中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
8期
1302-1306
,共5页
李文明%张志扬%谢文韬%陈冬冬
李文明%張誌颺%謝文韜%陳鼕鼕
리문명%장지양%사문도%진동동
心肌梗死%心室功能障碍,左%利钠肽,脑%预后
心肌梗死%心室功能障礙,左%利鈉肽,腦%預後
심기경사%심실공능장애,좌%리납태,뇌%예후
Myocardial infarction%Ventricular dysfunction,left%Natriuretic peptide,brain%Prognosis
目的：评估重组人脑利钠肽（rhBNP）对急性心肌梗死（AMI）并左心功能不全（LVD）的疗效。方法选择安溪县医院心内科2012年12月至2014年5月连续住院资料完整的急性ST段抬高型心肌梗死患者80例，随机分为rhBNP组及硝酸甘油组各40例，均采用标准治疗。比较两组的治疗效果，并随访6个月，观察主要心脏不良事件（恶性心律失常、心肌梗死、心力衰竭再入院、心源性死亡）发生情况。结果（1）两组在年龄、性别、血压、心肌梗死部位、糖尿病、高血压病及BNP无统计学差异（。2）与硝酸甘油组相比较：①治疗2 h，rhBNP组症状改善率（92.5%vs.75.0%），血氧饱和度[（98.4±5.7）% vs.（91.4±7.3）%]，心率[（89±15）次/min vs.（103±13）次/min）]与硝酸甘油组均有统计学差异（P 均＜0.05）；②出院时 rhBNP 组射血分数高[（50.64±4.62）% vs.（45.36±4.09）%]，左心室内径不大[（4.85±0.51）cm vs.（5.33±0.59）cm]，BNP较低[（283.4±69.7）pg/ml vs.（370.6±104.1）pg/ml]，不良事件较少（7.5%vs.25%），P均＜0.05；③随访6个月，rhBNP组射血分数高[（55.34±5.37）%vs.（47.83±4.78）%]，左心室内径不大[（4.57±0.43）cm vs.（5.21±0.64）cm]，不良事件较少（27.5%vs.52.5%），P均＜0.05，心血管风险下降45.5%（HR=0.545，95 CI：0.315～0.946，P=0.025）。结论 rhBNP可有效改善AMI-LVD患者症状，降低BNP，改善左心室射血分数，减少心脏不良事件的发生。
目的：評估重組人腦利鈉肽（rhBNP）對急性心肌梗死（AMI）併左心功能不全（LVD）的療效。方法選擇安溪縣醫院心內科2012年12月至2014年5月連續住院資料完整的急性ST段抬高型心肌梗死患者80例，隨機分為rhBNP組及硝痠甘油組各40例，均採用標準治療。比較兩組的治療效果，併隨訪6箇月，觀察主要心髒不良事件（噁性心律失常、心肌梗死、心力衰竭再入院、心源性死亡）髮生情況。結果（1）兩組在年齡、性彆、血壓、心肌梗死部位、糖尿病、高血壓病及BNP無統計學差異（。2）與硝痠甘油組相比較：①治療2 h，rhBNP組癥狀改善率（92.5%vs.75.0%），血氧飽和度[（98.4±5.7）% vs.（91.4±7.3）%]，心率[（89±15）次/min vs.（103±13）次/min）]與硝痠甘油組均有統計學差異（P 均＜0.05）；②齣院時 rhBNP 組射血分數高[（50.64±4.62）% vs.（45.36±4.09）%]，左心室內徑不大[（4.85±0.51）cm vs.（5.33±0.59）cm]，BNP較低[（283.4±69.7）pg/ml vs.（370.6±104.1）pg/ml]，不良事件較少（7.5%vs.25%），P均＜0.05；③隨訪6箇月，rhBNP組射血分數高[（55.34±5.37）%vs.（47.83±4.78）%]，左心室內徑不大[（4.57±0.43）cm vs.（5.21±0.64）cm]，不良事件較少（27.5%vs.52.5%），P均＜0.05，心血管風險下降45.5%（HR=0.545，95 CI：0.315～0.946，P=0.025）。結論 rhBNP可有效改善AMI-LVD患者癥狀，降低BNP，改善左心室射血分數，減少心髒不良事件的髮生。
목적：평고중조인뇌리납태（rhBNP）대급성심기경사（AMI）병좌심공능불전（LVD）적료효。방법선택안계현의원심내과2012년12월지2014년5월련속주원자료완정적급성ST단태고형심기경사환자80례，수궤분위rhBNP조급초산감유조각40례，균채용표준치료。비교량조적치료효과，병수방6개월，관찰주요심장불량사건（악성심률실상、심기경사、심력쇠갈재입원、심원성사망）발생정황。결과（1）량조재년령、성별、혈압、심기경사부위、당뇨병、고혈압병급BNP무통계학차이（。2）여초산감유조상비교：①치료2 h，rhBNP조증상개선솔（92.5%vs.75.0%），혈양포화도[（98.4±5.7）% vs.（91.4±7.3）%]，심솔[（89±15）차/min vs.（103±13）차/min）]여초산감유조균유통계학차이（P 균＜0.05）；②출원시 rhBNP 조사혈분수고[（50.64±4.62）% vs.（45.36±4.09）%]，좌심실내경불대[（4.85±0.51）cm vs.（5.33±0.59）cm]，BNP교저[（283.4±69.7）pg/ml vs.（370.6±104.1）pg/ml]，불량사건교소（7.5%vs.25%），P균＜0.05；③수방6개월，rhBNP조사혈분수고[（55.34±5.37）%vs.（47.83±4.78）%]，좌심실내경불대[（4.57±0.43）cm vs.（5.21±0.64）cm]，불량사건교소（27.5%vs.52.5%），P균＜0.05，심혈관풍험하강45.5%（HR=0.545，95 CI：0.315～0.946，P=0.025）。결론 rhBNP가유효개선AMI-LVD환자증상，강저BNP，개선좌심실사혈분수，감소심장불량사건적발생。
