rhBNP联合米力农治疗慢性肺心病心力衰竭的疗效及对心肺功能和甲状腺激素水平的影响

Effect of rhBNP combined with milrinone in the treatment of chronic cardiopulmonary disease with heart failure and its influence on cardiopulmonary function and thyroid hormone level

目的探究重组人脑利钠肽(rhBNP)联合米力农治疗慢性肺心病心力衰竭的疗效及对患者心肺功能和甲状腺激素水平的影响。方法选取深圳市龙岗区中心医院2018年3月至2020年12月收治的60例慢性肺心病心力衰竭患者作为研究对象,采用随机数表法分为对照组与研究组各30例。对照组患者给予米力农治疗,研究组患者给予rhBNP联合米力农治疗,两组患者连续治疗7 d。比较两组患者的临床疗效、心肺功能[心功能:治疗前及治疗7 d后患者的左心室射血分数(LVEF)、耗氧量(VO_(2))及心排血量(CO);肺功能:患者1 s呼气容积占预计值百分比(FEV_(1)%)、肺活量占预计值百分比(FVC%)及FEV_(1)/FVC]和甲状腺激素水平[(总三碘甲腺原氨酸(T3)、总甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)]。结果研究组患者的治疗总有效率为93.33%,明显高于对照组的70.00%,差异有统计学意义(P<0.05);治疗前,两组患者的心肺功能和甲状腺激素水平比较差异均无统计学意义(P>0.05);治疗后,治疗后,两组患者的LVEF、CO、FEV_(1)%、FVC%及FEV_(1)/FVC水平均明显升高,且治疗后研究组患者的LVEF、CO、FEV_(1)%、FVC%及FEV_(1)/FVC水平分别为(50.16±5.98)%、(5.96±1.33)mL/min、(50.09±8.25)%、(69.51±9.07)%、68.35±8.13,明显高于对照组的(44.15±4.65)%、(4.92±0.92)mL/min、(43.15±7.39)%、(63.96±8.31)%、59.24±6.99,VO_(2)水平为(108.65±10.12)L/min,明显低于对照组的(125.33±12.38)L/min,差异均有统计学意义(P<0.05);治疗后,两组患者的T3、T4、FT3、FT4水平明显高于治疗前,且治疗后研究组患者的T3、T4、FT3、FT4水平分别为(1.85±0.69)nmol/L、(182.42±72.58)nmol/L、(4.18±1.39)pmol/L、(19.14±3.83)pmol/L,明显高于对照组的(1.46±0.52)nmol/L、(159.76±50.12)nmol/L、(3.25±1.36)pmol/L、(17.31±2.63)pmol/L,差异均具有统计学意义(P<0.05),但两组患者治疗后的TSH、TGAb、TPOAb水平无明显变化,差异均无统计学意义(P>0.05)。结论rhBNP联合米力农治疗慢性肺心病心力衰竭疗效显著,能有效改善患者的心肺功能和甲状腺激素水平,值得临床推广应用。

Objective To study the effect of recombinant human brain natriuretic peptide(rhBNP)combined with milrinone in the treatment of chronic cardiopulmonary disease with heart failure and its effect on cardiopulmonary function and thyroid hormone levels.Methods Sixty patients of chronic cardiopulmonary disease with heart failure admitted in Shenzhen Longgang District Central Hospital from March 2018 to December 2020 were selected as the research objects.According to random number table method,the patients were divided into a control group and a study group,with 30 patients in each group.Patients in the control group were treated with milrinone,and those in the study group were treated with rhBNP combined with milrinone.The two groups of patients were continuously treated for 7 days.The clinical effects,cardiopulmonary function[cardiac function:left ventricular ejection fraction(LVEF),oxygen consumption(VO_(2)),and cardiac output(CO)of patients before and 7 days after treatment;pulmonary function:percentage of expiratory volume in predicted value(FEV_(1)%),percentage of vital capacity in predicted value(FVC%),and FEV_(1)/FVC],and thyroid hormone level[total triiodothyronine(T3),total thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb)]of the two groups were compared.Results The total effective rate of the study group was 93.33%,which was significantly higher than 70.00%of the control group(P<0.05).Before treatment,there was no significant difference in cardiopulmonary function and thyroid hormone level between the two groups(P>0.05);after treatment,the levels of LVEF,CO,FEV_(1)%,FVC%,and FEV_(1)/FVC in the two groups increased significantly after treatment,and the levels of LVEF,CO,FEV_(1)%,FVC%,and FEV_(1)/FVC in the study group were(50.16±5.98)%,(5.96±1.33)mL/min,(50.09±8.25)%,(69.51±9.07)%,68.35±8.13,which were significantly higher than(44.15±4.65)%,(4.92±0.92)mL/min,(43.15±7.39)%,(63.96±8.31)%,59.24±6.99 in the control group.After treatment,the level of VO_(2) was(108.65±10.12)L/min in the study group,which was significantly lower than(125.33±12.38)L/min in the control group(P<0.05).After treatment,the levels of T3,T4,FT3,and FT4 in the two groups were significantly higher than those before treatment,and after treatment,the levels of T3,T4,FT3,and FT4 in the study group were(1.85±0.69)nmol/L,(182.42±72.58)nmol/L,(4.18±1.39)pmol/L,(19.14±3.83)pmol/L,which were significantly higher than(1.46±0.52)nmol/L,(159.76±50.12)nmol/L,(3.25±1.36)pmol/L,(17.31±2.63)pmol/L in the control group(P<0.05).There was no significant difference in the levels of TSH,TGAb,and TPOAb between the two groups after treatment(P>0.05).Conclusion rhBNP combined with milrinone is effective in the treatment of chronic cardiopulmonary disease with heart failure,which can effectively improve the cardiopulmonary function and thyroid hormone level of patients,and thus is worthy of clinical application.