重组人脑利钠肽对不同血压水平的急性失代偿性心力衰竭患者临床疗效的对比研究

Comparison of clinical efficacy of recombinant human brain natriuretic peptide in patients with acute decompensated heart failure at different blood pressure levels

目的比较重组人脑利钠肽(rhBNP)对不同血压水平的急性失代偿性心力衰竭(ADHF)患者的临床疗效,进一步研究收缩压(SBP)在90～100mmHg(1mmHg=0.133kPa)的患者应用rhBNP的安全性。方法入选于保定市第一中心医院住院的纽约心脏协会(NYHA)Ⅲ～Ⅳ级、左心室射血分数(LVEF)<50%的ADHF患者141例,根据入院时患者收缩压水平分为试验组(90mmHg<SBP<100mmHg,63例)和对照组(100mmHg≤SBP<150mmHg,78例),在ADHF患者常规治疗基础上,给予rhBNP静脉泵入,记录患者一般资料、治疗前和治疗后血压水平、治疗前和治疗后24h和72h的血清肌酐(Scr)、尿素氮(BUN)、估算的肾小球滤过率(eGFR)水平,以及治疗后7d的血浆脑利钠肽(BNP)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)水平。结果试验组治疗前收缩压波动在91～99mmHg,舒张压波动在60～72mmHg,应用rhBNP后收缩压波动在87～96mmHg,舒张压波动在57～68mmHg;对照组治疗前收缩压波动在100～148mmHg,舒张压波动在60～110mmHg,应用rhBNP后收缩压波动在98～124mmHg,舒张压波动在58～92mmHg;两组患者血压均相对稳定,无严重低血压及进行性低血压发生。试验组治疗后24h、72h的尿素氮[(10.51±4.38)mmol/L比(8.38±4.01)mmol/L]、[(10.27±3.90)mmol/L比(8.38±4.01)mmol/L]、血肌酐[(98.47±38.74)μmol/L比(87.97±23.53)μmol/L]、[(97.32±39.13)μmol/L比(87.97±23.53)μmol/L]水平明显高于治疗前,差异有统计学意义(均P <0.05);试验组治疗后24h、72h的eGFR水平[(66.29±23.66)mmol/L比(72.60±27.80)mmol/L]、[(67.37±24.61)mmol/L比(72.60±27.80)mmol/L]明显低于治疗前,差异有统计学意义(均P <0.05)。对照组治疗后24h、72h的尿素氮、血肌酐平均水平高于治疗前,eGFR水平低于治疗前,但差异均无统计学意义(均P>0.05)。试验组治疗后7d的LVEF水平[(40.43±4.86)%比(33.29±8.92)%]和对照组[(44.41±7.46)%比(39.18±6.56)%],试验组治疗后7d的BNP[(1006.00±631.48)pg/ml比(2305.00±693.81)pg/ml]和对照组[(767.30±718.81)pg/ml比(1581.00±1014.70)pg/ml],明显高于治疗前,差异均有统计学意义(均P <0.05)。试验组治疗后7d的LVEDD[(51.55±6.02)mm比(54.64±9.66)mm]和对照组[(53.87±6.89)mm比(56.23±8.57)mm],差异均有统计学意义(均P <0.05)。试验组与对照组治疗后7d的BNP、LVEDD、LVEF水平比较,差异均无统计学意义(均P>0.05)。结论rhBNP可以改善ADHF患者的心功能,且不受ADHF患者血压水平的影响,在临床上对于收缩压在90～100mmHg的ADHF患者,应用rhBNP后血压趋于稳定;但是ADHF患者应用rhBNP后可产生潜在的肾功能损害作用,尤其对血压水平偏低的患者更明显,所以ADHF患者应用rhBNP时需要定期监测肾功能。

Objective To compare the clinical efficacy of recombinant human brain natriuretic peptide(rhBNP)in patients with acute decompensated heart failure(ADHF)at different blood pressure levels and to further investigate the safety of rhBNP in patients with systolic blood pressure(SBP)of 90 to 100 mmHg.Methods 141 ADHF patients admitted to the First Central Hospital of Baoding City undergoing cardiac function class Ⅲ-Ⅳ and LVEF <50% were divided into test group(90 mmHg<SBP<100 mmHg,n =63)and control group(100 mmHg≤SBP<150 mmHg,n =78)according to the systolic blood pressure.On the basis of routine treatment of patients with ADHF,rhBNP was given intravenously.Patients,general information was recorded.The levels of serum creatinine(SCR),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)were measured at baseline and repeated at the end of the 24 and 72 hours after infusion.The levels of plasma brain natriuretic peptide(BNP),left ventricular end-diastolic dimension(LVEDD),left ventricular ejection fraction(LVEF)were measured at baseline and repeated at 7 days after treatment.Results There was no significant difference in general data between the two groups(P >0.05).The systolic blood pressure fluctuated between 87-96 mmHg and diastolic pressure fluctuated between 57-68 mmHg after rhBNP administration in experimental group.The systolic blood pressure fluctuated between 98-124 mmHg and diastolic pressure fluctuated between 58-92 mmHg after administration of rhBNP in control group.The levels of urea nitrogen and serum creatinine in experimental group at 24 hand 72 hafter treatment were significantly higher than those before treatment(P <0.05).The levels of eGFR in experimental group at 24 hand 72 hafter treatment were significantly lower than those before treatment(P <0.05).The mean levels of urea nitrogen and serum creatinine in control group at 24 hand 72 hafter treatment were higher than those before treatment,and the levels of eGFR were lower than those before treatment,but the difference was not statistically significant(P >0.05).The levels of LVEF in experimental and control groups at 7 th day after treatment were significantly higher than those before treatment(P <0.05).The levels of BNP and LVEDD in experimental group and control group at 7 th day after treatment were significantly lower than those before treatment(P <0.05).The levels of BNP,LVEDD and LVEF in experimental group and control group at 7 days after treatment were not significantly different(all P >0.05).Conclusion BNP can improve cardiac function in patients with ADHF,while is not affected by the blood pressure level in patients with ADHF.For patients with ADHF and systolic blood pressure90-100 mmHg,the blood pressure stabilized after rhBNP.But rhBNP can produce potential of renal dysfunction on patients with ADHF,and for patients with low blood pressure is more obvious,so the application of rhBNP in ADHF patients need regular monitoring of renal function.