低剂量重组人脑利钠肽治疗急性失代偿性心力衰竭合并肾功能不全的疗效观察

Therapeutic effect of low dose recombinant human brain natriuretic peptide on patients with acute decompensated heart failure and renal dysfunction

目的:探讨低剂量重组人脑利钠肽(rhBNP)对急性代偿性心力衰竭(ADHF)合并肾功能不全的治疗效果。方法:选择我院收治的102例ADHF合并肾功能不全患者,随机分为对照组(50例)和治疗组(52例),治疗组在常规抗心力衰竭治疗的基础上加用rhBNP(0.005μg·kg^(-1)·min^(-1)输注7d),对比两组治疗前后的心功能和肾功能变化及治疗效果。结果:治疗前,两组基线资料及合并用药差异无统计学意义(P>0.05);与治疗前相比,治疗后两组的左室射血分数(LVEF)、N-末端B型利钠肽前体(NT-proBNP)、平均动脉压(MAP)、心率(HR)均有显著改善(P<0.05),且治疗组的改善更为显著(P<0.05);与对照组相比,治疗后治疗组的24h尿量明显增多(P<0.05);治疗前后,两组患者的肌酐(Cr)、估测的肾小球滤过率(eGFR)、胱抑素C(Cys-C)差异均无统计学意义(P>0.05);治疗组的总有效率显著高于对照组(P<0.05)。结论:低剂量rhBNP治疗急性失代偿性心力衰竭合并肾功能不全安全、有效、经济,值得临床推广。

Objective：To explore therapeutic effect of low dose recombinant human brain natriuretic peptide（rhBNP）in patients with acute decompensated heart failure（ADHF）and renal dysfunction.Method：A total of 102 patients with ADHF and renal dysfuncition were randomly divided into control group（n=50）and treatment group（n=52）.The treatment group received 7 days treatment of low dose rhBNP（0.005μg·kg^-1·min^-1）based on routine treatment.After 7 days treatment,cardiac function,renal function and total effective rate were measured and compared between two groups.Result：There was no significant difference in baseline characteristics and drug combination between two groups（P〉0.05）.The left ventricular ejection fraction（LVEF）,N-terminal pro-B-type natriuretic peptide（NT-proBNP）,mean arterial pressure（MAP）and heart rate（HR）were significantly improved in both groups after treatment（P〈0.05）.The improvement in treatment group was greater compared with control group（P〈0.05）.Compared with control group,the 24 hurine volume was more in treatment group after treatment（P〈0.05）.There were no significant difference in creatinine（Cr）,estimated glomerular filtration rate（eGFR）and cystatin C（Cys-C）between two groups whether before treatment or after treatment（P〉0.05）.Total effective rate of treatment group was significant higher than control group（P〈0.05）.Conclusion：The low dose rhBNP treatment is effective,safe and economic for patients with ADHF and renal dysfunction.