不同剂量重组人脑利钠肽对行经皮冠状动脉介入治疗的急性心肌梗死患者影响的对比研究

Impact of Different Doses of Recombinant Human Brain Natriuretic Peptide on Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention:a Comparative Study

目的比较不同剂量重组人脑利钠肽(rhBNP)对行经皮冠状动脉介入治疗(PCI)的急性心肌梗死(AMI)患者的影响。方法选取2015年1月-2018年1月中国人民解放军第九四医院和中山大学附属第七医院收治的AMI患者216例,采用随机数字表法分为对照组(n=54)、A组(n=54)、B组(n=54)、C组(n=54)。所有患者发病24 h内行PCI,对照组、A组、B组、C组患者分别在常规治疗基础上、PCI前2 h给予硝酸甘油、小剂量rhBNP、中等剂量rhBNP、较大剂量rhBNP。比较四组患者给药时及给药后0.5、1、3、6、12、24、48、72 h生命体征[包括心率、收缩压(SBP)、舒张压(DBP)],给药时及给药后24、48、72 h心功能指标[包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每分钟搏出量(SV)]及肾功能指标[包括血肌酐(Scr)、血尿素(Sur)、β2-微球蛋白(β2-MG)、胱抑素C(CysC)],给药后72 h心肌损伤标志物[包括肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)],并观察四组患者治疗期间不良反应发生情况。结果 (1)时间与方法在SBP、DBP上存在交互作用(P<0.05),在心率上无交互作用(P>0.05);时间、方法在SBP、DBP上主效应显著(P<0.05),在心率上主效应不显著(P>0.05)。A组、B组、C组患者给药后1、3、6 h SBP低于对照组,B组、C组患者给药后12、24、48、72 h SBP低于对照组,B、C组患者给药后1、3、6、12、24、48 h SBP低于A组,C组患者给药后72 h SBP低于A组且给药后1、3、6、12、72 h SBP低于B组(P<0.05);A组、B组、C组患者给药后1 h DBP低于对照组,B组、C组患者给药后3、6、12 h DBP低于对照组且给药后3、6 h DBP低于A组,B组患者给药后24 h DBP低于对照组,C组患者给药后24、48、72 h DBP低于对照组、A组、B组(P<0.05)。(2)时间与方法在LVEF、LVEDD、LVEDV、LVESV、SV上存在交互作用(P<0.05),时间、方法在LVEF、LVEDD、LVEDV、LVESV、SV上主效应显著(P<0.05)。B组、C组患者给药后24 h LVEDD短于对照组、A组,C组患者给药后24 h LVEDD短于B组(P<0.05);A组患者给药后48 h LVEDV、LVESV小于对照组(P<0.05);B组、C组患者给药后48 h LVEF高于对照组,LVEDD短于对照组、A组,LVEDV小于对照组、A组,LVESV小于对照组(P<0.05);C组患者给药后48 h LVEF高于A组,LVEDD短于B组,LVEDV小于B组,LVESV小于A组、B组,SV大于对照组、A组、B组(P<0.05);A组、B组、C组患者给药后72 h LVEF高于对照组,LVEDD短于对照组,LVEDV小于对照组(P<0.05);B组、C组患者给药后72 h LVEDD短于A组,LVEDV小于A组,LVESV小于对照组、A组,SV大于对照组、A组(P<0.05);C组患者给药后72 h LVEF高于A组、B组,LVEDV、LVESV小于B组(P<0.05)。(3)给药后72 h A组、B组、C组患者CK、CK-MB、cTnI低于对照组,B组、C组患者CK-MB、cTnI低于A组,C组患者CK-MB低于B组(P<0.05)。(4)时间与方法在Scr、Sur上存在交互作用(P<0.05),在β2-MG、Cys C上不存在交互作用(P>0.05);时间、方法在Scr、Sur上主效应显著(P<0.05),在β2-MG、Cys C上主效应不显著(P>0.05)。给药后24 h A组、B组、C组患者Scr、Sur高于对照组,B组、C组患者Scr、Sur高于A组,C组患者Scr、Sur高于B组(P<0.05);给药后48 h B组、C组患者Scr、Sur高于对照组、A组,C组患者Scr、Sur高于B组,A组患者Sur高于对照组(P<0.05);给药后72 h C组患者Scr、Sur高于对照组、A组、B组,A组、B组患者Sur高于对照组,B组患者Sur高于A组(P<0.05)。(5)C组患者治疗期间不良反应发生率高于对照组(P<0.05)。结论与小剂量、中等剂量rhBNP比较,较大剂量rhBNP可更有效地降低行PCI的AMI患者血压,改善患者心功能,减轻患者心肌损伤,但有可能使肾功能损伤发生风险升高。

