重组人脑利钠肽治疗老年缺血性失代偿性心力衰竭

Efficacy of Recombinant Human Brain Natriuretic Peptide in Senile Decompensated Iischemic Heart Failure

目的:探讨重组人脑利钠肽(rh BNP)治疗老年缺血性失代偿性心力衰竭的疗效及安全性。方法:选取心功能为NYHA IV级,经规范洋地黄强心、利尿剂利尿和硝酸甘油扩血管效果欠佳的老年缺血性失代偿性心力衰竭患者62例,随机分为2组:rh BNP治疗组(rh BNP组)31例,米力农治疗组(米力农组)31例。观察2组患者呼吸及心跳频率、NYHA心功能分级,左室射血分数(LVEF)、中心静脉压(CVP)、N末端B型钠尿肽(NT-pro BNP)水平并观察肝肾功能。结果:rh BNP组较米力农组患者的心率,肌酐及NT-pro BNP下降幅度明显增大,分别是(25.6±8.7)次/分,(18.5±7.3)次/分(p<0.05);(68.2±11.8)μmol/L,(46.4±10.9)μmol/L(p<0.01);(687.7±221.5)ng/L,(430.4±170.9)ng/L(p<0.01)。rh BNP组较米力农组患者的LVEF的增加水平有明显差异,分别是(8.1±4.7)%,(5.5±3.3)%(p<0.05)。而丙氨酸氨基转移酶、CVP、NYHA心功能分级及呼吸频率的改变则无明显差异,分别是(56.4±10.3)u/l,(47.8±2.6)u/l(p>0.05);(5.4±3.3)cm H2o,(4.0±2.8)cm H2o(p>0.05);(1.3±0.3),(1.0±0.4)(p>0.05);(15.1±8.7)/分,(12.5±9.3)/分(p>0.05)。结论:rh BNP治疗缺血性失代偿性心力衰竭疗效显著且安全性良好。

Objective: To explore the clinical efficacies of recombinant human brain natriuretic peptide(rh BNP) in senile patients with decompensated ischemic heart failure. Methods: 62 Patients,with grade NYHA IV heart function,had been poor effect by routine digitalis,diuretic and nitroglycerin therapy,were recruited into our centre,then were divided into 2 groups randomly: rh BNP therapy group(n = 31),milrinone therapy group(n = 31).The frequency of breathing and heart beating,the grade of NYHA heart function,left ventricular ejection fraction(LVEF),and the centre venous pressure(CVP),of the patients were observed.The level of creatinine,alanine aminotransterase(ALT) and amino—terminal pro—B—type natriuretic peptid(NT-pro BNP) were measured. Results: The descending frequency of heart beating,the descending amplitude of the level of creatinine and NT-pro BNP,of rh BNP group were higher than that of milrinone group respectively(25. 6 ± 8. 7) beating/min,(18. 5 ± 7. 3) beating/min(p < 0. 05);(68. 2±11. 8) μmol/L,(46. 4±10. 9) μmol/L(p <0. 01);(687. 7±221. 5) ng/L,(430. 4±170. 9) ng/L(p < 0. 01). The elevating amplitude of the LVEF of rh BNP group also were higher than that of milrinone group respectively(8. 1 ± 4. 7) %,(5. 5 ± 3. 3) %(p < 0. 05). There were no difference in the altered levels of alanine aminotransterase,the descending amplitude of CVP,the descending frequency of breathing,and the descending grade of NYHA heart function,between two groups respectively(56. 4 ±10. 3) u/l,(47. 8± 12. 6) u/l(p > 0. 05);(5. 4 ± 3. 3) cm H2 o,(4. 0 ± 2. 8) cm H2 o(p > 0. 05);(15. 1 ±8. 7)/min,(12. 5±9. 3)/min(p>0. 05);(1. 3±0. 3),(1. 0±0. 4)(p>0. 05). Conclusion: The rh BNP is efficacy and safe for decompensated ischemic heart failure.