重组人脑利钠肽联合芪苈强心胶囊治疗慢性充血性心力衰竭的临床观察

Clinical observation of recombinant human brain natriuretic peptide combined with Qiliqiangxin Capsule in treating chronic congestive heart failure

目的探讨重组人脑利钠肽(rhBNP)联合芪苈强心胶囊治疗慢性充血性心力衰竭(CHF)的效果,评价CHF患者应用芪苈强心胶囊的安全性。方法入选于保定市第一中心医院住院的美国纽约心脏病学会(NYHA)分级Ⅱ～Ⅳ级的CHF患者112例,随机分为试验组(54例)和对照组(58例),记录患者一般资料,入院后对照组给予CHF患者常规治疗,并给予rhBNP静脉泵入,试验组在对照组基础上给予芪苈强心胶囊口服,比较患者治疗前后血浆脑利钠肽(BNP)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、6分钟步行试验(6MWT)、血清肌酐(Scr)、尿素氮(BUN)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、心率及血压水平的变化。结果两组患者的一般资料比较差异无统计学意义(均P>0.05)。试验组治疗后BNP[(448.57±309.68)pg/ml比(903.80±593.72)pg/ml]、LVEDD[(50.24±7.52)mm比(57.63±8.90)mm]水平明显低于治疗前(均P <0.05);LVEF[(56.43±10.09)%比(41.33±9.70)%]、6MWT[(439.88±30.79)m比(343.76±32.60)m]水平明显高于治疗前(均P <0.05)。对照组治疗后BNP[(586.66±372.89)pg/ml比(922.69±605.32)pg/ml]、LVEDD[(53.53±7.95)mm比(57.52±8.71)mm]水平明显低于治疗前(均P <0.05);LVEF[(51.76±9.79)%比(40.55±9.52)%]、6MWT[(397.05±36.43)m比(335.19±44.52)m]水平明显高于治疗前(均P <0.05)。试验组治疗后BNP[(448.57±309.68)pg/ml比(586.66±372.89)pg/ml]、LVEDD[(50.24±7.52)mm比(53.53±7.95)mm]水平明显低于对照组,LVEF[(56.43±10.09)%比(51.76±9.79)%]、6MWT[(439.88±30.79)m比(397.05±36.43)m]水平明显高于对照组(均P <0.05)。试验组治疗后的心率[(68.02±7.83)次/min比(86.59±19.76)次/min]、收缩压[(115.53±9.07)mmHg比(134.66±20.64)mmHg]、舒张压[(70.94±7.17)mmHg比(81.63±13.50)mmHg]水平明显低于治疗前(均P <0.05)。对照组治疗后的心率[(72.48±9.10)次/min比(86.95±18.17)次/min]、收缩压[(122.49±12.27)mmHg比(134.15±22.26)mmHg]、舒张压[(74.45±7.45)mmHg比(80.79±15.56)mmHg]水平明显低于治疗前(均P <0.05)。试验组治疗后的[(68.02±7.83)次/min比(72.48±9.10)次/min]、收缩压[(115.53±9.07)mmHg比(122.49±12.27)mmHg]、舒张压[(70.94±7.17)mmHg比(74.45±7.45)mmHg]水平明显低于对照组(均P <0.05)。试验组治疗后呼吸困难程度评分[(1.35±0.56)分比(2.69±1.16)分]、全身状况评分[(1.43±0.72)分比(2.76±1.08)分]均明显低于治疗前(均P <0.05)。对照组治疗后呼吸困难程度评分[(1.66±0.85)分比(2.57±1.16)分]、全身状况评分[(1.74±0.87)分比(2.74±1.10)分]均明显低于治疗前(均P <0.05)。试验组治疗后呼吸困难程度评分[(1.35±0.56)分比(1.66±0.85)分]、全身状况评分[(1.43±0.72)分比(1.74±0.878)分]明显低于对照组(均P <0.05)。结论 rhBNP联合芪苈强心胶囊可显著改善CHF患者的心功能,有助于心率、血压的恢复,且在改善临床症状方面疗效显著;CHF患者口服芪苈强心胶囊对肝肾功能无明显损害作用,临床应用安全。

Objective To investigate the effect of recombinant human brain natriuretic peptide(rhBNP)combined with Qili Qiangxin Capsule in the treatment of chronic congestive heart failure(CHF)and to evaluate the safety of Qiliqiangxin Capsule in patients with chronic congestive heart failure.Methods A total of 112 patients with chronic congestive heart failure who were admitted to the First Central Hospital of Baoding City were enrolled in the study.Patients were randomly divided into experimental group(n =54)and control group(n =58),and record patient′s general information.After admission,the control group was given routine treatment of CHF patients,and given intravenous infusion of rhBNP.The experimental group was given Qiliqiangxin capsule on the basis of the control group.The changes of plasma brain natriuretic peptide(BNP),left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),6-minute walk test(6 MWT),serum creatinine(sCr),blood urea nitrogen(BUN),aspartate aminotransferase(AST),alanine aminotr-ansferase(ALT),heart rate,blood pressure before and after treatment were compared.Results There was no significant difference in general data between the two groups(P >0.05).The levels of BNP and LVEDD in both groups were significantly lower than those before treatment(P <0.05),and the levels of LVEF and 6 MWT were significantly higher than those before treatment(P <0.05).The levels of BNP and LVEDD in the experimental group were significantly lower than those in the control group,and the levels of LVEF and 6 MWT were significantly higher than those in the control group(all P <0.05).Heart rate,systolic blood pressure and diastolic blood pressure were significantly lower in both groups after treatment than those before treatment(all P <0.05).The heart rate,systolic blood pressure and diastolic blood pressure in the experimental group were significantly lower than those in the control group(all P <0.05).The levels of BUN,sCr,AST,ALT in the two groups after treatment did not differ from those before treatment(all P >0.05).The levels of BUN,sCr,AST and ALT in the experimental group were not significantly different from those in the control group(all P >0.05).After treatment,the scores of dyspnea and general condition in both groups were significantly lower than those before treatment(all P <0.05),and the scores of dyspnea score and general condition in the experimental group were significantly lower than those in the control group(all P <0.05).ConclusionRecombinant human brain natriuretic peptide combined with Qili Qiangxin capsule can significantly improve heart function in patients with chronic congestive heart failure,contribute to the recovery of heart rate and blood pressure,and have a significant curative effect in improving clinical symptoms.Oral administration of Qiliqiangxin Capsule in patients with chronic congestive heart failure has no obvious effect on liver and kidney function.The clinical application of Qiliuqiangxin capsule on patient with CHF was safety.