重组人脑利钠肽应用于高龄患者心力衰竭的疗效及安全性

Efficacy and safety of ecombinant human brain natriuretic peptide in the treatment of heart failure in elderly patients

目的探讨重组人脑利钠肽(recombinant human brain natriuretic peptide,rh BNP)应用于高龄心力衰竭患者的疗效及安全性。方法选择2012-01至2017-06就诊于解放军总医院心血管内科的慢性心力衰竭急性发作的高龄患者319例,其中常规治疗+rh BNP181例(rh BNP组),常规治疗138例(对照组)。比较两组患者治疗后5 d、3个月的B型利钠肽前体水平(NT-proBNP),左室射血分数(left ventricular ejection fraction,LVEF),心室短轴缩短指数(left ventricular short axis reduced index,FS),6分钟步行试验(6 minutes walking test,6MWT),肝、肾功能及血压的变化,以及再住院率的差异。结果治疗后5 d,rh BNP组中,NT-proBNP显著降低(P <0. 05),LVEF、FS及6MWT结果升高(P <0. 05)。治疗后3个月,rh BNP组NT-proBNP较对照组明显降低(P <0. 05),LVEF、FS及6MWT较治疗前改善(P <0. 05)。rh BNP组与对照组相比,治疗3个月后再住院率显著降低(P <0. 05)。结论 rh BNP治疗高龄患者慢性心力衰竭急性加重安全有效,且能降低3个月内因心力衰竭的再住院率。

Objective To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh BNP)when used in elderly patients.Methods A total of 319 elder patients with heart failure were chosen from our hospital between January 2012 and June 2017.They were randomly divided into the control group(n=138)and rh BNP treatment group(n=181).Patients in both groups were observed and compared in terms of type B natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),ventricular shortening index(FS),the 6-minute walk test(6 MWT),changes of liver function,renal function and blood pressure,and the difference in the rate of re-hospitalization.Results After 5 days,the level of NT-proBNP in the rh BNP treatment group was significantly lower than that in the control group(P<0.05),but LVEF,FS and 6 MWT increased(P<0.05).Three months after treatment,the level of NT-proBNP in the rh BNP treatment group was significantly lower than that in the control group(P<0.05),but LVEF,FS and 6 MWT improved significantly(P<0.05).After 3 months of treatment,the rate of re-hospitalization in the rh BNP treatment group was significantly lower than that in the control group(P<0.05).Conclusions Recombinant human brain natriuretic peptide(rh BNP)is safe and effective in the treatment of acute exacerbation of chronic heart failure in elderly patients,which can reduce the re-hospitalization rate of heart failure that occurs within 3 months.