重组人B型钠尿肽对围生期心肌病合并顽固性心力衰竭患者心功能的干预作用

The heart function efficacy of recombinant human B-type natriouretic peptide in peripartum cardiomyopathy with refractory heart failure

目的 评估重组人B型钠尿肽(rhBNP)治疗对围生期心肌病伴顽固性心力衰竭(PPCM-RHF)患者心功能的影响.方法 选取2010年1月至2014年1月在我院连续住院的PPCM-RHF患者61例,应用随机数字表分为rhBNP组30例和常规治疗组31例.两组均给予常规治疗,rhBNP组在常规治疗基础上给予rhBNP 1.5 μg/kg,2 min内匀速静脉注射后,以0.007 5 μg/(kg·min)静脉泵入,在收缩压(SBP)≥85 mmHg(1 mmHg=0.133 kPa),平均动脉压(MBP)≥65 mmHg的状态下,可调整剂量至0.015～0.030 μg/(kg·min),持续给药24h.记录呼吸困难改善情况并分别于给药前、用药后6h、14 d、30 d测定血浆BNP浓度.于给药前、用药24h、14 d和30 d分别行心脏超声检查,测定左心室射血分数(LVEF)和左心室舒张末期容积(LVEDD).记录30 d内主要心脏不良事件发生情况.结果 rhBNP组患者呼吸困难缓解时间(1.69±1.07)h显著短于对照组(2.69±1.39)h,P=0.002);rhBNP组血浆BNP水平用药后6 h(296.50±123.25) ng/L、14 d(141.37±69.54) ng/L、30 d(107.41±33.69) ng/L较基线时(727.07±146.84) ng/L明显降低.rhBNP组的LVEDD用药后24 h(52.23±4.54) mm、14 d (49.60±4.20) mm、30 d(42.59±3.90) mm均显著优于对照组[(56.33±4.38)、(53.03±4.95)、(48.85±4.96)mm],差异有统计学意义(P均＜0.05);两组间应用不同的药物后LVEF差异无统计学意义.但rhBNP组用药后24 h(41.13±4.12)％、14 d(43.00±4.10)％、30 d(44.52±3.43)％较基线时(36.73±5.82)％明显升高.30 d内主要心脏不良事件发生率rhBNP组明显少于对照组[10％ (3/30)与42％(13/31),P=0.005).结论 较常规治疗,rhBNP可及时有效地改善PPCM-RHF患者的心脏功能,减少30 d主要心脏不良事件的发生,改善患者的预后.

Objective To investigate the efficacy of recombinent human B-type natriuretic peptide (rhBNP) in peripartum cardiomyopathy (PPCM) with refractory heart failure (RHF).Methods From January 2010 to January 2014,a total of 61 patients with PPCM-RHF of the First Hospital of Qinhuangdao were enrolled into this study.All patients were randomly assigned into the rhBNP group (30 cases) and control group (31 cases).rhBNP was given 1.5 μg/kg,2 mim intravenously in rhBNP group and then infused intravenously 0.007 5-0.030 μg/(kg · min) for 24 hours,0.015-0.030 μg/(kg · min) for 24 hours when systolic blood pressure(SBP) ≥ 85 mmHg (1 mmHg =0.133 kPa) and mean brachial arterial pressure (MBP) ≥ 65 mmHg.Routine therapy followed the clinic practice was administrated in control group for 24 hours.Recorded the dyspnea change.Blood samples were collected at different time points to investigate BNP at 6 h,14 d and 30 d.Ultrasonic cardiography (UCG) was performed to evaluate left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension(LVEDD) before the initiation of the infusion,at day 1,14 and 30 after the infusion.All patients were followed up for one month to record the main adverse cardiac events (MACE),including heart failure recurrence,cardiac death and ventricular fibrillation and tachycardia.Results The time of dyspnea resolved in rhBNP group was significantly shorter than control group ((1.69 ± 1.07) h vs (2.69 ±1.39) h,P =0.002).Concentration of plasma BNP(6 h:(296.50±123.25) ng/L,14 d:(141.37±69.54) ng/L,30 d:(107.41±33.69) ng/L) was signifisantly reduced in both groups than basic line (727.07 =± 146.84) ng/L,and it was significantly different between two groups.LVEF raised and LVEDD decreased were observed at 24 hours((52.23±4.54) mm),14 d((49.60±4.20) mm) and 30 d((42.59±3.90) mm) in rhBNP group and were significant better than the control group ((56.33 ± 4.38) mm,(53.03 ± 4.95) mm,(48.85±4.96) mm;P ＜0.05).There was no significant difference in term of LVEF between two groups after treatment.However,24 h(4.12±41.13)％,14 d(4.10±43)％,30 d(44.52±3.43)％ were significantly higher than the baseline(36.73±5.82)％ in rhBNP group.MACEs were lower in rhBNP group at 30 dayscontrast to the control(10％ (3/30) vs.42％ (13/31);P =0.005).Conclusion Compared with conventional treatment,rhBNP can effectively improve the heart function in patients with PPCM-RHF,reduce the occurrence of major adverse cardiac events in 30 d,and improve the prognosis of patients.