脑钠肽对充血性心力衰竭患者恶性心脏事件发生的影响

Brain natriuretic peptide reduces incidence of adverse cardiac events in patients with congestive heart failure

关键词:  脑钠肽  慢性心力衰竭  心脏不良事件

Key words:  brain netriuretic peptide  congestive heart failure  adverse cardiac events

摘要:

目的 通过随机对照试验比较标准治疗基础上加用重组脑钠肽对患者心力衰竭疗效的影响,分析脑钠肽对心脏不良事件发生率的影响。方法 140例充血性心力衰竭患者,随机分为对照组(74例)和脑钠肽组(66例)。心力衰竭诊断采用Framingham标准,心功能采用美国纽约心脏病学会(NYHA)功能分级。全部患者均采用标准治疗(洋地黄、利尿剂、β受体阻滞剂及血管紧张素转换酶抑制剂)。脑钠肽组在此基础上加用冻干重组人脑利钠肽。观察治疗后症状的改变,采用彩色超声心动图检测左室舒张期终末容量(left ventricular enddiastolic volume,LVEDV)和左室收缩期终末容量(left ventricular end-systolic volume,LVESV)变化及左室射血分数(left ventricularejection fraction,LVEF)的变化;全部患者随访10个月,统计心脏不良事件发生情况。结果 脑钠肽组中总有效60例,有效率90.9%;对照组总有效63例,有效率85.1%(P＜0.05)。脑钠肽组因心脏原因再次入院10例,对照组15例(P＜0.05),脑钠肽组心脏原因死亡5例、对照组7例(P＞0.05)。两组患者治疗后LVESV、LVEF均有明显改善(P＜0.05)。与对照组比较,治疗后脑钠肽组LVESV、LVEDV、LVEF改善更显著(P＜0.05)。结论 脑钠肽可显著改善充血性心力衰竭患者的症状,起效时间短、作用时间长,且再次发生心脏不良事件的概率较标准治疗低。

Abstract:

Objective To investigate the effect of B-type natriuretic peptide(BNP) on incidence of adverse cardiac events in patients with decompensated congestive heart failure(CHF).Methods One hundred and forty patients with CHF were randomly assigned to routine therapy(digoxin,diuretic,β-receptor blocker and ACEI,n=74) or BNP therapy(routine therapy plus BNP I.V.,n=66).The improvement of symptoms was defined according to the cardiac function standard of New York Heart Association(NYHA).All patients underwent two-dimensional pulsed Doppler echocard-iography to measure the cardiac volume parameters(left ventricular end-diastolic volume,LVEDV;left ventricular end-systolic volume,LVESV) and the left ventricular ejection fraction(LVEF).Patients were followed up for 10months,and adverse cardiac events were defined as rehospitalization or/and death due to cardiac factors and malignant arrhythmia(ventricular tachycardia or fibrillation).Results In 66 patients receiving BNP 60 had a good therapeutic effect with an effective rate 90.9% and in control group,63 had a good therapeutic effect with an effective rate 85.1%(P＜0.05).Rehospitalization due to cardiac factors was occurred in 10 patients of BNP group and 15 of control group(P＜0.05).Five patients in BNP group died due to cardiac factors and 7died in control group(P＞0.05).LVESV and LVEF were improved after treatment in both groups(P＜0.05),but the improvement of LVESV,LVEDV and LVEF in BNP group was more markedly than that in control group(P＜0.05).Patients in both groups had improvement of symptoms with decreasement of heart rate and blood pressure,and there was no significant difference between two groups(P＞0.05).With 10months follow-up,80.3% patients in BNP group had a better cardiac function and improvement of symptoms,especially patients with NYHA Ⅱ and Ⅲ,the improvement was significantly(P＜0.01),however,patients with Ⅳ,the symptoms were not improved significantly(P＞0.05).Conclusion BNP may improve symptoms of patients with CHF and it may also reduce incidence of adverse cardiac events.