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目的观察重组人脑利钠肽(rhBNP)对初发舒张性心力衰竭(DHF)病人血管内皮功能和左室舒张功能的影响。方法将65例初发DHF病人随机分为对照组(30例)和rhBNP组(35例),对照组接受常规抗心力衰竭治疗,rhBNP组在常规治疗的同时加用rhBNP,首先以1.5μg·kg-1静脉冲击,然后以0.0075μg·kg-1·min-1的速度持续滴注5h,每周1次,共12wk。入选前和治疗12wk后测定各组病人的左室舒张功能指标、内皮素-1(ET-1)、一氧化氮(NO)和血管假性血友病因子(vWF)。结果rhBNP组治疗后二尖瓣口舒张早期及舒张晚期流速峰值比值(E/A)和NO较之同期对照组显著增加[(1.1±s0.4)vs(0.8±0.5),(67±13)μmol·L-1vs(49±13)μmol·L-1](P<0.05);左室等容舒张时间(IVRT)、E波减速时间(EDT)、收缩压、ET-1、vWF水平较之同期对照组明显减低[(80±6)msvs(95±6)ms,(140±21)msvs(161±28)ms,(141±23)mmHgvs(146±30)mmHg,(43±28)ng·L-1vs(56±12)ng·L-1,(110±24)%vs(149±32)%](P<0.05)。结论rhBNP对初发DHF病人具有保护血管内皮功能、改善舒张功能和降压的综合效应。
Objective To observe the effects of recombinant human brain natriuretic peptide (rhBNP) on endothelial function and left ventricular diastolic function in patients with newly diagnosed diastolic heart failure (DHF). Methods Sixty-five patients with newly diagnosed DHF were randomly divided into control group (n = 30) and rhBNP group (n = 35). The control group received routine anti-heart failure treatment. RhBNP group was given rhBNP at 1.5 μg · kg-1 intravenous shock, and then dripped at 0.0075μg · kg-1 · min-1 for 5h, once a week for 12wk. Left ventricular diastolic function, endothelin-1 (ET-1), nitric oxide (NO) and von Willebrand factor (vWF) were measured before and 12 weeks after treatment. Results Compared with the control group, the peak values of early diastolic and late diastolic velocities (E / A) and NO in rhBNP group were significantly higher than those in the control group [(1.1 ± s0.4) vs (0.8 ± 0.5), (67 ± 13 (P <0.05); IVRT, EDT, systolic blood pressure, ET-1 and vWF levels (140 ± 21) msvs (161 ± 28) ms, (141 ± 23) mmHg vs (146 ± 30) mmHg, (± 43) mmHg vs (80 ± 6) msvs 28) ng · L-1 vs (56 ± 12) ng · L-1, (110 ± 24)% vs (149 ± 32)%] (P <0.05). Conclusions rhBNP has the combined effect of protecting endothelial function, improving diastolic function and lowering blood pressure in primary DHF patients.