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