应用血清NT-proBNP、Copeptin、ST2水平综合评价重组人脑利钠肽治疗慢性心力衰竭的疗效

Evaluation of the efficacy of recombinant human brain natriuretic peptide in treating chronic heart failure by detecting blood NT-proBNR Copeptin and ST2

目的应用NT-pro BNP、Copeptin、ST2水平综合评价重组人脑利钠肽治疗慢性心力衰竭的疗效。方法采用随机、平行、阳性对照临床研究。选择射血分数≤0.40的慢性心力衰竭急性失代偿期住院患者80例,随机分配至2个组别:(1)对照组:按照指南给予慢性心力衰竭基础药物治疗,包括利尿剂、血管紧张素转换酶抑制剂、β受体阻滞剂、醛固酮受体拮抗剂、正性肌力药等。(2)重组人脑利钠肽组:基础药物加用重组人脑利钠肽。治疗前及治疗1周后监测患者生命体征、心力衰竭临床表现,酶联免疫吸附法(ELISA)测定血清NT-pro BNP、Copeptin、ST2值。结果共75例纳入结果分析。(1)临床有效率:对照组62.5%(25/40),重组人脑利钠肽组85.7%(30/35)(P=0.035)。(2)1治疗后血清NT-pro BNP水平较治疗前下降(Con组t=5.643,P<0.001;rh BNP组t=8.820,P<0.001);试验组优于对照组(t=-2.14,P=0.011)。2治疗后和肽素水平较治疗前均下降(Con组t=5.044,P<0.001;rh BNP组t=6.669,P=0.001);试验组优于对照组(t=-3.298,P=0.003)。3对照组治疗后ST2较治疗前下降(t=3.741,P=0.004)。重组人脑利钠钛组治疗前后血清ST2水平不具有统计学差异(t=0.549,P=0.595)。试验组ST2降低明显低于对照组(t=2.308,P=0.032)。(3)对照组与试验组不良反应发生率分别为5%(2/40)与8.3%(3/35),两组比较差异无统计学意义(P=0.663)。结论 (1)综合应用NT-pro BNP、Copeptin、ST2可以更加全面的评估心力衰竭患者的病情;(2)重组人脑利钠肽可能不利于抑制心肌炎症和纤维化的发展,从而对于心力衰竭患者长期预后不利,但对于短期改善心力衰竭症状有效。

Objective To assess the efficacy of recombinant human brain natriuretic peptid on chronic heart failure by determining the serum levels of NT-proBNP,Copeptin and ST2.Methods 80 patients were arranged into this clinical study：（1） Control group：these patients received routine medication treatment according to the Chinese Heart Failure Guidelines.（2） rhBNP group：these patients received recombinant human brain natriuretic peptid in addition to routine medication.To monitor the vital signs and clinical manifestations,examine NT-proBNP,Copeptin and ST2 before and after treatment.Results 75 patients were included in analysis.（1） Clinical efficacy rate：Con group was 62.5%（25/40）,while rhBNP group was 85.7%（30/35）（P=0.035）.（2） ①NT-proBNP decreased in both groups after treatment（Cont=5.643,P〈0.001,rhBNP t=8.820,P〈0.001）,and rhBNP group was superior（t=-2.14,P=0.011）.②Copeptin in rhBNP group had a more significant decrease compared with the control group（t=-3.298,P=0.003）.③ST2 decreased after treatment in the control group（t=3.741,P=0.004）,while no signifant decrease in the rhBNP group（t=0.549,P=0.595）.Conclusion（1） Application of NT-proBNP,Copeptin and ST2 can monitor efficacy more comprehensively.（2） Recombinant human brain natriuretic peptide may be harmful in the development of inflammation and fibrosis,but it can improve symptoms significantly.