冻干重组人脑钠肽联合复方α酮酸片对慢性心力衰竭合并肾衰竭患者心肾功能、血清炎症因子的影响

Effect of lyophilized recombinant human brain natriuretic peptide combined with compoundα-ketoacid tablets on heart and kidney function and serum inflammatory factors in patients with chronic heart fail⁃ure and renal failure

目的探讨冻干重组人脑钠肽(lyophilized recombinant human brain natriuretic peptide,lrhBNP;新活素)联合复方α酮酸片对慢性心力衰竭(chronic heart failure,CHF)合并肾衰竭患者的疗效及心肾功能、血清炎症因子的影响。方法选择北京联科中医肾病医院2018年12月至2019年12月期间收治的CHF合并肾衰竭患者116例为研究对象。采用随机数字法将患者分为对照组和观察组,各58例。所有患者均给予CHF及肾衰竭常规治疗,对照组患者给予lrhBNP治疗,观察组在对照组治疗的基础上给予复方α酮酸片治疗。比较两组患者治疗前后心功能[左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、心脏指数(cardiac index,CI)及心输出量(cardiac output,CO)],肾功能[血清肌酐(serum creatinine,SCr)、尿素氮(blood urea nitrogen,BUN)、内生肌酐清除率(creatinine clearance rate,Ccr)],炎症因子[基末端脑钠尿肽前体(NT pro brain natriuretic peptide,NT-proBNP)、细胞白介素-6(interleukin-6,IL-6)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]等变化及临床疗效。结果治疗前,两组患者的LVEF、LVEDD、CI、CO、SCr、BUN、Ccr、NT-proBNP、IL-6、hs-CRP、TNF-α比较,差异无统计学意义(P>0.05)。与治疗前比较,治疗后两组患者的LVEF、CI、CO、Ccr均显著升高,LVEDD、SCr、BUN、NT-proBNP、IL-6、hs-CRP、TNF-α均显著下降,差异有统计学意义(P<0.001)。观察组患者治疗后LVEF、CI、CO、Ccr均显著高于对照组,差异有统计学意义[(55.58±4.57)%vs.(48.45±4.78)%、(3.88±0.54)L/m^(2) vs.(3.42±0.60)L/m^(2)、(2.79±0.46)L/min vs.(2.41±0.45)L/min、(59.73±4.36)mL/min vs.(51.58±4.17)mL/min,P<0.05];LVEDD、SCr、BUN、NT-proBNP、IL-6、hs-CRP、TNF-α均显著低于对照组,差异有统计学意义[(45.46±4.16)L/m^(2) vs.(49.72±4.25)L/m^(2)、(106.47±31.36)μmol/L vs.(143.76±33.54)μmol/L、(13.25±3.04)mmol/L vs.(16.37±3.38)mmol/L、(1.05±0.56)μg/L vs.(1.58±0.59)μg/L、(45.76±8.89)ng/L vs.(56.78±10.64)ng/L、(1.45±0.62)mg/L vs.(3.23±1.31)mg/L、(2.65±1.04)ng/L vs.(4.23±1.35)ng/L,P<0.001]。两组患者治疗期间均无明显不良反应,观察组总有效率明显高于对照组,差异有统计学意义(93.10%vs.79.31%,P<0.05)。结论LrhBNP联合复方α酮酸片可有效提高CHF合并肾衰竭患者心肾功能,抑制炎症反应程度,临床疗效确切,用药安全,值得临床推广和应用。

Objectives To explore the effect of lyophilized recombinant human brain natriuretic peptide(lrhBNP)combined with compoundα-ketoacid tablets on the function of heart and kidney and the influence of serum inflammatory factors in patients with chronic heart failure(CHF)and renal failure.Methods Totally 116 cases of CHF with renal failure admitted in Beijing Lianke Hospital of Traditional Chinese Medicine and Nephrology from December 2018 to December 2019 were selected.They were randomly divided into control group and observation group,58 cases each.All the patients were treated with traditional treatment for CHF and renal failure.Control group was treated with lrhBNP,and observation group was treated with compoundα-ketoacid tablets on the basis of control group.The changes of cardiac function[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),cardiac index(CI)and cardiac output(CO)],renal function[serum creatinine(SCr),blood urea nitrogen(BUN),creatinine clearance rate(Ccr)],inflammatory factors[NT pro brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),high sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)]and clinical effect were compared before and after treatment between the two groups.Results Before treatment,there were no significant differences in LVEF,LVEDD,CI,CO,SCr,BUN,Ccr,NT-proBNP,IL-6,hs-CRP,TNF-αbetween the two groups(P>0.05).Compared with those of before treatment,LVEF,CI,CO,SCr significantly increased,LVEDD,SCr,BUN,NT-proBNP,IL-6,hs-CRP,TNF-αsignificantly decreased in both group after treatment(P<0.001).After treatment,LVEF,CI,CO,Ccr in observation group were significantly higher than those in control group[(55.58±4.57)%vs.(48.45±4.78)%,(3.88±0.54)L/m^(2) vs.(3.42±0.60)L/m^(2),(2.79±0.46)L/min vs.(2.41±0.45)L/min,(59.73±4.36)mL/min vs.(51.58±4.17)mL/min,P<0.05];LVEDD,SCr,BUN,NT-proBNP,IL-6,hs-CRP,TNF-αwere significantly lower than those of control group[(45.46±4.16)L/m^(2) vs.(49.72±4.25)L/m^(2),(106.47±31.36)μmol/L vs.(143.76±33.54)μmol/L,(13.25±3.04)mmol/L vs.(16.37±3.38)mmol/L,(1.05±0.56)μg/L vs.(1.58±0.59)μg/L,(45.76±8.89)ng/L vs.(56.78±10.64)ng/L,(1.45±0.62)mg/L vs.(3.23±1.31)mg/L,(2.65±1.04)ng/L vs.(4.23±1.35)ng/L,P<0.001].There were no significant adverse reactions in the two groups during the treatment period,and the total effective rate in observation group was significantly higher than that in control group(93.10%vs.79.31%,P<0.05).Conclusions LrhBNP combined with compoundα-ketoacid tablets can effectively improve the heart and kidney function of CHF patients with renal failure,inhibit the degree of inflammatory reaction,have a definite clinical effect and safe drug use,which is worth clinical promotion and application.