目的: 探讨重组人脑利钠肽治疗射血分数保留心力衰竭患者的疗效和安全性,以及患者用药后sST2及N末端B型利钠肽原(NT-proBNP)水平变化。方法: 选取包头市第四医院2020年2月-2022年2月收治射血分数保留心力衰竭患者60例,按照是否接受重组人脑利钠肽治疗分为观察组(联合注射用重组人脑利钠肽治疗)30例及对照组(常规治疗)30例,观察两组治疗前、治疗72 h后,6 min步行试验(6 MWT)、血清sST2和NT-proBNP水平、超声心动图指标及临床疗效。结果: 治疗72 h后,观察组6 MWT高于对照组,NT-proBNP水平低于对照组(P＜0.05);治疗72 h后,观察组左心房容积指数(LAVI)低于对照组,左心室射血分数(LVEF)升高(P＜0.05);观察组总有效率高于对照组(P＜0.05);治疗72 h后,观察组血清sST2水平降低(P＜0.05)。结论: 注射用重组人脑利钠肽可改善射血分数保留心力衰竭患者的心肌功能,增加心脏排血量,减轻心肌细胞损伤,经sST2及NT-proBNP水平评估后确保有效,且临床用药安全性好,建议推广。
Objective: To investigate the efficacy and safety of recombinant human brain natriuretic peptide in the treatment of patients with heart failure with preserved ejection fraction, and the changes of sST2 and NT-proBNP levels after treatment. Methods: A total of 60 patients with heart failure with preserved ejection fraction were selected from February 2020 to February 2022 in Baotou Fourth Hospital. All patients were divided into observation group (combined with recombinant human brain natriuretic peptide for injection) and control group (conventional treatment) according to whether they received recombinant human brain natriuretic peptide treatment, with 30 patients in each group. The 6-minute walking test (6 MWT), serum sST2 and N-terminal B-type natriuretic peptide (NT-proBNP) levels, echocardiographic indicators and clinical efficacy of the two groups were observed before treatment and 72 hours after treatment. Results: After treatment, the 6 MWT of the observation group was higher than that of the control group, and the level of NT-proBNP was lower than that of the control group (P＜0.05); the left atrial volume index (LAVI) in the observation group was lower than that in the control group, and the left ventricular ejection fraction (LVEF) was higher than that in the control group (P＜0.05); the total effective rate of the observation group was higher than that of the control group (P＜0.05); the serum sST2 level in the observation group was lower than that in the control group (P＜0.05). Conclusion: Recombinant human brain natriuretic peptide for injection can improve myocardial function, increase cardiac output and reduce myocardial cell injury in patients with heart failure with preserved ejection fraction. It is effective after evaluation of sST2 and NT-proBNP levels, and the safety of clinical medication is good.
[1] Zhao JJ, Zhang CY, Liu J, et al. Prognostic significance of serum cysteine-rich protein 61 in patients with acute heart failure[J]. Cell Physiol Biochem, 2018, 48(3): 1177-1187.
[2] 张奇, 翁志远, 苏大宇. 达格列净对射血分数保留心力衰竭合并2型糖尿病患者心功能及炎症因子的影响[J]. 河南医学研究, 2023, 32(12): 2226-2229.
[3] 闫少华, 耿巍, 田祥. 射血分数保留心力衰竭发病机制及治疗研究进展[J]. 临床合理用药, 2023, 16(13): 166-169.
[4] 陈跃欢, 章秋芳. 左西孟坦联合冻干重组人脑利钠肽对急性心肌梗死合并心力衰竭患者心肌保护作用的临床研究[J]. 中国基层医药, 2021, 28(9): 1303-1307.
[5] 俞锦霞. 重组人脑利钠肽对急性心肌梗死行PCI术后并发心力衰竭患者心脏功能、氧化应激的影响[J]. 现代实用医学, 2021, 33(8): 1038-1039.
[6] 张伟. 小剂量呋塞米联合冻干重组人脑利钠肽对老年急性心肌梗死合并心力衰竭患者的影响[J]. 中国实用医药, 2021, 16(21): 135-137.
[7] 王芍. 冻干重组人脑利钠肽治疗慢性心力衰竭急性加重的疗效及对患者NT-proBNP、TnI改善情况分析[J]. 北方药学, 2023, 20(2): 159-161.
[8] 王晓利, 杨帆. 沙库巴曲缬沙坦钠片联合重组人脑利钠肽对慢性心力衰竭患者左心室功能的影响[J]. 河南医学研究, 2023, 32(2): 327-330.
[9] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会.中国心力衰竭诊断与治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.
[10] 郑筱萸. 中药新药临床研究指导原则:试行[M]. 北京:中国医药科技出版社, 2002: 77-85.
[11] Li N, Gao X, Wang WZ, et al. Protective effects of recombinant human brain natriuretic peptide on the myocardial injury induced by acute carbon monoxide poisoning[J]. Cardiovasc Diagn Ther, 2020, 10(6): 1785-1794.
[12] 方文宾, 王文标, 潘一先, 等. 重组人脑利钠肽对急性冠脉综合征伴心力衰竭患者的影响[J]. 中国现代医生, 2020, 58(25): 42-45.
[13] 刘倩, 翟玉停, 刘洁银, 等.重组人脑利钠肽治疗保留射血分数心力衰竭患者临床效果观察[J]. 临床军医杂志, 2021, 48(12): 1295-1301.
[14] 张小芳. 重组人脑利钠肽对心力衰竭患者心功能及血清CRP、BNP、VEGF水平的影响[J]. 现代医学与健康研究电子杂志, 2021, 5(4): 74-76.
[15] 冯胜东, 周芃. 芪苈强心胶囊联合冻干重组人脑利钠肽对扩张型心肌病合并心力衰竭的疗效[J]. 河南医学研究, 2021, 30(4): 738-740.
[16] 张蒙. 重组人脑利钠肽联合沙库巴曲缬沙坦钠序贯治疗射血分数偏低心力衰竭的效果分析[J]. 医学理论与实践, 2023, 36(2): 226-228.
[17] 贾妍, 张瑞宁, 黄柳, 等. 重组人脑利钠肽治疗急性失代偿性心力衰竭的临床疗效及其对血清sST2、CT-1水平的影响[J]. 药物评价研究, 2021, 44(3): 545-549.
[18] 杜培俊. 冻干重组人脑利钠肽在急性心力衰竭治疗中的应用[J]. 中国药物与临床, 2020, 20(24): 4101-4102.
[19] 郑茜, 张勇. 联合应用重组人脑利钠肽与呋塞米治疗急性心肌梗死并发急性左心衰竭的效果[J]. 临床医学, 2020, 40(12): 90-91.
[20] 曹林芝, 杨晋. 重组人脑利钠肽在ST段抬高型心肌梗死患者心功能恢复中疗效观察[J]. 中国药物与临床, 2021, 21(1): 110-112.
[21] 刘颖. 重组人脑利钠肽对心力衰竭患者心功能与血清BNP、IL-6、CRP水平的影响[J]. 现代医学与健康研究电子杂志, 2021, 5(6): 73-75.
[22] 王延增. 参附注射液+冻干重组人脑利钠肽对急性心肌梗死伴急性心力衰竭患者心功能的影响[J]. 黑龙江医药科学, 2020, 43(5): 89-90.
