重组人BNP联合黄芪注射液对AMI PCI术后心力衰竭患者心功能及血清炎症因子的影响

Influence of recombinant human BNP combined Astragalus injection on heart function and serum levels of inflammatory factors in AMI patients with post-PCI heart failure

目的:探讨重组人脑利钠肽(rhBNP)联合黄芪注射液对急性心肌梗死(AMI)经皮冠脉内介入治疗(PCI)术后心力衰竭患者心功能及血清炎症因子水平的影响。方法:选择96例AMI行PCI术后心力衰竭患者,随机均分为rhBNP组(在常规治疗基础上给予rhBNP治疗)和联合治疗组(在rhBNP组基础上联用黄芪注射液),治疗14d,观察两组临床疗效,治疗前后心功能、血清N末端B型脑钠肽前体(NT-proBNP)、肿瘤坏死因子-α(TNF-α)、hsCRP、基质金属蛋白酶-9 (MMP-9)、髓过氧化物酶(MPO)水平变化,及不良反应发生率。结果:治疗后,联合治疗组临床总有效率显著高于rhBNP组(91.67%比72.92%, P =0.016);与rhBNP组比较,联合治疗组LVEF[(44.26±7.39)%比(49.67±7.46)%]增加更显著,LVEDV[(129.27±8.71)ml比(117.39±7.59) ml]、LVESV [(78.10±6.22)ml比(66.74±5.96)ml]减小更显著,NT-proBNP [(968.43±172.49)ng/L比(796.30±158.24)ng/L]、TNF-α[(118.67±23.59)ng/L比(97.73±18.48) ng/L]、hsCRP[(4.19±0.85)mg/L比(3.38±0.57)mg/L]、MMP-9[(82.47±14.28)ng/ml比(60.92± 11.45)ng/ml]、MPO[(497.52±64.32)mg/L比(452.82±60.57)mg/L]水平下降更显著( P 均=0.001)。两组不良反应发生率无显著差异( P =0.584)。结论: rhBNP联合黄芪注射液治疗AMI行PCI术后心力衰竭患者可显著改善心功能,减轻炎症反应,且安全,值得推广。

Objective: To explore influence of recombinant human B type natriuretic peptide (rhBNP) combined Astragalus injection on heart function and serum levels of inflammatory factors in AMI patients with post-percutaneous coronary intervention (PCI) heart failure. Methods: A total of 96 AMI patients with post-PCI heart failure were randomly and equally divided into rhBNP group (received rhBNP based on routine treatment) and combined treatment group (received Astragalus injection based on rhBNP group),both groups were treated for 14d. Clinical therapeutic effect,heart function,serum levels of N terminal pro BNP (NT-proBNP),tumor necrosis factor (TNF)-α,hsCRP,matrix metalloproteinase (MMP)-9 and myeloperoxidase (MPO) before and after treatment,and incidence of adverse reactions were observed in two groups. Results: After treatment,total effective rate of combined treatment group was significantly higher than that of rhBNP group (91.67% vs. 72.92%, P =0.016). Compared with rhBNP group after treatment,there was significant rise in LVEF[(44.26±7.39)% vs.(49.67±7.46)%],and significant reductions in LVEDV [(129.27±8.71)ml vs.(117.39±7.59) ml],LVESV [(78.10±6.22)ml vs.(66.74±5.96) ml],serum levels of NT-proBNP [(968.43±172.49)ng/L vs.(796.30±158.24)ng/L],TNF-α[(118.67± 23.59)ng/L vs.(97.73±18.48) ng/L],hsCRP[(4.19±0.85)mg/L vs.(3.38±0.57) mg/L],MMP-9[(82.47±14.28)ng/ml vs.(60.92±11.45)ng/ml] and MPO [(497.52±64.32) mg/L vs.(452.82±60.57)mg/L] in combined treatment group, P =0.001 all. There was no significant difference in incidence rate of adverse reactions between two groups, P =0.584. Conclusion: RhBNP combined Astragalus injection can significantly improve heart function,relieve inflammatory reactions with safety in AMI patients with post-CI heart failure,which is worth extending.