左西孟旦联合rhBNP对缺血性心肌病患者心力衰竭的改善作用及对ITBVI、Copeptin的影响  

Improvement effect of levosimendan combined with recombinant human brain natriuretic peptide on heart failure and its influence on intrathoracic blood volume index and Copeptin in patients with ischemic cardiomyopathy

作　　者：李广运[1] 吕树志[2] 李相芬[1] 陈晓旭[1] 丁旭萌[3] Li Guangyun;Lyu Shuzhi;Li Xiangfen;Chen Xiaoxu;Ding Xumeng(Department of Cardiovascular Medicine,Second People's Hospital of Nanyang City,Nanyang 473000,China;不详)

机构地区：[1]南阳市第二人民医院心血管内科三病区,南阳473000 [2]南阳市第二人民医院心血管内科四病区,南阳473000 [3]南阳市第二人民医院超声科,南阳473000

出　　处：《中国循证心血管医学杂志》2023年第3期297-301,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划项目(LHGJ20191474)。

摘　　要：目的探讨左西孟旦联合重组人脑钠肽(rhBNP)治疗缺血性心肌病患者心力衰竭(心衰)的效果。方法选取2018年10月至2021年3月于南阳市第二人民医院收治的84例缺血性心肌病合并心衰的患者作为研究对象,采用随机数字表法分为对照组(43例)和观察组(41例),对照组采用左西孟旦治疗,观察组在对照组基础上加用rhBNP。分别于治疗前后检测患者血清N末端脑钠肽前体(NTproBNP)、人和肽素(Copeptin)、大内皮素1(BigET-1)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、胸腔内血容量指数(ITBVI)、全心舒张末期容量指数(GEDVI)和血管外肺水指数(EVLWI),观察并记录患者不良反应的发生情况,统计治疗总有效率。结果治疗后两组患者LVEDD、LVESD、血清NT-pro BNP、Copeptin、BigET-1均较治疗前降低,且观察组低于对照组(P<0.05);LVEF较治疗前升高,且观察组高于对照组(P<0.05);给药12 h和24 h后,观察组ITBVI、GEDVI和EVLWI均低于对照组(P<0.05);观察组血清载脂蛋白B(APOB)、载脂蛋白A-I(APOA-I)水平以及APOB/APOA-I比值低于对照组(P<0.05)。观察组治疗有效率高于对照组(P<0.05),两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论左西孟旦联合rhBNP可降低ITBVI、Copeptin水平,改善患者血流动力学,提高心功能水平,安全有效。Objective To investigate the therapeutic effect of levosimendan(Levo)combined with recombinant human brain natriuretic peptide(rhBNP)in patients with ischemic cardiomyopathy(ICM).Methods The patients with ICM complicated by heart failure(HF,n=84)were chosen from the Second People’s Hospital of Nanyang City from Oct.2018 to Mar.2021,and divided,according to random digital table,into control group(n=43)and observation group(n=41).The control group was treated with Levo,and observation group was treated with Levo and rhBNP.Before and after treatment,the indexes of N-terminal pro-brain natriuretic peptide(NT-proBNP),Copeptin,big endothelin-1(BigET-1),left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDD),left ventricular end-systolic diameter(LVESD),intrathoracic blood volume index(ITBVI),global end-diastolic volume index(GEDVI)and extravascular lung water index(EVLWI)were detected in 2 groups.The incidence of adverse reactions were observed and recorded,and the total effective rate was statistically treated in 2 groups during the treatment.Results After treatment,the indexes of LVEDD,LVESD,NT-pro BNP,Copeptin and BigET-1 decreases in 2 groups,which were lower in observation group than those in control group(P<0.05),LVEF increased,which was higher in observation group than that in control group(P<0.05).After treatment for 12 h and 24 h,the indexes of ITBVI,GEDVI and EVLWI were all lower in observation group than those in control group(P<0.05),and levels of apolipoprotein B(APOB),apolipoprotein A-I(APOA-I)and APOB to APOA-I ratio were lower in observation group than those in control group(P<0.05).The effective rate was higher in observation group than that in control group(P<0.05),and difference in the incidence rates of adverse reactions had no statistical significance between 2 groups(P>0.05).Conclusion Levo combined with rhBNP can reduce the levels of ITBVI and Copeptin,improve hemodynamics and promote heart function in patients with ICM complicated by HF,and it is safe and

关 键 词：心力衰竭 缺血性心肌病 重组人脑钠肽 左西孟旦 胸腔内血容量指数 肽素 

分 类 号：R541.61[医药卫生—心血管疾病]