重组人脑利钠肽联合托伐普坦对急性左心衰竭患者心力衰竭标志物、心室重构及临床疗效的影响

Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with Tolvaptan in the Treatment of Acute Left Heart Failure and its Effects on Heart Failure Markers and Ventricular Remodeling

目的:研究重组人脑利钠肽(rhBNP)联合托伐普坦治疗急性左心衰竭(ALHF)的临床疗效及对心力衰竭标志物、心室重构的影响。方法:选择2022年1月~2023年2月于某院治疗的ALHF患者102例,采用随机数字表法分为对照组与观察组,每组51例。对照组在常规治疗基础上给予rhBNP治疗,观察组在对照组基础上加用托伐普坦治疗,两组均治疗3天。比较两组患者治疗前及治疗后7天的血气分析指标[动脉血氧分压(PaO2)、血氧饱和度(SaO2)及pH]、心力衰竭标志物[血清乏氧诱导因子-1ɑ(HIF-1ɑ)、葡萄糖调节蛋白78(GRP78)、微小核糖核酸-499(miR-499)]以及左室重构指标[左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)]等指标水平的变化,并比较两组临床疗效及不良反应发生情况。结果:治疗后7天,观察组PaO2、SaO2及pH均高于对照组(P<0.05);血清HIF-1ɑ、GRP78、miR-499水平均低于对照组(P<0.05);LVEDD、LVESD均低于对照组,LVEF高于对照组(P<0.05)。观察组治疗总有效率(94.12%)高于对照组(78.43%,P<0.05)。两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:rhBNP联合托伐普坦可有效改善ALHF患者血气分析指标水平,降低血清HIF-1ɑ、GRP78、miR-499等心力衰竭标志物水平,抑制心室重构,且未增加不良反应发生风险。

Objective:To investigate the clinical efficacy of recombinant human brain natriuretic peptide(rhBNP)combined with tolvaptan in the treatment of acute left heart failure(ALHF)and its effects on heart failure markers and ventricular remodeling.Methods:A total of 102 patients with ALHF from January 2022 to February 2023 were selected and divided into the control group and the observation group by random number table method,with 51 patients in each group.The control group was treated with rhBNP in addition to the conventional treatment,whereas the observation group was treated with tolvaptan in addition to the treatment given in the control group,and both groups were treated for 3 days.The changes in blood gas analysis results[arterial partial arterial pressure of oxygen(PaO2),oxygen saturation(SaO2)and pH],heart failure markers[serum hypoxia-inducible factor-1ɑ(HIF-1ɑ),glucose regulatory protein 78(GRP78),microRNA-499(miR-499)],and left ventricular remodeling-related parameters[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)]before and after 7 days of treatment as well as clinical effect and adverse reactions were observed and compared between the two groups.Results:After 7 days of treatment,PaO2,SaO2 and pH in the observation group were higher than those in the control group(P<0.05),and the levels of serum HIF-1ɑ,GRP78 and miR-499 in the observation group were lower than those in the control group(P<0.05).LVEDD and LVESD in the observation group were both lower than those in the control group,with LVEF higher than that in the control group(P<0.05).The total response rate in the observation group(94.12%)was higher than that in the control group(78.43%,P<0.05).No statistically significant difference was observed in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The combined rhBNP and tolvaptan is effective in improving the blood gases in patients with ALHF,reducing such heart failure markers as levels of serum HIF-1ɑ,GRP78,and miR-499,and inhibiting ventricular remodeling,and did not increase the risk of adverse reactions.