重组人脑利钠肽联合沙库巴曲缬沙坦钠治疗扩张型心肌病合并心力衰竭的疗效观察

陈宝珍 罗建

[摘要]目的觀察重组人脑利钠肽（rhBNP）联合沙库巴曲缬沙坦钠片治疗扩张型心肌病合并心力衰竭的应用效果。方法选取温州医科大学附属衢州医院2019年3月至2020年10月住院符合入选标准的扩张型心肌病合并心力衰竭患者50例，依照疾病诊断标准及治疗所用药物的不同分为治疗组（ n=24）和对照组（ n=26），对照组采用常规治疗，治疗组在对照组基础上加用rhBNP及沙库巴曲缬沙坦钠，观察两组患者治疗前及治疗1周、1个月后相关指标，分别观察两组在降低脑利钠肽（BNP）、超敏 C 反应蛋白（hs-CRP）、左心室舒张末期内径（LVEDd）水平及提高左心室射血分数（LVEF）等指标。结果治疗1周后，治疗组在降低心率、肌酐、血压水平和增加尿量方面较对照组明显，差异有统计学意义（ P <0.05）;治疗组的血浆 BNP、hs-CRP 水平下降较对照组更明显，差异有统计学意义（ P <0.05）;治疗1个月后，治疗组 LVEF 及LVEDd较对照组改善更明显，差异有统计学意义（ P <0.05），治疗组血浆 BNP、hs-CRP 水平下降较对照组更明显，差异有统计学意义（ P <0.05）。结论rhBNP联合沙库巴曲缬沙坦钠对扩张型心肌病合并心力衰竭患者有显著的临床治疗效果。

[关键词]重组人脑利钠肽;沙库巴曲缬沙坦钠片;扩张性心肌病;心力衰竭

[中图分类号] R541.6  [文献标识码] A   [文章编号]2095-0616（2021）24-0022-05

Observation on the therapeutic efficacy of recombinant human brain natriuretic peptide combined with sacubitril valsartan sodium on dilated cardiomyopathy complicated with heart failure

CHEN  Baozhen    LUO  Jian

Department of General Medicine， Quzhou Hospital Affiliated to Wenzhou Medical University， Quzhou People's Hospital， Zhejiang， Quzhou 324000， China

[Abstract] Objective To observe the application effect of recombinant human brain natriuretic peptide （rhBNP） combined with sacubitril valsartan sodium tablets on dilated cardiomyopathy complicated with heart failure. Methods A total of 50 patients with dilated cardiomyopathy complicated with heart failure who met the election criteria and admitted to Quzhou Hospital Affiliated to Wenzhou Medical University from March 2019 to October 2020 were selected， and they were divided into the treatment group （n=24） and the control group （n=26） according to the diagnostic criteria of the disease and the drugs used for treatment. The control group was treated with conventional treatment. The treatment group was additionally treated with rhBNP and sacubitril valsartan sodium on the basis of the control group. And the related indices of the two groups of patients were observed before treatment， 1 week after treatment and 1 month after treatment. The indices of the two groups were observed when they decreased the levels of BNP ，hs-CRP， LVEDd and increased LVEF. Results 1 week after treatment， the treatment group was more significant than the control group in reducing the levels of heart rate， creatinine， blood pressure and increasing urine output， with statistically significant differences （P <0.05）. The levels of plasma BNP and hs-CRP in the treatment group decreased more significantly than those in the control group， with statistically significant differences （P <0.05）.1 month after treatment， LVEF and LVEDd in the treatment group improved more significantly than those in the control group， with statistically significant differences （P <0.05）. The levels of plasma BNP and hs-CRP in the treatment group decreased more significantly than those in the control group， with statistically significant differences （P <0.05）. Conclusion rhBNP combined with sacubitril valsartan sodium has a significant clinical therapeutic efficacy on patients with dilated cardiomyopathy complicated with heart failure.

[Key words] Recombinant human brain natriuretic peptide; Sacubitril valsartan sodium tablets; Dilated cardiomyopathy; Heart failure

扩张性心肌病合并心力衰竭患者病情迁延不愈，病死率很高，中国心力衰竭注册登记研究中，患者因心力衰竭住院死亡率可高达4.1%[1]。国外研究显示，随着人口的老龄化问题日益严重，预计在未来20年内，心力衰竭的患病率将增加25%[2]。由急性心力衰竭导致的心血管疾病死亡率仍居高不下，常规药物治疗在心力衰竭方面遇到瓶颈。

重组人脑利钠肽（rhBNP）在急性心力衰竭治疗方面有确切疗效[3]，但如何使心力衰竭患者得到持续获益？沙库巴曲缬沙坦钠能降低心力衰竭患者的再住院率及全因死亡率，欧美指南同步对沙库巴曲缬沙坦进行了Ⅰ级推荐[4-5]。……