重组人脑利钠肽联合左西孟旦对老年急性失代偿性心力衰竭患者心功能和血清N末端B型脑钠肽前体及和肽素水平的影响

Effect of recombinant human brain natriuretic peptide combined with levosimendan on cardiac function,serum levels of N-terminal pro-brain natriuretic peptide and copeptin in elderly patients with acute decompensated heart failure

目的探讨重组人脑利钠肽(rh BNP)联合左西孟旦对老年急性失代偿性心力衰竭ADHF患者心功能及血清N末端B型脑钠肽前体(NT-proBNP)与和肽素水平的影响。方法选取2014年6月至2017年6月于宁夏医科大学总医院就诊采用常规治疗无效的老年ADHF患者120例作为研究对象,按照随机数字表法分为观察组和对照组,每组60例。对照组在常规治疗基础上给予左西孟旦治疗;观察组在对照组基础上给予rh BNP治疗。2组均治疗7 d。比较2组临床疗效、治疗前后心功能指标、血清NT-proBNP、和肽素水平及不良反应发生情况。结果观察组总有效率明显高于对照组[86. 7%(52/60)比70. 0%(42/60)],差异有统计学意义(P=0. 001)。治疗后,观察组左心室舒张末期内径、左心室收缩末期内径水平明显小于对照组[(53±9) mm比(58±9) mm、(46±8) mm比(53±6) mm],左心室射血分数、心输出量、心脏指数明显高于对照组[(45±5)%比(43±6)%、(4. 9±1. 3) L/min比(4. 2±1. 0) L/min、(2. 9±0. 9) L/(min·m^2)比(2. 5±0. 8) L/(min·m^2)](均P <0. 05)。治疗后,2组患者血清NT-proBNP、和肽素水平均明显低于治疗前,且观察组明显低于对照组,差异均有统计学意义(均P <0. 05)。2组不良反应发生率比较,差异无统计学意义(P=0. 528)。结论 rh BNP联合左西孟旦用于老年ADHF患者的治疗,可有效改善预后,具有较好的治疗效果,同时安全性较高。

Objective To investigate the effect of recombinant human brain natriuretic peptide(rhBNP)combined with levosimendan on cardiac function, serum levels of N-terminal pro-brain natriuretic peptide( NT-proBNP) and copeptin in elderly patients with acute decompensated heart failure( ADHF). Methods From June 2014 to June 2017,120 elderly patients with ADHF who failed with conventional treatment were enrolled at General Hospital of Ningxia Medical University. The patients were randomly divided into observation group and control group,with 60 cases in each group. The control group was treated with levosimendan on the basis of routine treatment. The observation group was treated with rh BNP on the basis of control group. Cardiac function indexes,serum NT-proBNP and copeptin levels,clinical efficacy and adverse reactions were analyzed after 7 days of treatment. Results Total effective rate in observation group was significantly higher than that in control group[86. 7%( 52/60) vs 70. 0%( 42/60) ]( P = 0. 001). After treatment,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in observation group were significantly less than those in control group[( 53 ±9) mm vs( 58 ± 9) mm,( 46 ± 8) mm vs( 53 ± 6) mm];left ventricular ejection fraction,cardiac output and cardiac index in observation group were significantly higher than those in control group [( 45 ± 5) % vs( 43 ± 6) %,( 4. 9 ± 1. 3) L/min vs( 4. 2 ± 1. 0) L/min,( 2. 9 ± 0. 9) L/( min·m^2) vs( 2. 5 ± 0. 8) L/( min·m^2) ]( all P <0. 05). After treatment,levels of NT-proBNP and copeptin significantly decreased in both groups and the levels in observation group were significantly lower than those in control group( all P < 0. 05). There was no significant difference in the incidence of adverse reactions between groups( P = 0. 528). Conclusion Rh BNP combined with levosimendan can safely and effectively improve the prognosis in elderly patients with ADHF.