重组人B型钠尿肽联合尼可地尔与尼可地尔单用治疗急性心力衰竭的效果及安全性比较

Comparing effectiveness and safety of combined recombinant human BNP and nicorandil with those of nicorandil alone in treatment of AHF

目的 观察重组人B型钠尿肽联合尼可地尔与尼可地尔单用治疗急性心力衰竭(acute heart failure, AHF)的效果及安全性。方法 选取2017年5月~2020年6月首都医科大学附属北京安贞医院心内科AHF患者212例,根据治疗方案不同分为研究组106例,对照组106例。在常规治疗的基础上,对照组给予尼可地尔,研究组给予重组人B型钠尿肽联合尼可地尔。对比2组患者疗效、不良反应、治疗前后LVEF、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、血清NO、内皮素1、瞬时受体电位通道1(transient receptor potential channel 1,TRPC1)以及miR-181b水平。结果 治疗后,研究组患者总有效率显著高于对照组(93.4%vs 81.1%,P=0.007);研究组治疗后LVESV、LVEDV水平显著低于对照组[(52.8±7.2)ml vs(61.5±9.0)ml、(103.7±7.2)ml vs(112.4±8.4)ml,P<0.05],LVEF显著高于对照组[(49.8±5.1)%vs(45.7±4.9)%,P<0.05];研究组治疗后血清NO、miR-181b水平显著高于对照组[(79.3±9.1)μmol/L vs(66.0±8.5)μmol/L、25.6±2.5 vs 22.4±2.8,P<0.05],内皮素1、TRPC1水平显著低于对照组[(38.4±6.8)ng/L vs(47.2±7.3)ng/L、(27.2±1.9)%vs(32.3±2.3)%,P<0.05];治疗期间研究组与对照组不良反应发生率比较差异无统计学意义(11.32%vs 6.60%,P=0.229)。结论 尼可地尔联合重组人B型钠尿肽治疗AHF可提升疗效,改善心功能、血管内皮功能、TRPC1及miR-181b水平,且安全性良好。

Objective To compare the effectiveness and safety of combined recombinant human B-type natriuretic peptide(BNP) and nicorandil with those of nicorandil alone in treatment of acute heart failure(AHF).Methods Two hundred and twelve AHF patients admitted to our hospital from May 2017 to June 2020 were divided into study group(n=106) and control group(n=106) according to their treatment plan.The patients in control group received conventional treatment plus nicorandil and those in study group were treated with combined recombinant human BNP and nicorandil.The therapeutic effectiveness, adverse reactions, LVESV,LVEDV,LVEF,serum levels of NO,endothelin 1(ET-1),transient receptor potential channel 1(TRPC1) and miR-181 b were compared brtween the two groups before and after treatment.Results The total effective rate was significantly higher while the LVESV and LVEDV were significantly lower, the LVEF and serum levels of NO and miR-181 b were significantly higher while the serum levels of ET-1 and TRPC1 were significantly lower in study group than in control group after treatment(93.4% vs 81.1%,P=0.007;52.8±7.2 ml vs 61.5±9.0 ml, 103.7±7.2 ml vs 112.4±8.4 ml, P<0.05;49.8%±5.1% vs 45.7%±4.9%,P<0.05;79.3±9.1 μmol/L vs 66.0±8.5 μmol/L,25.6±2.5 vs 22.4±2.8,P<0.05;38.4±6.8 ng/L vs 47.2±7.3 ng/L,27.2%±1.9% vs 32.3%±2.3%,P<0.05).No significant difference was detected in incidence of adverse reactions between the two groups during the treatment(11.32% vs 6.60%,P=0.229).Conclusion Nicorandil combined with recombinant human BNP can improve the therapeutic effectiveness, heart function, vascular endothelial function, serum TRPC1 and miR-181 b levels in treatment of AHF with a good safety.