左西孟坦联合重组人脑钠肽对顽固性心力衰竭患者氨基末端脑钠肽前体水平的影响

Effect of levosimendan combined with recombinant human brain natriuretic peptide on the level of NT-proBNP in patients with refractory heart failure

目的探究左西孟坦联合重组人脑钠肽对顽固性心力衰竭患者氨基末端脑钠肽前体(NT-proBNP)、内皮素-1(ET-1)和尿酸(UA)水平的影响。方法选取116例顽固性心力衰竭患者作为研究对象,按照随机数字表法均分为观察组和对照组,各58例。对照组给予左西孟坦治疗,观察组在对照组治疗的基础上联合重组人脑钠肽治疗。治疗1周后,观察2组患者的临床疗效、血清NT-proBNP、ET-1和UA水平、临床症状、心功能及不良反应。结果治疗后,观察组总有效率(89.7%)明显高于对照组(70.7%)(P<0.05),NT-proBNP、ET-1和UA水平均明显低于治疗前(P<0.05);观察组心率、收缩压、肺部湿啰音得分、呼吸困难得分和下肢水肿得分均明显低于治疗前(P<0.05);观察组左室舒张末内径明显低于治疗前,左室射血分数及左室短轴缩短率明显高于对照组(P<0.05);观察组24 h尿量明显高于对照组(P<0.05);观察组不良反应发生率(6.9%)明显低于对照组(29.3%)(P<0.05)。结论左西孟坦联合重组人脑钠肽治疗顽固性心力衰竭疗效显著,可有效降低NT-proBNP、ET-1和UA水平,改善临床症状及心功能,安全可靠。

Objective To investigate the effects of levosimendan combined with recombinant human brain natriuretic peptide(RH-BNP)on N-terminal pro-brain natriuretic peptide in plasma(NT-proBNP),endothelin-1(ET-1)and uric acid(UA)levels in patients with refractory heart failure.Methods A total of 116 patients with refractory heart failure were divided into observation group and control group according to the random number table method,with 58 cases in each group.The control group was treated with levosimendan,and the observation group additionally received RH-BNP.After 1 week of treatment,the clinical efficacy,serum NT-proBNP,ET-1 and UA levels,clinical symptoms,cardiac function and safety were observed.Results After treatment,the total effective rate of the observation group was significantly higher than that of the control group(89.7%vs 70.7%,P<0.05).After treatment,the levels of NT-proBNP,ET-1 and UA in the observation group were significantly lower than those in the control group(P<0.05).The heart rate,systolic blood pressure,lung wet voice score,dyspnea score and lower limb edema scores in the observation group were significantly lower than in the control group(P<0.05).The left ventricular end diastolic diameter in the observation group was significantly lower than that before treatment,while the left ventricular ejection fraction and left ventricular short axis shortening rate were significantly higher than that in the control group(P<0.05).The 24 h urine volume of the observation group was significantly higher than that of the control group(P<0.05);The adverse reaction rate of the observation group was significantly lower than that of the control group(6.9%vs 29.3%,P<0.05).Conclusion Levosimendan combined with RH-BNP is effective in the treatment of refractory heart failure,which can effectively reduce the levels of NT-proBNP,ET-1 and UA,improve clinical symptoms and cardiac function,and is safe and reliable.