小剂量rhBNP治疗慢性充血性心力衰竭患者的疗效性和安全性观察
发布时间：2018-11-18 10:25
【摘要】：目的慢性心力衰竭5年生存率和恶性肿瘤相似,目前药物治疗目的主要包括改善心肌重塑、影响远期预后、缓解临床症状以及保证近期生存率等方面,本研究主要通过对慢性充血性心力衰竭(chronic congestive heart failure,CCHF)患者早期小剂量持续静脉泵入冻干重组人脑钠肽(recombinant human brain natriuretic peptide,rh BNP,简称新活素),观察血浆氮-末端人脑钠肽(N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP)、临床症状缓解、超声心动图参数变化以及血清肌酐、钠离子、钾离子浓度变化情况,并评估其临床疗效性及安全性。方法本次研究入选了2015.2-2016.2在安徽省立医院心内科住院,明确诊断为慢性充血性心力衰竭,且符合本次入选条件的患者80例。分为rh BNP组和常规治疗组,其中常规治疗组38例,rh BNP组42例。两组均给予心力衰竭一般标准化治疗,rh BNP组在常规的心力衰竭标准化治疗的基础上早期加用小剂量rh BNP静脉泵入7 d,常规治疗组给予等量生理盐水治疗。收集统计两组患者治疗前后的以下参数:美国纽约心脏病协会(NYHA)心功能分级、行超声心动图检查:记录左心室射血分数(LVEF)、肺动脉压力(SPAP)、左心室舒张末内径(LVEDD)等参数、血肌酐浓度、血钾离子浓度、血钠离子浓度、血浆NT-pro BNP值以及所有入选患者治疗期间24 h尿量,以心源性死亡、心力衰竭恶化需辅助通气、实验药物不能耐受为终点事件,分析比较rh BNP在治疗CCHF时的疗效性和安全性。结果(1)两组患者治疗前后血浆NT-pro BNP水平均有下降,rh BNP组由(4937±3009)pg/ml降至(2636±1670)pg/ml,常规治疗组血浆NT-pro BNP水平由(4603±2640)pg/ml降至(3474±1964)pg/ml,统计分析结果表明rh BNP组NT-pro BNP水平下降更明显,优于常规治疗组,差异有统计学意义(P0.05)。(2)rh BNP组治疗后纽约心功能分级改善更显著(P0.05)。(3)两组患者经治疗后,rh BNP组LVEF由(34±6)%增加至(44±6)%(P0.05),差异有统计学意义。rh BNP组SPAP和LVEDD虽较治疗前有所改善,但改善不显著,差异无统计学意义(P0.05);常规治疗组LVEF、SPAP和LVEDD治疗前后变化均无统计学差异。(4)rh BNP组治疗期间人均尿量(2429±824)ml优于常规治疗组水平(2136±581)ml,两组差异有统计学意义(P0.05)。(5)两组患者治疗前后血清肌酐、钠离子、钾离子水平均无显著性差异(P0.05)。结论早期持续应用小剂量冻干重组人脑钠肽治疗慢性充血性心力衰竭患者,可在传统标准化心力衰竭治疗的基础上可进一步提高LVEF、降低血浆NT-pro BNP、增加尿量、改善患者NYHA分级,其临床疗效优于传统治疗,且安全性好,不影响患者肾功能及其电解质浓度。
[Abstract]:Objective the 5-year survival rate of chronic heart failure is similar to that of malignant tumor. At present, drug therapy aims at improving myocardial remodeling, affecting long-term prognosis, relieving clinical symptoms and ensuring short-term survival rate. In this study, early low-dose continuous intravenous infusion of freeze-dried recombinant human brain natriuretic peptide (recombinant human brain natriuretic peptide,rh BNP,) was performed in patients with chronic congestive heart failure (chronic congestive heart failure,CCHF). To observe the changes of plasma N-terminal human brain natriuretic peptide (N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP),) in clinical symptom relief, echocardiographic parameters and serum creatinine, sodium ion and potassium ion concentration. The clinical efficacy and safety were evaluated. Methods 80 patients with chronic congestive heart failure (CHF) were enrolled in this study in Anhui Provincial Hospital from May 2 to June 2012.There were 80 patients who were diagnosed as chronic congestive heart failure (CHF). The patients were divided into rh BNP group and routine treatment group, including 38 cases of routine treatment group and 42 cases of, rh BNP group. Both groups were given general standardized treatment for heart failure. The, rh BNP group was given the same amount of normal saline at the early stage on the basis of routine standardized treatment of heart failure and intravenous infusion of small dose of rh BNP for 7 days. The following parameters were collected before and after treatment: (NYHA) cardiac function grading, echocardiography, left ventricular ejection fraction (LVEF),) pulmonary artery pressure (SPAP),) were recorded by the New York Heart Association. The parameters of left ventricular end-diastolic diameter (LVEDD), serum creatinine concentration, serum potassium ion concentration, plasma sodium ion concentration, plasma NT-pro BNP value, and 24 h urine volume during treatment in all patients died of cardiogenic death. Auxiliary ventilation was required for the deterioration of heart failure. The efficacy and safety of rh BNP in the treatment of CCHF were analyzed and compared. Results (1) Plasma NT-pro BNP levels decreased from (4937 卤3009) pg/ml to (2636 卤1670) pg/ml, in both groups before and after treatment. Plasma NT-pro BNP levels in routine treatment group decreased from (4603 卤2640) pg/ml to (3474 卤1964) pg/ml,. The results of statistical analysis showed that the level of NT-pro BNP in rh BNP group was significantly lower than that in routine treatment group. The difference was statistically significant (P0.05). (2) rh BNP group, P 0.05). (3) the LVEF of, rh BNP group increased from (34 卤6)% to (44 卤6)% (P0.05). There was significant difference between SPAP and LVEDD in. Rh BNP group, but the improvement was not significant (P0.05). There was no significant difference in LVEF,SPAP and LVEDD before and after treatment in routine treatment group (4) urine volume per capita in) rh BNP group (2429 卤824) ml was better than that in routine treatment group (2136 卤581) ml,. There was no significant difference in serum creatinine, sodium ion and potassium ion between the two groups before and after treatment (P0.05). Conclusion early continuous use of low-dose lyophilized recombinant human brain natriuretic peptide in the treatment of patients with chronic congestive heart failure can further improve LVEF, and reduce plasma NT-pro BNP, and increase urine volume in patients with chronic congestive heart failure on the basis of traditional standardized heart failure treatment. The improvement of NYHA grade was superior to the traditional treatment, and the safety was good, and the renal function and electrolyte concentration were not affected.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.61
