rhBNP对心力衰竭合并肾功能不全的临床疗效观察  

Effect of Recombinant form of Human Brain Natriuretic Peptide in Heart Failure and Renal Insufficiency

作　　者：孙丽秀[1] 支继新[1] 高宇囡[1] 刘俊艳[1] 李学奇[1] 

机构地区：[1]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2013年第25期4877-4880,共4页Progress in Modern Biomedicine

基　　金：国家重点基础研究发展计划"973"项目(2007CB512000)

摘　　要：目的:通过观察心力衰竭合并肾功能不全患者应用rhBNP与硝普钠后心、肾功能指标的变化,探讨rhBNP对心力衰竭合并肾功能不全的治疗效果,期望为心力衰竭晚期合并肾功能不全的患者找到疗效更好的治疗药物,减轻患者痛苦,同时减少患者的住院费用及住院时间。方法:57例心力衰竭合并肾功能不全的患者随机分为对照组和治疗组,对照组27例,使用硝普钠,治疗组30例,使用rhBNP,比较两组患者治疗前及治疗1周后心率、左室射血分数、NT-proBNP、血肌酐、尿素氮、胱抑素C、尿酸水平。结果:与对照组相比,治疗组心率、NT-proBNP下降更明显(P<0.05),两组患者治疗后左室射血分数无明显差异(P>0.05);治疗组用药后血肌酐及胱抑素C较治疗前下降(P<0.01),而对照组二者变化无统计学差异(P>0.05),两组患者用药前后尿素氮和尿酸水平变化无统计学差异(P>0.05)。结论:(1)在维持血压高于90/60 mmHg的情况下,与硝普钠相比,中等剂量0.01μg/(kg·min)rhBNP能有效改善失代偿性心力衰竭合并肾功能不全患者的血流动力学状态、呼吸困难及水肿症状;(2)rhBNP可以提高肾小球滤过率,改善肾功能;(3)在心力衰竭治疗中,rhBNP疗效优于硝普钠等单纯血管扩张剂,可以在短时间内缓解患者症状,减轻患者痛苦,避免患者进行超滤等价格昂贵且有创的治疗。SUN Li-xiu, ZHI Yi-xin, GAO Yu-nan, LIU Yun-yan, LI Xue-qia （The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China） Objective： To investigate the efficacy of recombinant form of human brain natriuretic peptide （rhBNF） in patients who had decompensated heart failure with renal insufficiency. Methods： Fifty-seven patients were divided into rhBNP and sodium nitroprus- side group randomly. The level of heart rate, left ventricular ejection fractions, N-terminal prohormone BNP （NT-proBNP）, creatinine, urea nitrogen, cystatin C and uric acid were measured before and after therapy. Results： Compared with the sodium nitroprusside group, patients in rhBNP group presented a greater heart rate and NT-proBNP reduction （P〈0.05）, while left ventricular ejection fraction （LVEF） was not changed significantly （P〉0.05） after the course of therapy. Group the serum creatinine and cystatin C were reduced sig- nificantly after the course of therapy in rhBNP （P〈0.01）. However, the serum creatinine and cystatin C in sodium nitroprusside group had no signif- icant difference （P〉0.05）. Urea nitrogen and uric acid of the two groups had no significant difference before and after treatment （P〉0.05）. Conclusion： （1） Compared with the sodium nitroprusside, the strategy with a dose of 0.01 μg / （kg. rain） rhBNP can effectively improve hemodynamic status and relieve symptoms of dyspnea and edema in patients of heart failure accompanied with renal insufficien- cy; （2） rhBNP can improve the glomerular filtration rate, and improve renal function; （3） rhBNP has better effect than other vasodilators in heart failure treatment.

关 键 词：重组人脑利钠肽 心力衰竭 肾功能不全 

分 类 号：R541.6[医药卫生—心血管疾病]