重组人脑利钠肽对急性心肌梗死患者血管内皮功能及心率变异性的影响

Effect of recombinant human brain natriuretic peptide on vascular endothelial function and heart rate variability in patients with acute myocardial infarction

目的探讨重组人脑利钠肽(recombinant human brainnatriuretic peptide,rhBNP)对急性心肌梗死(acute myocardialinfarction,AMI)患者血管内皮功能及心率变异性(heart ratevariability,HRV)的影响.方法纳入2016年1月至2017年1月于我院接受治疗的120例AMI患者,采用随机数字表法分为两组,各60例.对照组仅予常规治疗;观察组联用冻干rhBNP.分别于患者入院后7d(即观察组应用rhBNP前)、入院后10d(即观察组rhBNP应用完毕后1 d),测评并对比患者血清一氧化氮(serum nitric oxide,NO)、内皮素l(endothelin 1,ET-1)、肱动脉内皮依赖性舒张功能(brachial arterial endothelium-dependent diastolicfunction,FMD)、HRV相关指标变化情况.结果所有患者均测得2次血管内皮功能和HRV检测指标,观察组院内治疗和院外随访期间病死率、心肌梗死再发率分别为1.67%、5.00%,略低于对照组的10.00%、13.33%,但未见统计学差异(P>0.05).两组首次检测时各指标基线值均未见统计学差异(P>0.05),治疗后各检测指标均明显改善(P<0.05),且治疗后观察组FMD、NO、全部正常窦性心搏RR间期标准差(standard deviation of all normal RRintervals,SDNN)、相邻窦性心搏RR间期均值的标准差(standarddeviation of average RR interval in 5-min segments,SDANN)、相邻窦性心搏RR间期差值的均方根(the square root of the mean of thesquared differences between adjacent NN intervals,RMSSD)、高频(high frequency,HF)和低频(low frequency,LF)分别为(14.42±3.63)%、(44.18±6.30)μmol/L、(105.81±8.83)ms、(93.38±8.72)ms、(40.24±8.31)ms、(274.14±77.36)ms2/Hz、(149.33±50.17)ms2/Hz明显高于对照组,其分别为(11.71 ±3.05)%、(41.41±5.34)μmol/L、(91.71±9.55)ms、(77.16±5.93)ms、(35.58±10.71)ms、(226.64±69.31)ms2/Hz、(114.68±61.33)ms2/Hz,ET-1为(58.82±12.17)ng/L明显低于对照组的(66.42±15.81)ng/L,上述差异均有统计学意义(P<0.05).结论对AMI患者,在常规治疗基础上联用rhBNP,能够更好地改善患者内皮功能及HRV,这可能有助于改善心肌供血,改善预后.

Objective To investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on vascular endothelial function and heart rate variability (HRV) in patients with acute myocardial infarction (AMI). Methods 120 patients with AMI treated in our hospital from January 2016 to January 2017 were randomly divided into 2 groups, with 60 cases each group. The control group received routine treatment only, while the observation group was treated with lyophilized rhBNP in addition. At 7 days after admission (before rhBNP was used in the observation group) and at 10 days after admission (1 day after rhBNP application completed in the observation group), serum nitric oxide (NO), endothelin 1 (ET-1), brachial arterial endothelium-dependent diastolic function (FMD) and HRV index changes in 2 groups were observed. Results The mortality and the recurrence rate of myocardial infarction in the observation group were 1.67% and 5.00% respectively, which were slightly lower than those in the control group (10.00% and 13.33% respectively), but with no significant difference (P>0.05). At first time of detection, every index at baseline in 2 groups showed no significant difference(P>0.05). After treatment, all indexes were significantly improved(P<0.05). FMD, NO,SDNN , SDANN , RMSSD, LF and HF were ( 14.42±3.63 )%,(44.18±6.30) pmol/ L,(105.81 ±8.83 ) ms,(93.38±8.72 ) ms,(40.24±8.31) ms,(274.14±77.36) ms2/Hz and (149.33±50.17) ms2/Hz in the observation group were significantly higher than those in the control group, which were respectively (11.71 ± 3.05 )%,(41.41±5.34)pmol/L,(91.71 ±9.55) ms,(77.16±5.93) ms,(35.58± 10.71) ms,(226.64±69.31) ms2/Hz and (114.68±61.33)ms2/Hz;ET-1 (58.82±12.17)ng/L was significantly lower than that in the control group(66.42± 15.81 ) ng / L. The differences were statistically significant (P<0.05). Conclusion For AMI patients, rhBNP combined with conventional treatment can improve the vascular endothelial function and HRV better, which may contribute to myocardial blood supply and prognosis.