重组人脑利钠肽对急性心肌梗死后急性心力衰竭循环内分泌激素及左室功能的影响

目的:了解重组人脑利钠肽(rhBNP)对急性心肌梗死(AMI)后急性失代偿性心力衰竭(HF)患者循环内分泌激素及左室功能的影响,并评判其临床疗效和安全性。方法:AMI并发急性失代偿性HF患者58例,随机分为rhBNP组26例和硝酸异山梨酯组32例,在标准抗缺血、抗HF治疗的基础上,持续静脉应用rhBNP或硝酸异山梨酯48h,分别于治疗前和治疗后6h、24h及72h,检测血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度;治疗前及治疗后72h测定血BNP、超声心动图测定左室舒张末期内径(LVDd)及左室射血分数(LVEF);同时比较30d内主要不良心脏事件(MACE)的发生情况。结果:与硝酸异山梨酯组比较,rhBNP组血浆PRA、AngⅡ、ALD治疗6h后即降低(均P<0.05),72h时仍保持较低水平(均P<0.01);治疗后72hBNP下降(P<0.01),LVDd及LVEF明显改善(P<0.05,P<0.01),30dMACE事件发生率rhBNP组显著低于硝酸异山梨酯组(P<0.05)。结论:rhBNP对AMI伴HF患者的血浆肾素、AngⅡ和ALD水平有快速而持续的抑制作用,可以显著改善左室功能,同时降低30d内MACE事件发生率。

Efficacy of recombinant human brain natriuretic peptide on endocrine hormone and left ventricular function of acute heart failure patients from acute myocardial infarction

Objective:To investigate the clinical efficacy of recombinant human brain natriuretic peptide(rhBNP) on endocrine hormone and left ventricular function of acute decompensated heart failure(ADHF) patients resulted from acute myocardial infarcfion(AMI). Method:Fifty-eight patients with AMI-ADHF were randomly divided into rhBNP group(n=26) and isosorbide mononitrate group(n=32).They were all received standard anti-ischemic and anti-heart failure treatment.We detected plasma renin activity(PRA),angiotensin Ⅱ(Ang Ⅱ) and aldosterone(ALD) concentration before treatment and after 6,24 and 72 hours.Blood BNP,left ventricular end-diastolic diameter(LVDd) and left ventricular ejection fraction(LVEF) were determined before treatment and after 72 hours.All patients were followed up for l month to record the main adverse cardiac event(MACE). Result:Compared with isosorbide mononitrate group,plasma PRA,AngⅡ,ALD were significantly decreased at 6 h(P<0.05),and still remained the lower level at 72 h.Blood BNP was decreased(P<0.05),LVDd and LVEF were improved significantly(P<0.05,P<0.01) at 72 h.MACE were lower in rhBNP group within 30 days than those of isosorbide mononitrate group(P<0.05). Conclusion:In patients with AMI-ADHF,rhBNP can inhibit plasma renin,AngⅡ and ALD,significantly improve left ventricular function and reduce the rate of the MACE within 30 days.