冻干重组人脑利钠肽联合左西孟旦治疗急性心力衰竭患者的疗效及对血清FT4和tT3的影响  

Efficacy of freeze-dried recombinant human brain natriuretic peptide combined with Levosimendan in patients with acute heart failure and its effect on serum FT4 and tT

作　　者：刘妍君 LIU Yan-jun(Department of Critical Medicine,Heze Hospital of Traditional Chinese Medicine,Heze Shandong 274000,China)

机构地区：[1]菏泽市中医医院重症医学科,山东菏泽274000

出　　处：《临床和实验医学杂志》2020年第15期1609-1613,共5页Journal of Clinical and Experimental Medicine

基　　金：山东省卫生厅基金资助项目(编号:2018HZ809)。

摘　　要：目的探究冻干重组人脑利钠肽(rhBNP)联合左西孟旦治疗急性心力衰竭(AHF)的疗效及对患者血清游离甲状腺素(FT4)、总三碘甲状腺原氨酸(tT3)水平的影响。方法回顾性分析2017年5月至2018年10月菏泽市中医医院收治的159例AHF患者的临床资料,根据治疗方案不同将患者分为三组,每组各53例,均行常规对症治疗,在此基础上,A组患者采用rhBNP治疗,B组患者采用左西孟旦治疗,联合组患者采用rhBNP联合左西孟旦治疗,均持续治疗3~7 d。比较三组治疗效果、恢复情况、治疗前、治疗结束后病情程度(APACHEⅡ评分),心功能指标[心脏指数(CI)、左室射血分数(LVEF)],血清氨基末端B型脑利钠肽前体(NT-proBNP)、心型脂肪酸结合蛋白(H-FABP)、FT4、tT3水平及出院后1年内再入院率。结果联合组患者的治疗总有效率(94.34%)高于A组(81.13%)、B组(77.36%),差异有显著性(P<0.05);联合组患者的症状改善[(4.62±1.95) d]、心力衰竭纠正[(2.46±1.14) h]及住院时间[(10.86±1.79) d]均短于A组、B组(P<0.05);联合组治疗结束后APACHEⅡ评分[(8.62±2.15)分]低于A组、B组,CI[(3.20±0.23) L/(min·m^2)]、LVEF[(49.53±3.64)%]高于A组、B组(P<0.05);联合组治疗结束后血清NTproBNP[(72.51±16.83) pg/ml、H-FABP(20.95±8.97) ng/ml]水平低于A组、B组(P<0.05);联合组治疗结束后血清tT3水平[(1 297.54±252.94) pg/ml]高于A组、B组,血清FT4水平[(1.22±0.21) pg/ml]低于A组、B组(P<0.05);联合组出院后1年内再入院率(3.77%)低于A组(16.98%)和B组(18.87%),差异均有显著性(P<0.05)。结论采用rhBNP联合左西孟旦治疗AHF,能显著改善心肌细胞损伤,减轻病情程度,增强患者心功能,促进患者恢复,疗效显著,且能进一步调节血清FT4、tT3水平,降低再入院率,改善患者预后。Objective To investigate the effect of freeze-dried recombinant human brain natriuretic peptide(rhBNP) combined with Levosimendan in the treatment of acute heart failure(AHF) and its effect on serum free thyroxine(FT4) and total triiodothyronine(tT3).Methods The clinical data of 159 patients with AHF in Heze Hospital of Traditional Chinese Medicine from May 2017 to October 2018 were selected for retrospective analysis.They were divided into three groups according to different treatment plans,with 53 cases in each group,all were treated with routine symptomatic treatment,on this basis,group A was treated with rh BNP,group B was treated with Levosimendan,and combined group was treated with rhBNP combined with Levosimendan,all continued treatment for three to seven days.The treatment effect,recovery situation,the degree of the disease before and after treatment(APACHE II score),cardiac function indicators [heart index(CI),left ventricular ejection fraction(LVEF) ],Serum amino-terminal B-type natriuretic peptide precursor(NT-proBNP),cardiac fatty acid binding protein(H-FABP),serum FT4,tT3 levels,and readmission rates within 1 year after discharge were compared among the three groups.Results The total effective rate of patients in the combined group(94.34%) was higher than those in group A(81.13%) and group B(77.36%)(P< 0.05);patients in the combination group had(4.62 ± 1.95) days of improved symptoms,(2.46 ± 1.14) hours of heart failure correction,and(10.86 ± 1.79) days of hospital stays were shorter than those in group A and group B(P< 0.05);the score of APACHEⅡ(8.62 ± 2.15) after the end of treatment in the combination group was lower than those in group A and group B,CI(3.20 ± 0.23) L/(min·m^2) and LVEF(49.53 ±3.64) % were higher than those in group A and group B(P< 0.05);serum NT-proBNP(72.51 ± 16.83) pg/ml and H-FABP(20.95 ± 8.97) ng/ml levels in the combined group after treatment were lower than those in group A and group B(P< 0.05),the serum tT3 level(1297.54 ± 252.94) pg/ml was higher in the combi

关 键 词：急性心力衰竭 重组人脑利钠肽 左西孟旦 心功能 心型脂肪酸结合蛋白 游离甲状腺素 总三碘甲状腺原氨酸 

分 类 号：R541.6[医药卫生—心血管疾病]