重组人脑利钠肽治疗高龄老年人急性非ST抬高心肌梗死合并心力衰竭的疗效及安全性

A study on clinical efficacy and safety of recombinant human brain natriuretic peptide for the treatment of elderly patients with acute heart failure caused by acute non-ST elevated myocardial Infarction

目的观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rh BNP)在治疗合并心力衰竭的急性非ST抬高心肌梗死的老年患者的临床疗效。方法选择2013年6月至2014年3月在宣武医院综合科和心内科确诊为急性非ST抬高心肌梗死合并心力衰竭住院的高龄老年患者86例,男47例,女39例,平均年龄(79.63±4.41)岁。随机分为rh BNP治疗组(41例)及硝酸甘油对照组(45例),2组均给予常规治疗,治疗组在此基础上加用rh BNP,先给予1.5μg/kg负荷量,继之以0.01μg/(kg·min)静脉持续泵入72h。对照组在常规治疗基础上加用硝酸甘油10-15μg/min静脉持续泵入72h。2组均总治疗7d。分别对2组治疗前及治疗后48h、72h、7d收缩压、舒张压、心率、N末端B型利钠肽原(N terminal B type natriuretic peptide,NT-pro BNP)、左室射血分数(Left ventricular ejection fraction,LVEF)、左室舒张末期内径(Left ventricular end diastolic dimensio,LVEDD)、左室收缩末期内径(Left ventricular endsystolic volume,LVSDD)、每搏输出量(Stroke volume,SV)、心排血量(Cardiac output,CO)等指标进行检测。观察记录患者住院期间及出院后1个月6min步行试验(6 minutes walking test,6MWT),随访1个月内发生的不良心血管事件(Major adverse cardiacevents,MACE),包括恶性心律失常、再次心肌梗死以及死亡发生情况。结果治疗7d后rh BNP组收缩压、心率和NT-pro BNP与对照组比较明显下降(P<0.05)。rh BNP组治疗后左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO)均优于对照组(P<0.05),左室舒张末期内径(LVEDD)和左室收缩末期内径(LVSDD)较对照组显著降低(P<0.05)。rh BNP组患者6MWT大于对照组(P<0.05)。rh BNP组住院及出院后1个月内MACE明显低于对照组(P<0.05)。结论对老年急性非ST抬高心肌梗死并发心力衰竭患者常规治疗基础上加用rh BNP治疗,可进一步改善心功能,减少MACE。

Objective To evaluate the clinical efficacy and safety of recombinant human brain natriuretic peptide（ rhBNP） in elderly patients with acute heart failure caused by acute non-ST elevated myocardial infarction. Methods A total of 86 elderly patients with acute non-ST elevated myocardial infarction complicated with HF were randomly divided into the treatment group（41cases） and the control group（45cases）. Both groups were treated with routine therapies, while the treatment group was added with lyophilized recombinant human brain natriuretic peptidel. 5 p.g/kg loading initially and then intravenous pump of 0. 01μg/（kg.min） for 72h, whereas the control group was added with nitroglycerin（NG）. Both groups were treated for 7d. The clinical data and laboratory results were collected. Indicators which reflected the cardiac function such as N terminal B type natriuretic peptide （NT-proBNP）, left ventricular ejection fraction （LVEF）, left ventricular end diastolic dimension （LVEDD）, left ventricular end systolic volume （LVSDD）, stroke volume （SV）,cardiac output（CO）and 6-minute walking test （6MWT） were also compared between the two groups. The clinical curative effect, all the parameters and hypotension during hospitalization of the two groups were observed and compared. Results After treatment, heart rate（HR）, systolic blood pressure（SBP）, diastolic blood pressure（DBP） and NT-pro BNP decreased markedly than before treatment in both groups, which were apparently lower in the treatment group than in the control group（P 〈0.01）. Left ventricular ejection fraction（LVEF）, stroke volume（SV） and cardiac output（CO） were improved prominently after treatment than before treatment in both groups, which were apparently higher in the treatment group than in the control group（P〈 0. 05 or P〈 0.01）.RhBNP showed no adverse influence on liver function parameters, renal function parameters ,blood glucose level, cholesterol and triglyceride level. Patients receiving rhBNP had significantly less side effects than their counterparts of the NG group （P〈0.05）.Conelusion Application of rhBNPon the basis of routine therapies can improve the cardiac function of elderly patients with acute non-ST elevated myocardial infarction patients with heart failure. Thus deserves to be widely used in clinic.