重组人脑利钠肽联合米力农对急诊充血性心力衰竭患者左心功能及炎症因子的影响

Effects of rhBNP combined with Milrinone on left heart function and inflammatory factors in emergency patients with congestive heart failure

目的探讨重组人脑利钠肽(rhBNP)联合米力农对急诊充血性心力衰竭(CHF)左心功能及炎症因子的影响。方法前瞻性选取2020年6月至2022年6月芜湖市第一人民医院收治的急诊CHF患者106例作为研究对象,按照随机数字表法将其分为对照组及观察组,各53例。对照组予以米力农治疗,观察组在对照组基础上予以rhBNP治疗。比较两组治疗前后的左心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左心室收缩末期内径(LVESD)]、心力衰竭程度[N末端脑钠肽前体(NT-pro BNP)、胰岛素样生长因子-1(IGF-1)]、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超敏C反应蛋白(hs-CRP)]水平、肾素-血管紧张素-醛固酮(RAAS)系统参数[血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)及醛固酮]及安全性。结果治疗后,两组LVEF、IGF-1水平均较治疗前升高,LVEDD、LVESD、NT-pro BNP水平均较治疗前降低,且观察组LVEF、IGF-1水平分别为(47.36±2.92)%、(141.32±32.67)ng/mL,均高于对照组[(43.22±3.85)%、(125.66±28.34)ng/mL],LVEDD、LVESD、NT-pro BNP水平分别为(51.37±4.58)mm、(45.67±4.15)mm、(421.59±51.84)pg/mL,均低于对照组[(55.99±4.27)mm、(50.46±4.27)mm、(566.32±74.38)pg/mL],差异均有统计学意义(P<0.05)。治疗后,两组TNF-α、IL-6、hs-CRP、PRA、AngⅡ及醛固酮水平均较治疗前降低,且观察组TNF-α、IL-6、hs-CRP、PRA、AngⅡ及醛固酮水平分别为(5.09±1.83)ng/L、(8.41±2.04)ng/L、(4.25±1.04)mg/L、(1.42±0.18)ng/mL、(109.08±12.72)pg/mL、(94.53±17.64)pg/mL,均低于对照组[(11.56±2.89)ng/L、(12.36±3.53)ng/L、(6.78±1.21)mg/L、(50.46±4.27)ng/mL、(147.36±15.48)pg/mL、(149.34±22.67)pg/mL],差异均有统计学意义(P<0.05)。两组不良反应及不良事件发生率比较,差异均无统计学意义(P>0.05)。结论急诊CHF患者经rhBNP联合米力农治疗可增强左心功能,减轻心力衰竭程度,抑制炎症反应水平,改善RAAS系统因子,且具有较高安全性。

Objective To investigate the effects of recombinant human brain natriuretic peptide(rhBNP)combined with Milrinone on left heart function and inflammatory factors in emergency congestive heart failure(CHF).Methods A total of 106 cases of emergency CHF patients admitted to Wuhu First People's Hospital from June 2020 to June 2022 were studied and divided into the control group and the observation group,according to the random number table with 53 cases in each group.The control group was treated with milrinone,while the observation group was treated with rhBNP on the basis of the control group.Left heart function[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)],severity of heart failure[N-terminal brain natriuretic peptide precursor(NT-pro BNP),insulin like growth factor-1(IGF-1)],levels of inflammatory factors[tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)],parameters of renin-angiotensin-aldosterone(RAAS)system[plasma renin activity(PRA),angiotensinⅡ(AngⅡ)and aldosterone]and safety were compared between the two groups.Results After treatment,the levels of LVEF and IGF-1 in both groups increased compared to those before treatment,while the levels of LVEDD,LVESD,and NT pro-BNP decreased compared to those before treatment,the levels of LVEF and IGF-1 in the observation group were(47.36±2.92)%and(141.32±32.67)ng/mL,respectively,which were higher than those in the control group[43.22±3.85)%and(125.66±28.34)ng/mL],the levels of LVEDD,LVESD,and NT pro-BNP were(51.37±4.58)mm,(45.67±4.15)mm,and(421.59±51.84)pg/mL,respectively,which were lower than those in the control group[(55.99±4.27)mm,(50.46±4.27)mm,(566.32±74.38)pg/mL],and the differences were statistically significant(P<0.05).After treatment,the levels of IL-6,hs CRP,TNF-α,PRA,Ang II,and aldosterone of both groups were lower than those before treatment,and the levels of TNF-α,IL-6,hs-CRP,PRA,Ang II,and aldosterone in the observation group were(5.09±1.83)ng/L,(8.41±2.04)ng/L,(4.25±1.04)mg/L,(1.42±0.18)ng/mL,(109.08±12.72)pg/mL,and(94.53±17.64)pg/mL,respectively,which were lower than those in the control group[(11.56±2.89)ng/L,(12.36±3.53)ng/L,(6.78±1.21)mg/L,(50.46±4.27)ng/mL,(147.36±15.48)pg/mL,(149.34±22.67)pg/mL],and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions and events between the two groups(P>0.05).Conclusion rhBNP combined with Milrinone can enhance the left heart function,reduce the degree of psychological failure,reduce inflammation and improve RAAS system factors in patients with emergency CHF,and with high safety.