重组人脑利钠肽治疗急性心力衰竭的效果及影响因素分析

Effect of recombinant human brain natriuretic peptide in the treatment of acute heart failure and its influence factors

目的探讨重组人脑利钠肽(rhBNP)治疗急性心力衰竭(AHF)的效果及影响其疗效的因素。方法回顾性分析2017年1月至2020年6月空军军医大学第一附属医院收治的240例AHF患者的临床资料,根据治疗方法的不同分为rhBNP组180例和硝普钠组60例。比较两组患者的治疗效果、用药1 h后的呼吸困难好转率和治疗后不同时间的临床指标变化。将rhBNP组中治疗显效和有效的患者纳入有效组,治疗无效的患者纳入无效组,比较两组患者的临床特征。使用受试者工作曲线(ROC)分析脑利钠肽(BNP)在rhBNP治疗AHF疗效中的预测价值,使用二元Logistic回归分析法分析rhBNP治疗AHF疗效的危险因素。结果rhBNP组患者的治疗总有效率为80.56%,明显高于硝普钠组的66.67%,差异有统计学意义(P<0.05);rhBNP组患者用药1 h后的呼吸困难好转率为93.89%,明显高于硝普钠组的85.00%,差异有统计学意义(P<0.05);rhBNP组患者治疗后3 d、7 d和1个月的左心室射血分数(LVEF)明显高于硝普钠组,左室舒张末期前后径(LVEDd)明显低于硝普钠组,差异均有统计学意义(P<0.05);rhBNP组患者治疗后3 d、7 d和1个月的心率(HR)明显低于硝普钠组,24 h尿量明显高于硝普钠组,差异均有统计学意义(P<0.05);rhBNP组患者治疗后3 d、7 d和1个月的BNP明显低于硝普钠组,C反应蛋白(CRP)明显低于硝普钠组,差异均有统计学意义(P<0.05);有效组患者的BNP水平为(1039.01±329.60)ng/L,明显低于无效组的(1712.78±604.97)ng/L,差异有统计学意义(P<0.05);有效组患者的rhBNP早期应用率为79.31%,明显高于无效组的45.71%,差异有统计学意义(P<0.05);ROC曲线分析结果显示,BNP在rhBNP治疗AHF效果的预测价值中,AUC为0.887,截断值为1514.395 ng/L,灵敏度为71.40%,特异度为92.41%;二元Logistic回归分析发现,BNP≥1514.395 ng/L和rhBNP晚期应用均为影响rhBNP治疗AHF疗效的独立危险因素(P<0.05)。结论rhBNP治疗AHF能够有效改善患者的心功能、血流动力学等临床指标,疗效确切;rhBNP应用时机和患者治疗前BNP水平均对rhBNP治疗AHF的疗效具有明显影响。

Objective To study the effect of recombinant human brain natriuretic peptide(rhBNP)in the treatment of acute heart failure(AHF)and its influence factors.Methods The clinical data of 240 AHF patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2017 to June 2020 were retrospectively analyzed.According to the different treatment methods,they were divided into rhBNP group(180 cases)and sodium nitroprussidegroup(60 cases).The treatment effect,improvement rate of dyspnea after 1 hour of medication,and clinical indicators at different times after treatment were compared between the two groups.Patients with significant and effective treatment effect in the rhBNP group were included in the effective group,and patients with ineffective treatment effect were included in the ineffective group.The clinical characteristics of the two groups were compared.The ROC curve was used to analyze the predictive value of BNP in the treatment effect of rhBNP on AHF,and the risk factors those affected the treatment effect of rhBNP on AHF were analyzed by binary logistic regression.Results The therapeutic effect for AHF in rhBNP group(80.56%)was significantly better than that in sodium nitroprusside group(66.67%),and the difference was statistically significant(P<0.05).The improvement rate of dyspnea in rhBNP group(93.89%)after 1 hour of treatment was significantly better than that of sodium nitroprusside group(85.00%),and the difference was statistically significant(P<0.05).At 3 d,7 d and 1 month after treatment,the left ventricular ejection fraction(LVEF)in rhBNP group was significantly higher than that in sodium nitroprusside group,and the left ventricular end diastolic diameter(LVEDd)in rhBNP group was significantly lower than that in sodium nitroprusside group,with statistically significant differences(P<0.05).At 3 d,7 d and 1 month after treatment,the heart rate(HR)in rhBNP group was significantly lower than that in sodium nitroprusside group,and the 24 h urine volume in rhBNP group was significantly higher than that in sodium nitroprusside group,with statistically significant differences(P<0.05).At 3 d,7 d and 1 month after treatment,the BNP in rhBNP group was significantly lower than that in sodium nitroprusside group,and the C-reactive protein(CRP)in rhBNP group was significantly lower than that in sodium nitroprusside group,with statistically significant differences(P<0.05).The BNP level of the effective group was(1039.01±329.60)ng/L,which was significantly lower than(1712.78±604.97)ng/L in the ineffective group(P<0.05).The early application rate of rhBNP in the effective group was 79.31%,which were significantly higher than 45.71%in the ineffective group(P<0.05).ROC curve analysis showed that in the predictive value of BNP for the effect of rhBNP in the treatment of AHF,the AUC was 0.887,the cut-off value was 1514.395 ng/L,the sensitivity was 71.40%,and the specificity was 92.41%.Binary logistic regression analysis found that BNP≥1514.395 ng/L and late application of rhBNP were independent risk factors which affect the therapeutic effect of rhBNP on AHF patients.Conclusion rhBNP can effectively improve the patients’cardiac function,hemodynamics,and the curative effect is definite.The timing of rhBNP application and the patient’s BNP level before treatment have a significant impact on the effect of rhBNP in the treatment of AHF.