不同剂量重组人脑利钠肽联合比索洛尔在老年急性心肌梗死患者PCI后的应用对比

Comparison of Different Doses of Recombinant Human Brain Natriuretic Peptide Combined with Bisoprolol in Elderly Patients with Acute Myocardial Infarction after PCI

目的 比较不同剂量的重组人脑利钠肽(rhBNP)联合比索洛尔在老年急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后的应用价值。方法 选取2020年1月—2022年10月秦皇岛市第一医院收治的138例老年AMI患者进行前瞻性研究,按照随机数字表法分为三组,各46例。各组均行PCI和比索洛尔治疗,术前2 h,小剂量组给予1.5μg/(kg·min)的rhBNP,中剂量组给予2.0μg/(kg·min)的rhBNP,大剂量组给予3.0μg/(kg·min)的rhBNP。比较各组治疗前后心功能[左室射血分数(LVEF)、心脏指数(CI)、每分钟搏出量(SV)、血浆脑钠肽(BNP)]、心电生理指标[窦性心搏RR间期标准差(SDNN)、相邻RR间期差值均方根(RMSSD)、低频段/高频段(LF/HF)]、肾功能[血肌酐(Scr)、β2-微球蛋白(β2-MG)、血尿素氮(BUN)]、核因子E2相关因子2/血红素加氧酶-1(Nrf2/HO-1)通路及治疗后不良反应、心血管不良事件的发生情况。结果 治疗72 h后,大剂量组LVEF、CI、SV、SDNN、RMSSD及Nrf2、HO-1蛋白水平均高于中剂量组和小剂量组(P<0.05),大剂量组的血浆BNP水平、LF/HF低于中剂量组和小剂量组(P<0.05);治疗72 h后,中剂量组和小剂量组的心功能、心电生理指标、Nrf2/HO-1信号通路的蛋白比较差异均无统计学意义(P>0.05)。治疗前、治疗72 h后,各组血清Scr、β2-MG、BUN水平比较差异均无统计学意义(P>0.05),各组不良反应总发生率、心血管不良事件的总发生率比较差异均无统计学意义(P>0.05)。结论 rhBNP联合比索洛尔应用于老年AMI患者PCI后疗效确切,大剂量rhBNP可显著改善心功能、心率变异性,可能与激活Nrf2/HO-1通路有关,且对肾功能损害、不良反应及心血管不良事件无明显影响。

Objective To compare the value of different doses of recombinant human brain natriuretic peptide(rhBNP)combined with bisoprolol after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 138 elderly patients with AMI in First Hospital of Qinhuangdao from January 2020 to October 2022 were prospectively selected,they were divided into 3 groups with 46 cases in each group by random number table.All groups were treated with PCI and bisoprolol,2 hours before surgery,the low-dose group received 1.5μg/(kg·min)rhBNP,the medium-dose group received 2.0μg/(kg·min)rhBNP,and the high-dose group received 3.0μg/(kg·min)rhBNP.Cardiac function[left ventricular ejection fraction(LVEF),cardiac index(CI),stroke volume per minute(SV),plasma brain natriuretic peptide(BNP)],electrocardiographic parameters[standard diviation of NN intervals(SDNN),root mean square of successive RR interval differences(RMSSD),low frequency band/high frequency band(LF/HF)],renal function[serum creatinine(Scr),β2-microglobulin(β2-MG),blood urea nitrogen(BUN)],nuclear factor E2-related factor 2/heme oxygenase-1(Nrf2/HO-1)pathway were compared between the groups before and after treatment.The occurrence of adverse reactions and adverse cardiovascular events after treatment were compared between the groups.Results After 72 h of treatment,LVEF,CI,SV,SDNN,RMSSD,Nrf2 and HO-1 protein levels in the high-dose group were higher than those in the medium-dose and low-dose groups(P<0.05),and plasma BNP levels and LF/HF in the high-dose group were lower than those in the medium-dose and low-dose groups(P<0.05);after 72 h of treatment,there were no significant differences in cardiac function,electrophysiological parameters,and proteins of the Nrf2/HO-1 signaling pathway between the medium-dose and low-dose groups(P>0.05).Before treatment and 72 h after treatment,there was no significant difference in serum Scr,β2-MG and BUN levels between the groups(P>0.05).There was no significant difference in the total incidence of adverse reactions and the total incidence of adverse cardiovascular events between the groups(P>0.05).Conclusion The treatment of rhBNP combined with bisoprolol is effective in elderly AMI patients after PCI.Large doses of rhBNP can significantly improve cardiac function and heart rate variability,which may be related to the activation of the Nrf2/HO-1 signaling pathway,and has no significant effect on renal function damage,adverse reactions and adverse cardiovascular events.