肌酐[（93±8） μmol/L比（234±69） μmol/L],肾小球滤过率[（46 ±6） ml/min比（34±3）ml/min],血清胱抑素C[（1.4±0.1） mg/L比（3.2±1.9）mg/L],2组间差异有统计学意义（P＜0.05）.结论 rhBNP在心力衰竭合并肾功能不全治疗中近期疗效安全有效并能改善肾功能.

Objective To analyze the efficacy of recombinant human brain natriuretic peptide （rhBNP） treating congestive heart failure complicated with renal failure.Methods A retrospective analysis of 105 cases of heart failure and renal failure patients were randomly divided into two groups：group rhBNP （55 cases,on the basis of conventional therapy plus rhBNP） and routine treatment group （50 cases,treated with routine therapy）.The effect of recombinant human brain natriuretic peptide [0.007 5 μg/（kg · min） micro pump intravenous infusion,once a day,each lasting approximately 10 hours,7 days for a course of treatment] was recorded before treatment,7 days and 3 months after treatment,including left ventricular ejection fraction,left ventricular end diastolic volume,left ventricular systolic end diastolic volume,24 hour urine volume,blood urea nitrogen,serum creatinine,serum cystatin C,NT-proBNP and creatinine clearance rate.Results Compared with routine therapy group after 7 days,NT-proBNP[（1 516 ±432）ng/L vs （4 951 ± 1 314）ng/L],the left ventricular ejection fraction[（46.9 ±6.8）% vs （30.6 ± 2.5） %],left ventricular end diastolic diameter [（50 ± 3） mm vs （57 ± 5） mm],left ventricular end systolic diameter [（35 ±6）mm vs （43 ±3）mm],24 hours urine volume [（975 ± 172） ml vs （786 ± 143）ml],urea nitrogen [（7.3 ± 2.3）mmol/L vs （12.9 ± 3.2）mmol/L],serum creatinine [（93 ± 8）μmol/L vs （234 ± 69） μmol/L],glomerular filtration rate [（46 ±6）ml/min vs （34 ±3）ml/min],serum cystatin C[（1.4 ± 0.1）mg/L vs （3.2 ± 1.9）mg/L] had significant differences between the two groups （P 〈 0.05）.Conclusion The recombinant human brain natriuretic peptide is safe and can improve the renal function in chronic heart failure.