冻干重组人脑钠肽治疗急性失代偿性心力衰竭患者的临床研究

Clinical study of lyophilized recombinant human brain natriuretic peptide in the treatment of patients with acute decompensated heart failure

目的探讨冻干重组人脑钠肽(lyophilized recombinant human brain natriuretic peptide,lrhBNP;新活素)治疗急性失代偿性心力衰竭(acute decompensated heart failure,ADHF)患者的临床疗效和安全性。方法分析南方医科大学南方医院心脏监护(CCU)病房2014年3月至2015年5月期间收治的126例应用IrhBNP治疗的ADHF患者。所有患者均在常规抗心力衰竭治疗的基础上加用IrhBNP,临床疗效评价主要观察治疗前、治疗后24 h和出院前临床症状:呼吸频率(RR)、心率(HR)、纽约心脏协会(NYHA)心功能分级、血浆氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室舒张末径(LV)、左心室射血分数(LVEF)及肌钙蛋白I(TnI)的变化。结果 108例(85.7%)患者心功能明显改善,8例患者心功能改善不明显,4例因心力衰竭加重死亡,4例因感染加重死亡,2例因突发恶性心律失常死亡。1rhBNP治疗24 h后患者呼吸频率、心率即有明显改善,纽约心脏协会心功能分级上升,血浆NT-proBNP浓度明显下降,与治疗前比较,差异有统计学意义(P<0.05)。出院前患者呼吸频率、心率、纽约心脏协会心功能分级、血浆NT-proBNP浓度还可进一步改善(P<0.05),左心室舒张末径缩小(P<0.05),左心室射血分数明显增加(P<0.05),血清肌钙蛋白I浓度显著降低,住院时间为(9.3±6.1)d。结论 ADHF的常规治疗基础上联合应用lrhBNP,可有效改善患者的呼吸频率、心率、纽约心脏协会心功能分级、左心室射血分数、血浆NT-proBNP浓度,治疗过程中对收缩压、肝和肾功能无明显影响。

Objectives To assess the clinical effects and safety of lyophilized recombinant human brain natriuretic peptide （lrhBNP, nesiritide） in the treatment of patients with acute deeompensated heart failure （ADHF）. Methods Clinical data of 126 patients with ADHF who received lrhBNP treatment in the Cardiac Care Unit of Nanfang Hospital from March 2014 to May 2015 were analyzed. All the patients were treated with lrhBNP in addition to routine heart failure therapy. Clinical effects were evaluated mainly according to the clinical symptoms before treatment, 24 h after treatment and before discharge, including the changes of respiratory rate （RR）, heart rate （HR）, New York Heart Association （NYHA） functional class, N-terminal pro-brain natriuretic peptide （NT-proBNP）, left ventficular end- diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF） and troponin-I （TnI）. Results Among the 126 patients, 108 （85.7%） patients showed significantly improvement in cardiac function, while 8 patients showed minor improvement, 4 patients died of heart failure, 4 patients died of infection aggravation and 2 patients died of sudden malignant arrhythmias. After 24 h treatment with lrhBNP, RR and HR improved significantly （P〈0.05）, NYHA functional class also improved （P〈0.05） and plasma concentration of NT-proBNP reduced greatly （P〈0.05）. Before discharge, patients＇ RR, HR, NYHA functional class and NT-proBNP further improved （P〈0.05）, LVEDD reduced（P〈0.05）, LVEF increased significantly （P〈O.05） and TnI decreased significantly. The average duration of stay was （9.3±6.1） days. Conclusions Routine therapy in combination with lrhBNP can effectively improve RR, HR, LVEF, NT-proBNP and NYHA classification in patients with ADHF without visible negative influence on systolic blood pressure, liver and kidney functions.