冻干重组人脑利钠肽与富马酸比索洛尔对缺血性心肌病室性心律失常并急性心力衰竭患者血管内皮功能和血清炎性因子水平影响的对比研究

Impact on Vascular Endothelial Function and Serum Inflammatory Cytokines Levels in Ischemic Cardiomyopathyinduced Ventricular Arrhythmias Patients Complicated with Acute Heart Failure:a Comparative Study between Lyophilized Recombinant Human Brain Natriure

目的比较冻干重组人脑利钠肽与富马酸比索洛尔对缺血性心肌病室性心律失常并急性心力衰竭患者血管内皮功能和血清炎性因子水平的影响。方法选取2016年11月—2017年12月襄阳市中心医院收治的缺血性心肌病室性心律失常并急性心力衰竭患者85例,根据治疗方案分为对照组40例和观察组45例。在常规药物治疗基础上,对照组患者给予富马酸比索洛尔治疗7周,观察组患者给予冻干重组人脑利钠肽治疗2周。比较两组患者治疗前后心率、血压、血清N末端B型利钠肽前体(NT-pro BNP)水平、心功能指标、心肌损伤标志物、肾功能指标、血管内皮功能指标、血清炎性因子水平,并观察两组患者治疗期间不良反应发生情况。结果 (1)治疗前后两组患者心率、收缩压、舒张压、血清NT-pro BNP水平比较,差异无统计学意义(P>0.05);治疗后两组患者心率、收缩压、舒张压、血清NT-pro BNP水平低于治疗前(P<0.05)。(2)治疗前后两组患者左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、舒张早期峰值血流速度/舒张晚期峰值血流速度(E/A比值)比较,差异无统计学意义(P>0.05);治疗后两组患者LVEDV、LVESV小于治疗前,LVEF、E/A比值高于治疗前(P<0.05)。(3)治疗前后两组患者心肌肌钙蛋白I(c Tn I)、肌酸激酶同工酶(CK-MB)、肌红蛋白、血肌酐(Scr)、尿素氮(BUN)比较,差异无统计学意义(P>0.05);治疗后两组患者c Tn I、CK-MB、肌红蛋白、Scr、BUN与治疗前比较,差异无统计学意义(P>0.05)。(4)治疗前两组患者血清一氧化氮(NO)、内皮素1(ET-1)、C反应蛋白(CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清NO水平高于对照组,血清ET-1、CRP、IL-6、TNF-α水平低于对照组(P<0.05);治疗后两组患者血清NO高于治疗前,血清ET-1、CRP、IL-6、TNF-α水平低于治疗前(P<0.05)。(5)观察组患者治疗期间不良反应发生率低于对照组(P<0.05)。结论冻干重组人脑利钠肽与富马酸比索洛尔均可有效降低缺血性心肌病室性心律失常并急性心力衰竭患者心率、收缩压、舒张压、血清NT-pro BNP水平,改善患者心功能,而对心肌损伤标志物、肾功能无明显影响;但与富马酸比索洛尔相比,冻干重组人脑利钠肽可更有效地改善患者血管内皮功能,降低血清炎性因子水平,且安全性较高。

Objective To compare the impact on vascular endothelial function and serum inflammatory cytokines levels in ischemic cardiomyopathy-induced ventricular arrhythmias patients complicated with acute heart failure between lyophilized recombinant human brain natriuretic peptide and bisoprolol fumarate.Methods A total of 85 ischemic cardiomyopathy-induced ventricular arrhythmias patients complicated with acute heart failure were selected in the Central Hospital of Xiangyang from November 2016 to December 2017,and they were divided into control group(n=40)and observation group(n=45)according to the therapeutic regimens.Based on conventional drug therapy,patients in control group received bisoprolol fumarate for 7 weeks,while patients in observation group received lyophilized recombinant human brain natriuretic peptide for 2 weeks.Heart rate,blood pressure,serum NT-proBNP level,index of cardiac function,myocardial injury markers,index of renal function,index of vascular endothelial function and serum inflammatory cytokines levels before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during treatment.Results (1)No statistically significant differences of heart rate,SBP,DBP or serum NT-proBNP level was found between the two groups before or after treatment(P>0.05);after treatment,heart rate,SBP,DBP and serum NT-proBNP level in the two groups were statistically significantly lower than those before treatment(P<0.05).(2)No statistically significant differences of LVEDV,LVESV,LVEF or E/A ratio was found between the two groups before or after treatment(P>0.05);after treatment,LVEDV and LVESV in the two groups were statistically significantly lower than those before treatment,while LVEF and E/A ratio in the two groups were statistically significantly higher than those before treatment(P<0.05).(3)No statistically significant differences of cTnI,CK-MB,myohemoglobin,Scr or BUN was found between the two groups before or after treatment(P>0.05);after treatment,cTnI,CK-MB,myohemoglobin,Scr or BUN was not statistically significantly different compared with that before treatment,respectively(P>0.05).(4)No statistically significant differences of serum level of NO,ET-1,CRP,IL-6 or TNF-αwas found between the two groups before treatment(P>0.05);after treatment,serum NO level in observation group was statistically significantly higher than that in control group,serum levels of ET-1,CRP,IL-6 and TNF-αin observation group were statistically significantly lower than those in control group(P<0.05);after treatment,serum NO level in the two groups was statistically significantly lower than that before treatment,respectively,serum levels of ET-1,CRP,IL-6 and TNF-αin the two groups were statistically significantly lower than those before treatment(P<0.05).(5)Incidence of adverse reactions in observation group was statistically significantly lower than that in control group during treatment(P<0.05).Conclusion In ischemic cardiomyopathy-induced ventricular arrhythmias patients complicated with acute heart failure,both lyophilized recombinant human brain natriuretic peptide and bisoprolol fumarate can effectively reduce the heart rate,SBP,DBP and serum NT-proBNP level,improve the cardiac function,without significant influence on myocardial injury markers or renal function;but compared with bisoprolol fumarate,lyophilized recombinant human brain natriuretic peptide can more effectively improve the vascular endothelial function and reduce the serum inflammatory cytokines levels,with higher safety.