冻干重组人脑利钠肽治疗年龄大于60岁HFrEF患者的临床研究

Clinical exploration of lyophilized recombinant human brain natriuretic peptide in treatment of patients aged over 60 with HFrEF

目的:探究冻干重组人脑利钠肽(rhBNP)对年龄大于60岁、左室射血分数降低型心衰(HFrEF)患者心功能及血清N端前体脑钠肽(NT-proBNP)水平的影响。方法:选取某院114例年龄大于60岁HFrEF患者为研究对象,根据患者就诊序号采用随机数字表法分成对照组和研究组,每组57例。对照组接受琥珀酸美托洛尔缓释片(MSSRT)治疗,研究组接受rhBNP联合MSSRT治疗。比较2组患者总有效率、治疗前、治疗7 d后左室收缩期最大心肌弹性劲度(max EAV)、左室射血分数(LVEF)、血清NT-proBNP、心肌肌钙蛋白I2(cTnI I2)水平、心型脂肪酸结合蛋白(H-FABP)、肾素-血管紧张素-醛固酮(RAAS)系统指标[醛固酮(ALD)、血管紧张素Ⅱ(AngⅡ)、肾素(PRA)]及不良反应发生率。结果:研究组总有效率(94.74%)高于对照组(77.19%),差异有统计学意义(P<0.05);治疗7 d后,研究组LVEF、max EAV分别为(54.49±5.37)%、(9.54±1.69)N/cm2,均高于对照组的(47.51±4.72)%、(8.01±1.41)N/cm2,血清NT-proBNP、CTnII2、H-FABP、AngⅡ、ALD、PRA水平分别为(552.38±38.84)pmol/L、(0.13±0.03)ng/mL、(22.08±9.74)ng/mL、(98.75±7.48)pg/mL、(227.76±16.26)pg/mL、(1.25±0.13)ng/mL,均低于对照组的(612.39±43.57)pmol/L、(0.20±0.05)ng/mL、(37.59±11.64)ng/mL、(113.18±7.52)pg/mL、(253.46±18.41)pg/mL、(1.59±0.26)ng/mL(P<0.05);研究组治疗期间不良反应发生率(10.53%)与对照组(5.26%)比较,差异无统计学意义(P>0.05)。结论:在MSSRT治疗HFrEF患者基础上,加用rhBNP可进一步提高疗效,改善心功能,调节患者血清NT-proBNP、cTnI I2水平,抑制RAAS系统活性,且无明显其他不良反应,值得临床推广应用。

Objective:To explore the effect of lyophilized recombinant human brain natriuretic peptide(rhBNP)on heart function and serum NT-proBNP level in treatment of patients aged over 60 with heart failure with reduced left ventricular ejection fraction(HFrEF).Methods:114 patients aged over 60 with HFrEF were selected as objects and were randomly divided into an observation group and a control group,57 cases in each.The control group was treated with metoprolol succinate sustained-release tablets(MSSRT),while the observation group received the treatment of rhBNP combined with MSSRT.The two groups were compared in terms of the total effective rate,max EAV,LVEF,serum NT-proBNP,cTnI I2,H-FABP,RAAS indexes before and 7 days after the treatment and incidence of adverse reactions.Results:The total effective rate of the observation group(94.74%)was higher than that of the control group(77.19%)(P<0.05).7 days after the treatment,LVEF and max EAV of the observation group were respectively(54.49±5.37)%and(9.54±1.69)N/cm2,higher than the control group's(47.51±4.72)%and(8.01±1.41)N/cm2;levels of serum NT-proBNP,CTnII2,H-FABP,AngⅡ,ALD,and PRA were respectively(552.38±38.84)pmol/L,(0.13±0.03)ng/mL,(22.08±9.74)ng/mL,(98.75±7.48)pg/mL,(227.76±16.26)pg/mL and(1.25±0.13)ng/mL,lower than the control group's(612.39±43.57)pmol/L,(0.20±0.05)ng/mL,(37.59±11.64)ng/mL,(113.18±7.52)pg/mL,(253.46±18.41)pg/mL and(1.59±0.26)ng/mL(P<0.05).There was no significant difference in incidence of adverse reactions between the observation group(10.53%)and the control group(5.26%)(P>0.05).Conclusion:RhBNP combined with MSSRT in treatment of HFrEF can further enhance the therapeutic effect,improve the heart function,regulate levels of serum NT-proBNP and cTnI I2,and inhibit the activity of RAAS without other adverse reactions.It is worth to be clinically promoted.