重组人B型钠尿肽对急性心肌梗死后心力衰竭患者心功能及心率变异性的影响

Effects of recombinant human B-type natriuretic peptide on cardiac function and heart rate variability in patients with heart failure after acute myocardial infarction

目的观察重组人B型钠尿肽(rhBNP)对急性心肌梗死(AMI)后心力衰竭(心衰)患者心功能和心率变异性(HRV)的影响.方法选择2015年1月至2018年1月河北省沧州市中心医院心内科收治的AMI后心衰患者120例,将患者按随机数字表法分为常规治疗组及rhBNP治疗组,每组60例.两组患者均按照AMI指南进行治疗,常规治疗组给予常规抗心肌缺血和抗心衰治疗;rhBNP治疗组在常规治疗基础上给予rhBNP,首负荷剂量2μg/kg静脉注射冲击治疗,继以8.5 ng·kg^-1·min^-1的剂量静脉滴注(静滴)维持治疗,疗程为7 d.观察两组治疗前后超敏C-反应蛋白(hs-CRP)、N末端B型钠尿肽前体(NT-proBNP)、左室射血分数(LVEF)及HRV指标〔包括平均正常RR间期的标准差(SDNN)、正常RR间期标准差的平均值(SDANN)、相邻RR间期差的均方根(RMSSD)、相邻RR间期差值>50 ms的百分数(PNN50)〕的变化;并观察两组不良反应发生情况.结果两组治疗后hs-CRP、NT-proBNP均较治疗前明显降低(均P<0.05),LVEF、SDNN、SDANN、RMSSD、PNN50均较治疗前升高,且以rhBNP治疗组上述指标的变化较常规治疗组更显著〔hs-CRP(mg/L):6.2±3.3比11.8±5.5,NT-proBNP(ng/L):2.5±2.0比6.4±4.3,LVEF:0.49±0.02比0.44±0.04,SDNN(ms):93.3±18.1比79.1±16.0,SDANN(ms):87.3±17.8比70.9±14.9,RMSSD:30.3±11.0比23.8±10.4,PNN50:(15.9±7.3)%比(9.6±5.5)%,均P<0.05〕;两组治疗过程中均无明显不良反应发生.结论rhBNP能明显改善AMI后心衰患者的心功能,降低炎症反应指标水平,提高HRV,具有临床疗效好、安全性高等优势,值得在临床上推广使用.

Objective To observe the effects of recombinant human B-type natriuretic peptide(rhBNP)on cardiac function and heart rate variability(HRI)in patients with heart failure after acute myocardial infarction(AMI).Methods One hundred and twenty patients with heart failure after AMI admitted to the Department of Cardiology of Cangzhou Central Hospital of Hebei Province from January 2015 to January 2018 were enrolled.The patients were divided into a conventional treatment group and an rhBNP treatment group according to random number table method,with 60 cases in each group.The two groups were treated according to the AMI guidelines,the conventional treatment group received west medicine anti-myocardial ischemia and anti-heart failure treatment;the rhBNP treatment group received rhBNP on the basis of routine treatment;the first load dose was 2 pg/kg intravenous injection impact treatment,followed by maintaining dose 8.5 ng·kg^-1·min^-1 intravenous drip for 7 days.The changes of hypersensitivity C-reactive protein(hs-CRP),N-terminal B-type natriuretic peptide precursor(NT-proBNP).left ventricular ejection fraction(LVEF)and HR\index were observed before and after treatment in the two groups[HRY indexes including the changes of average normal RR interval standard deviation(SDNN),the average value of the normal RR interval standard deviation(SDANN),the root mean square(RMSSD)of the adjacent RR interval difference,and the percentage of adjacent RR interval difference>50 ms(PNN50)];the incidences of adverse reactions in the two groups were observed.Results After treatment,the levels of hs-CRP and NT-proBNP in the two groups were significantly lower than those before treatment(all P<0.05).LVEF.SDNN,SDANN.RMSSD and PNN50 were higher than those before treatment,and the changes of the above indicators in the rhBNP treatment group were more significant than those in the conventional treatment group[hs-CRP(mg/L):6.2±3.3 vs.1 1.8±5.5.NT-proBNP(ng/L):2.5±2.0 vs.6.4±4.3.LVEF:0.49±0.02 vs.0.44±0.04.SDNN(ms):93.3±18.1 vs.79.1±16.0.SDANN(ms):87.3±17.8 vs.70.9±14.9.RMSSD:30.3±11.0 vs.23.8±10.4.PNN50:(15.9±7.3)%vs.(9.6±5.5)%,all P<0.05];No significant adverse reactions occurred during the treatment ol the two groups.Conclusion rhBNP can significantly improve the heart function of patients w ith heart failure after AMI,reduce the levels of inflammatory response indicators and improve HRY;since its clinical efficacy is good,and its application safe,it is worthy to promote its clinical use.