冻干重组人脑利钠肽联合呋塞米对老年急性心力衰竭患者血清心肌酶的影响  

Impact of lyophilized rhBNP combined with furosemide on serum myocardial enzymes in elderly patients with AHF

作　　者：尹嘉 汤舒洁 Yin Jia;Tang Shujie(Department of Emergency Medicine,Chengdu Third People's Hospital,Chengdu 610000,Sichuan Province,China)

机构地区：[1]成都市第三人民医院急诊科,610000

出　　处：《中华老年心脑血管病杂志》2024年第7期732-736,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：四川省科技计划项目(2023YFS0115)。

摘　　要：目的 探讨冻干重组人脑利钠肽(rhBNP)联合呋塞米对老年急性心力衰竭(AHF)患者血清心肌酶的影响。方法 选取2020年1月至2023年11月成都市第三人民医院急诊科住院的老年AHF患者162例,根据随机数字表法分为呋塞米组和rhBNP组,每组81例。呋塞米组给予呋塞米治疗,rhBNP组在呋塞米治疗基础上给予rhBNP治疗,观察2组临床症状缓解时间,对比治疗前及治疗2周后心力衰竭程度评分、病情危重程度评分、超声心动图指标以及血清生化指标变化,包括左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、每搏输出量(SV)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、微小核糖核酸-181b(miR-181b)、瞬时受体电位C1(TRPC1)、生长分化因子15(GDF-15)水平。结果 rhBNP组治疗后气促缓解时间和水肿消退时间明显短于呋塞米组[(3.31±0.62)d vs(5.18±1.08)d,(3.86±0.82)d vs(6.08±1.19)d,P<0.01]。2组治疗后心力衰竭程度评分、急性生理与慢性健康状况Ⅱ评分、LVEDD、LVESD、LDH、CK、CK-MB、α-HBDH、TRPC1及GDF-15水平较治疗前明显降低,LVEF、SV、miR-181b水平较治疗前明显升高,差异有统计学意义(P<0.05)。结论 rhBNP联合呋塞米治疗老年AHF患者能缩短症状持续时间,不仅可改善心力衰竭病情,而且能改善血清心肌酶指标,减少心肌损伤程度,保护心脏。Objective To explore the effect of lyophilized recombinant human brain natriuretic peptide(rhBNP)combined with furosemide on serum myocardial enzymes levels in elderly patients with acute heart failure(AHF).Methods A total of 162elderly AHF patients admitted in our department from January 2020to November 2023were recruited,and randomly divided into furosemide group and furosemide+rhBNP group,with 81cases in each group.The remission times of clinical symptoms were observed in the two groups.The score of heart failure degree,disease severity score,echocardiographic indicators and serum biochemical indicators before and in 2weeks after treatment were studied and compared between the two groups.These indicators included left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),stroke volume(SV),and levels ofα-hydroxybutyrate dehydrogenase(α-HBDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)and micro ribonucleic acid-181b(miR-181b),transient receptor potential C1(TRPC1)and growth differentiation factor 15(GDF-15).Results The remission time of shortness of breath and time of edema subsidence after treatment were significantly shorter in the furosemide+rhBNP group than the furosemide group(3.31±0.62dvs 5.18±1.08d,3.86±0.82dvs 6.08±1.19d,P<0.01).After treatment,the heart failure degree score,APACHEⅡscore,LVEDD,LVESD,and levels of LDH,CK,CK-MB,α-HBDH,TRPC1and GDF-15were obviously declined,while LVEF,SV and miR-181blevel were notably risen in both groups when compared to the levels before treatment(P<0.05).Conclusion rhBNP combined with furosemide can shorten the duration of AHF symptoms in the elderly patients.It can not only relieve the disease condition of heart failure,but also improve serum myocardial enzyme indicators,alleviate the myocardial injury and protect the heart in the patients.

关 键 词：利钠肽 脑 呋塞米 心力衰竭 羟丁酸脱氢酶 

分 类 号：R541.6[医药卫生—心血管疾病]