Objective To explore the clinical effect of lyophilized recombinant human brain natriuretic peptide (rhBNP) on treating acute myocardial infarction (AMI) complicating left ventricular dysfunction (LVD). Methods From December 2012 to May 2014, 80 consecutive patients hospitalized with acute ST segment elevation myocardial infarction included in this study. All patients were randomly divided into rhBNP group and Nitroglyceri group on top of standard therapy. All patients discharged were followed up six months, compared the treatment effect and observed the major cardiac adverse events (cardiac death, decompensated HF readmission, repeat MI or malignant arrhythmia). Results (1)There were no significant differences between the two groups with regard to age, gender, blood pressure, myocardial infarction area, diabetes, hypertension and brain natriuretic peptide (BNP). (2)Compared with Nitroglyceri group, ①after 2 hours treatment, rhBNP group had a significantly higher rate of symptom improvement (92.5% vs. 75.0%) and SpO2 [(98.4±5.7)% vs. (91.4±7.3)%], lower heart beats[(89±15) times/min vs. (103±13)times/min], all P<0.05. ②Hospital discharge rhBNP group had a higher left ventricular ejection fraction (LVEF) [(50.64±4.62)% vs. (45.36±4.09)%], lower left ventricular end-diastolic dimension (LVEDD) [(4.85±0.51)cm vs. (5.33±0.59)cm] and plasma BNP level [(283.4±69.7)pg/ml vs. (370.6±104.1)pg/ml], lower percentage of adverse event (7.5% vs. 25%), all P<0.05. ③After followed up for six months, rhBNP group had a higher left ventricular ejection fraction (LVEF) [(55.34±5.37)% vs. (47.83±4.78)%], lower left ventricular end-diastolic dimension (LVEDD) [(4.57±0.43)cm vs. (5.21±0.64)cm] and percentage of adverse event (27.5% vs. 52.5%), all P<0.05. The risk of cardiac event were significant decreased by 45.5%(hazard ratio, HR=0.545, 95%CI:0.315-0.946, P=0.025). Conclusion The application of rhBNP can effectively improve the symptom and LVEF, decrease plasma BNP level and recurrence of cardiac event for patients with AMI complicating LVD.