本文编号：2339778
[Abstract]:Objective the 5-year survival rate of chronic heart failure is similar to that of malignant tumor. At present, drug therapy aims at improving myocardial remodeling, affecting long-term prognosis, relieving clinical symptoms and ensuring short-term survival rate. In this study, early low-dose continuous intravenous infusion of freeze-dried recombinant human brain natriuretic peptide (recombinant human brain natriuretic peptide,rh BNP,) was performed in patients with chronic congestive heart failure (chronic congestive heart failure,CCHF). To observe the changes of plasma N-terminal human brain natriuretic peptide (N-Terminal Pro-brain Natriuretic Peptide,NT-pro BNP),) in clinical symptom relief, echocardiographic parameters and serum creatinine, sodium ion and potassium ion concentration. The clinical efficacy and safety were evaluated. Methods 80 patients with chronic congestive heart failure (CHF) were enrolled in this study in Anhui Provincial Hospital from May 2 to June 2012.There were 80 patients who were diagnosed as chronic congestive heart failure (CHF). The patients were divided into rh BNP group and routine treatment group, including 38 cases of routine treatment group and 42 cases of, rh BNP group. Both groups were given general standardized treatment for heart failure. The, rh BNP group was given the same amount of normal saline at the early stage on the basis of routine standardized treatment of heart failure and intravenous infusion of small dose of rh BNP for 7 days. The following parameters were collected before and after treatment: (NYHA) cardiac function grading, echocardiography, left ventricular ejection fraction (LVEF),) pulmonary artery pressure (SPAP),) were recorded by the New York Heart Association. The parameters of left ventricular end-diastolic diameter (LVEDD), serum creatinine concentration, serum potassium ion concentration, plasma sodium ion concentration, plasma NT-pro BNP value, and 24 h urine volume during treatment in all patients died of cardiogenic death. Auxiliary ventilation was required for the deterioration of heart failure. The efficacy and safety of rh BNP in the treatment of CCHF were analyzed and compared. Results (1) Plasma NT-pro BNP levels decreased from (4937 卤3009) pg/ml to (2636 卤1670) pg/ml, in both groups before and after treatment. Plasma NT-pro BNP levels in routine treatment group decreased from (4603 卤2640) pg/ml to (3474 卤1964) pg/ml,. The results of statistical analysis showed that the level of NT-pro BNP in rh BNP group was significantly lower than that in routine treatment group. The difference was statistically significant (P0.05). (2) rh BNP group, P 0.05). (3) the LVEF of, rh BNP group increased from (34 卤6)% to (44 卤6)% (P0.05). There was significant difference between SPAP and LVEDD in. Rh BNP group, but the improvement was not significant (P0.05). There was no significant difference in LVEF,SPAP and LVEDD before and after treatment in routine treatment group (4) urine volume per capita in) rh BNP group (2429 卤824) ml was better than that in routine treatment group (2136 卤581) ml,. There was no significant difference in serum creatinine, sodium ion and potassium ion between the two groups before and after treatment (P0.05). Conclusion early continuous use of low-dose lyophilized recombinant human brain natriuretic peptide in the treatment of patients with chronic congestive heart failure can further improve LVEF, and reduce plasma NT-pro BNP, and increase urine volume in patients with chronic congestive heart failure on the basis of traditional standardized heart failure treatment. The improvement of NYHA grade was superior to the traditional treatment, and the safety was good, and the renal function and electrolyte concentration were not affected.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.61
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