Objective To compare the impact of different doses of recombinant human brain natriuretic peptide(rh BNP)on acute myocardial infarction(AMI)patients undergoing percutaneous coronary intervention(PCI). Methods A total of 216 patients with AMI were selected in the Seventh Hospital Affiliated to Sun Yat-sen University and the 94 th Hospital of Chinese People’s Liberation Army from January 2015 to January 2018,and they were divided into control group(n=54),A group(n=54),B group(n=54)and C group(n=54)according to random number table method. All of the 216 patients underwent PCI within 24 hours after attack,thereinto patients in control group,A group,B group and C group were given nitroglycerin,low-dose rh BNP,medium-dose rh BNP and high-dose rh BNP 2 hours before PCI based on conventional treatment. Comparison of vital signs(including heart rate,SBP and DBP)at drug delivery,0.5 hour,1 hour,3 hours,6 hours,12 hours,24 hours,48 hours and 72 hours after drug delivery,index of cardiac function(including LVEF,LVEDD,LVEDV,LVESV and SV)and renal function(including Scr,Sur,β2-MG and Cys C)at drug delivery,24 hours,48 hours and 72 hours after drug delivery,markers of myocardial injury(including CK,CK-MB and c Tn I)72 hours after drug delivery was conducted in the four groups,and incidence of adverse reactions was observed during treatment. Results (1)There was statistically significant interaction in SBP and DBP between time and method(P<0.05),while there was no tatistically significant interaction in hear rate between time and method(P>0.05);main effects of time and method were statistically significant in SBP and DBP(P<0.05),while main effect of time or method was not statistically significant in hert rate(P>0.05).SBP in groups A,B and C was statistically significantly lower than that in control group 1 hour,3 hours and 6 hours after drug delivery,respectively(P<0.05),SBP in groups B and C was statistically significantly lower than that in control group 12 hours,24 hours,48 hours,72 hours after drug delivery,respectively(P<0.05),SBP in groups B and C was statistically significantly lower than that in A group 1 hour,3 hours,6 hours,12 hours,24 hours and 48 hours after drug delivery,respectively(P<0.05),SBP in C group was statistically significantly lower than that in A group 72 hours after drug delivery and that in B group 1 hour,3 hours,6 hours,12 hours and 72 hours after drug delivery(P<0.05);DBP in groups A,B and C was statistically significantly lower than that in control group 1 hour after drug delivery,respectively(P<0.05),DBP in groups B and C was statistically significantly lower than that in control group 3 hours,6 hours and 12 hours after drug delivery and that in A group 3 hours and 6 hours after drug delivery,respectively(P<0.05),DBP in B group was statistically significantly lower than that in control group 24 hours after drug delivery(P<0.05),DBP in C group was statistically significantly lower than that in groups control,A and B 24,48 and 72 hours after drug delivery,respectively(P<0.05).(2)There was statistically significant interaction in LVEF,LVEDD,LVEDV,LVESV and SV between time and method(P<0.05);main effects of time and method were statistically significant in LVEF,LVEDD,LVEDV,LVESV and SV(P<0.05).LVEDD in groups B and C was statistically significantly shorter than that in group control and A group 24 hours after drug delivery,respectively(P<0.05),meanwhile LVEDD in C group was statistically significantly shorter than that in B group(P<0.05);LVEDV and LVESV in A group were statistically significantly lower than those in control group 48 hours after drug delivery(P<0.05);LVEF in groups B and C was statistically significantly higher than that in control group 48 hours after drug delivery,respectively,LVEDD in groups B and C was statistically significantly shorter than that in groups control and A,respectively,LVEDV in groups B and C was statistically significantly lower than that in groups control and A,respectively,LVESV in groups B and C was statistically significantly lower than that in control group,respectively(P<0.05);LVEF in C group was statistically significantly higher than that in A group 48 hours after drug delivery,LVEDD in C group was statistically significantly shorter than that in B group,LVEDV in C group was statistically significantly lower than that in B group,LVESV in C group was statistically significantly lower than that in groups A and B,respectively,SV in C group was statistically significantly higher than that in groups control,A and B,respectively(P<0.05);LVEF in groups A,B and C was statistically significantly higher than that in control group 72 hours after drug delivery,respectively,LVEDD in groups A,B and C was statistically significantly shorter than that in control group,respectively,LVEDV in groups A,B and C was statistically significantly lower than that in control group,respectively(P<0.05);LVEDD in groups B and C was statistically significantly shorter than that in A group 72 hours after drug delivery,respectively,LVEDV in groups B and C was statistically significantly lower than that in A group,respectively,LVESV in groups B and C was statistically significantly lower than that in groups control and A,respectively,SV in groups B and C was statistically significantly higher than that in groups control and A,respectively(P<0.05);LVEF in C group was statistically significantly higher than that in groups A and B 72 hours after drug delivery,respectively,while LVEDV and LVESV in C group were statistically significantly lower than those in B group(P<0.05).(3)After 72 hours of drug delivery,CK,CK-MB and c Tn I in groups A,B and C were statistically significantly lower than those in control group,CK-MB and c Tn I in groups B and C were statistically significantly lower than those in A group,meanwhile CK-MB in C group was statistically significantly lower than that in B group(P<0.05).(4)There was statistically significant interaction in Scr and Sur between time and method(P<0.05),while there was no tatistically significant interaction in β2-MG or Cys C between time and method(P>0.05);main effects of time and method were statistically significant in Scr and Sur(P<0.05),while main effect of time or method was not statistically significant in β2-MG or Cys C(P>0.05).After 24 hours of drug delivery,Scr and Sur in groups A,B and C were statistically significantly higher than those in control group,Scr and Sur in groups B and C were statistically significantly higher than those in A group,meanwhile Scr and Sur in C group were statistically significantly higher than those in B group(P<0.05);after 48 hours of drug delivery,Scr and Sur in groups B and C were statistically significantly higher than those in groups control and A,Scr and Sur in C group were statistically significantly higher than those in B group,Sur in A group was statistically significantly higher than that in control group(P<0.05);after 72 hours of drug delivery,Scr and Sur in C group were statistically significantly higher than those in groups control,A and B,Sur in groups A and B was statistically significantly higher than that in control group,Sur in B group was statistically significantly higher than that in A group(P<0.05).(5)Incidence of adverse reactions in C group was statistically significantly higher than that in control group during treatment(P<0.05). Conclusion Compared with low-and medium-dose rh BNP,high-dose rh BNP can more effectively reduce the blood pressure,improve the cardiac function and relieve the myocardial injury in AMI patients undergoing PCI,but it may increase the risk of renal injury.