CAJ | 학술논문

目的研究重组人B型利钠肽(rhBNP)治疗急性前壁心肌梗死(AAMI)伴收缩性心力衰竭(SHF)老年患者的临床疗效和安全性.方法连续住院的发病72 h内AAMI-SHF老年患者(>60岁)87例,随机分为rhBNP组和硝酸甘油(NTG)组,在常规治疗的基础上,分别给予持续静脉滴注rhBNP或NTG 24 h.记录呼吸困难改善情况、测定BNP、血肌酐和肾小球滤过率(GFR),观察治疗后心脏功能改变和30 d内的主要不良心脏事件(MACE)的发生情况.结果 rhBNP组患者呼吸困难缓解时间显著短于NTG组(P<0.05),左室射血分数(LVEF)、左室舒张末容积(LVEDD)以及血浆BNP水平的改善在rhBNP组显著优于NTG组(P<0.01).两组GFR均下降,第3天GFR回升,第7天时,GFR水平已经显著高于基线水平,两组各时间点比较均无显著性差异.用药后7 d内rhBNP组室性心律失常发生率显著少于NTG组(P<0.05).14和30 d MACE事件发生率rhBNP组均显著少于NTG组(P<0.05).结论 rhBNP可有效改善老年急性心肌梗死合并SHF患者的心脏功能,降低30 d MACE事件发生率,对患者肾功能无显著影响.
목적 연구중조인B형리납태(rhBNP)치료급성전벽심기경사(AAMI)반수축성심력쇠갈(SHF)노년환자적림상료효화안전성.방법 련속주원적발병72 h내AAMI-SHF노년환자(>60세)87례,수궤분위rhBNP조화초산감유(NTG)조,재상규치료적기출상,분별급여지속정맥적주rhBNP혹NTG 24 h.기록호흡곤난개선정황、측정BNP、혈기항화신소구려과솔(GFR),관찰치료후심장공능개변화30 d내적주요불양심장사건(MACE)적발생정황.결과 rhBNP조환자호흡곤난완해시간현저단우NTG조(P<0.05),좌실사혈분수(LVEF)、좌실서장말용적(LVEDD)이급혈장BNP수평적개선재rhBNP조현저우우NTG조(P<0.01).량조GFR균하강,제3천GFR회승,제7천시,GFR수평이경현저고우기선수평,량조각시간점비교균무현저성차이.용약후7 d내rhBNP조실성심률실상발생솔현저소우NTG조(P<0.05).14화30 d MACE사건발생솔rhBNP조균현저소우NTG조(P<0.05).결론 rhBNP가유효개선노년급성심기경사합병SHF환자적심장공능,강저30 d MACE사건발생솔,대환자신공능무현저영향.
Objective To investigate the efficacy and safety of recombinent human B-type natriuretic peptide (rhBNP) on systolic heart failure (SHF) resulted from acute anterior myocardial infarction (AAMI) in the elderly. Methods 87 patients with AAMI-SHF were randomly divided into the rhBNP and nitroglycerin (NTG) groups. rhBNP was given at 1.5 μg/kg intravenously and then infused intravenously (0.007 5～0.030 μg·kg~(-1)·min~(-1)). NTG was used intravenously in NTG group as control (10～100 μg/min). Both drugs were administered for 24 h. Blood samples were collected at different time points to investigate TnI, BNP, serum creatinine and other biochemic parameters. Glomerular filtration rate (GFR) was calculated according to the simplified equation of MDRD formula.Ultrasonic cardiography (UCG) was performed before the initiation of the infusion, at day 1, 14 and 30 after the infusion. All patients were followed up for 1 month to record the main adverse cardiac events (MACEs). Results Clinical characteristics of heart failure were all improved much more in rhBNP group than that of NTG group. Left ventricular ejection fraction (LVEF) was raised at 24 h in both groups and it was raised much more in rhBNP group. Left ventricular end-diastolic dimension (LVEDD) was decreased significantly at 24 h in both groups and it was decreased much more in rhBNP group. Concentration of plasma BNP was significantly reduced in both groups and there was significant difference between 2 groups. GFR was lowered in both 2 groups at 1 day. At 3 day, GFR rebounded to baseline value. At 7 day, GFR was higher than baseline. There was no difference between 2 groups at different time point. The rate of ventricular arrhythmia was fewer within 7 days in rhBNP group than that of NTG group. MACEs were lower in rhBNP group at 14 and 30 d than those of NTG group. Conclusions rhBNP can improve the heart function of old patients with AAMI-SHF, reduce the rate of the MACEs of AAMI-SHF within 30 days, and has no significant effect on patients renal function.