重组人脑利钠肽联用达格列净对射血分数降低的心力衰竭患者预后的影响

Combined therapy with recombinant human brain natriuretic peptide and dapagliflozin offers benefit on prognosis in patients with heart failure and reduced ejection fraction

目的探讨在射血分数降低的心力衰竭(HFrEF)患者中联合使用重组人脑利钠肽(rhBNP)与达格列净治疗后对该类患者预后的影响。方法纳入HFrEF患者80例,将患者随机分为对照组和观察组,每组40例。患者入院后均予利尿、强心等常规治疗,对照组静脉泵入rhBNP 1 mg·d^(-1)×3 d,观察组静脉泵入rhBNP 1 mg·d^(-1)×3 d+口服达格列净10 mg·d^(-1),持续3个月。比较2组治疗前后的心室重构和心功能指标,记录治疗期间2组主要心血管不良事件发生情况。结果治疗前,2组患者左室收缩末期内径(LVEDS)、左室舒张末期内径(LVEDD)、血清N末端脑钠肽前体(NT-proBNP)水平、左室射血分数(LVEF)、6 min步行试验距离(6MWD)无显著差异(P>0.05)。与治疗前相比,2组治疗后LVEDD、NT-proBNP降低,LVEF、6MWD增加(P<0.05);观察组LVEDS显著降低,各指标改变显著优于对照组(P<0.05)。观察组主要心血管不良事件发生率显著低于对照组(8%vs.35%,P<0.05)。结论rhBNP联用达格列净可显著改善HFrEF患者心功能,逆转心室重构,降低主要心血管不良事件发生率。

AIM To investigate the effects of the combined therapy with recombinant human brain natriuretic peptide(rhBNP)and dapagliflozin on prognosis of patients with heart failure and reduced ejection fraction(HFrEF).METHODS Eighty patients with HFrEF were included and randomly divided into control group and observation group,with 40 patients in each group.After admission,all patients were given conventional treatment such as diuresis and cardiotonic therapy.The patients in the control group were given rhBNP 1 mg·d^(-1)×3 d by intravenous pump,while those in the observation group were given rhBNP 1 mg·d^(-1)×3 d by intravenous pump and dapagliflozin 10 mg·d^(-1) by oral administration for 3 months.The indexes of ventricular remodeling and cardiac function were compared between the two groups before and after treatment,and the incidence of major adverse cardiovascular events was recorded.RESULTS Before treatment,there were no significant differences in left ventricular end-systolic dimension(LVEDS),left ventricular enddiastolic dimension(LVEDD),serum N-terminal pro-B-type natriuretic peptide(NT-proBNP)level,left ventricular ejection fraction(LVEF),and 6-minute walk test distance(6MWD)between the two groups(P>0.05).LVEDD and NTproBNP were decreased,while LVEF and 6MWD were increased in both groups after treatment(P<0.05).The LVEDS of the observation group was significantly lower than that of the control group(P<0.05).After 3-month treatment,the incidence of major adverse cardiovascular events in the observation group was significantly lower than that in the control group(8%vs.35%,P<0.05).CONCLUSION rhBNP combined with dapagliflozin can significantly improve cardiac function,reverse ventricular remodeling and reduce the incidence of major adverse cardiovascular events in patients with HFrEF.