重组人脑利钠肽对慢性收缩性心力衰竭合并利尿剂抵抗患者的疗效及对TNF-α、NPY的影响

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (7): 814-820.

重组人脑利钠肽对慢性收缩性心力衰竭合并利尿剂抵抗患者的疗效及对TNF-α、NPY的影响

刘玉¹，张颖¹，王安才²

¹合肥市第一人民医院老年病科，合肥 230001，安徽； ²皖南医学院第一附属医院弋矶山医院老年医学科，芜湖 241001，安徽

收稿日期:2016-11-09 修回日期:2016-12-15 出版日期:2017-07-26 发布日期:2017-07-19
通讯作者: 王安才，男，博士，主任医师，研究方向：心血管内科。 Tel:13909633699 E-mail:yjswac@sina.com
作者简介:刘玉,女，硕士，主治医师，研究方向：心血管内科。 Tel:13637057489 E-mail:75564332@qq.com

Effect of rhBNP on chronic systolic heart failure combined with diuretic resistance and concentration of TNF-α and NPY

LIU Yu ¹, ZHANG Ying¹, WANG Ancai ²

¹Department of Geriatrics, the First People's Hospital of Hefei, Hefei 230001, Anhui, China;² Department of Geriatrics, Wannan Medical College Affiliated Yijishan Hospital, Wuhu 241001, Anhui, China

Received:2016-11-09 Revised:2016-12-15 Online:2017-07-26 Published:2017-07-19

摘要/Abstract

摘要：

目的: 研究重组人脑利钠肽（rhBNP）治疗慢性收缩性心力衰竭合并利尿剂抵抗患者的疗效，并观察rhBNP对肿瘤坏死因子-α（TNF-α）及神经肽Y（NPY）的影响。方法: 60例慢性收缩性心力衰竭合并利尿剂抵抗的患者随机分为观察组与对照组各30例，两组患者均接受吸氧、利尿、强心、营养心肌等常规抗心衰治疗，观察组在此基础上追加 rhBNP 治疗。记录治疗前及治疗后1、3 d的临床症状、尿量情况。检测两组治疗前及治疗后7 d的血清B型脑钠肽(BNP)、TNF-α、NPY浓度，左室射血分数(LVEF)和左室舒张末内径(LVEDD)，并治疗前后进行6 min步行试验。结果: 观察组患者治疗后1 d及第3天的呼吸困难好转率为80%、90%，明显高于对照组的67%、80%，差异有统计学意义(P<0.05)。观察组患者治疗后1天及第3天的肺部湿啰音好转率为90%、97%，明显高于对照组的63%、90%，差异有统计学意义(P<0.05)。观察组患者治疗后1 d及第3天的下肢水肿好转率为77%、90%，明显高于对照组的60%、77%，差异有统计学意义(P<0.05)。观察组治疗后第1天及第3天尿量为（1 367±198）、（1 528±389） mL，对照组治疗后第1天及第3天尿量为（1 040±139）、（1 096±222） mL，治疗前后两组尿量均有增加，差异均有统计学意义(P<0.05)，与对照组比较，观察组的增加幅度更为明显，差异均有统计学意义(P<0.05)。观察组患者治疗前后的6 min步行距离及LVEF、LVEDD差值分别为（201±52） m、（15.8±10.5）%、（3.5±8.2） mm，对照组分别为（162±66） m、（8.2±6.2）%、（2.2±6.7） mm，治疗后两组患者的6 min步行距离和 LVEF明显升高，差异均有统计学意义(P<0.05)，与对照组比较，观察组的升高幅度更为明显，差异均有统计学意义(P<0.05)，而两组治疗前后LVEDD均无明显变化，差异均无统计学意义(P>0.05)。观察组治疗前后的BNP、TNF-α、NPY差值分别为(725.1±258.3)、 (15.8±9.2)、(150.0±30.3) pg/mL，对照组治疗前后的BNP、TNF-α、NPY差值分别为(231.8±289.2)、 (10.1±6.4) 、(75.9±28.3) pg/mL，两组患者的上述3项指标治疗后均有所降低(P<0.05)，而观察组的降低幅度更明显，差异均有统计学意义(P<0.05)。结论: rhBNP能明显改善慢性收缩性心力衰竭合并利尿剂抵抗患者的临床症状，可能与减少TNF-α表达和降低NPY浓度有关。

关键词: 慢性收缩性心力衰竭, 重组人脑利钠肽, 肿瘤坏死因子-α, 神经肽Y

Abstract:

AIM: To investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on chronic systolic heart failure combined diuretic resistance, and to observe the change of tumor necrosis factor-α (TNF-α) and neuro-peptide-Y (NPY) level of these patients. METHODS: Sixty patients of chronic systolic heart failure combined with diuretic resistance were enrolled and were randomized into the control group and the observation group (n=30). Conventional anti-heart failure treatment, including oxygen uptake, diureses, cardiotonic, myocardial nutrition was administered to all patients while patients in the observation group received extra rhBNP treatment. Clinical symptoms and urine volume were observed before treatment and 1d and 3d after. The serum BNP, TNF-α and NPY as well as the ejection fraction (EF) and left ventricular end-diastolic diameter (LVEDD) were measured before treatment and 7 d after. Six minutes walk test (6MWT) was recommended to all patients so as to evaluate the heart function. RESULTS: Compared with the control group, the dyspnea improvement rates at day 1 (80% vs. 67%) and day 3 (90% vs.80%) were significantly improved (P<0.05); so were the lung crakles improvement rates at day 1 (90% vs. 63%) and day 3 (97% vs. 90%) (P<0.05) and the edema of lower extremity improvement rates at day 1 (77% vs. 60%) and day 3 (90% vs. 77%).Urine volume of the both group were significantly increased after treatment, while those (1 367±198) mL (day 1) , (1 528±389) mL (day 3) of the observation group presented more significant change than the control group (1 040±139) mL (day 1), (1 096±222) mL (day 3) (P<0.05).The scores of 6MWT［(201±52) m］ and difference value of LVEF［(15.8±10.5)%］ before and after treatment were significantly higher than those ［(162±66) m］,［(2.2±6.7) mm］ of the control group (P<0.05), while LVEDD of the both group［(3.5±8.2)% ］ vs. ［(8.2±6.2)%］ presented no significant difference (P>0.05). BNP ［(725.1±258.3) pg/mL vs. (231.8±289.2) pg/mL］, TNF-α［(15.8±9.2) pg/mL vs. (10.1±6.4) pg/mL］ and NPY［(150.0±30.3) pg/mL vs. (75.9±28.3) pg/mL］ were all decreased after treatment (P<0.05), while decrease of the observation group was more significant (P<0.05)CONCLUSION:rhBNP can alleviate the symptoms of chronic systolic heart failure combined with diuretic resistance; the mechanism may be related to down-regulating serum TNF-α and NPY.

Key words: chronic systolic heart failure, recombinant human brain natriuretic peptide, TNF-α, neuropeptide Y

中图分类号:

R544.1

刘玉，张颖，王安才. 重组人脑利钠肽对慢性收缩性心力衰竭合并利尿剂抵抗患者的疗效及对TNF-α、NPY的影响[J]. 中国临床药理学与治疗学, 2017, 22(7): 814-820.

LIU Yu, ZHANG Ying, WANG Ancai. Effect of rhBNP on chronic systolic heart failure combined with diuretic resistance and concentration of TNF-α and NPY[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(7): 814-820.

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