重组人脑利钠肽联合左西孟旦治疗脓毒症心力衰竭的效果观察

王斌; 蔡薛芳; 林乐清

doi:10.16766/j.cnki.issn.1674-4152.002357

重组人脑利钠肽联合左西孟旦治疗脓毒症心力衰竭的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002357

1.
杭州师范大学附属医院重症医学科，浙江杭州 310000
2.
杭州师范大学附属医院体检中心，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2020KY217

详细信息

通讯作者:
林乐清，E-mail：690861687@qq.com

中图分类号: R631 R541.6
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- 文章访问数: 450
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-18
- 网络出版日期: 2022-08-13

Effect of recombinant human brain natriuretic peptide combined with levosimendan in patients with septic heart failure

1.
Department of Critical Medicine, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的探讨重组人脑利钠肽(recombinant human brain natriuretic peptide, rh-BNP)联合左西孟旦治疗脓毒症心力衰竭的疗效及安全性，分析其对患者外周血miR-132、miR-31水平的影响。方法选择2017年3月—2019年6月杭州师范大学附属医院收治的脓毒症并发心力衰竭患者117例，采用随机数字表法分为观察组(61例)和对照组(56例)，对照组采用左西孟旦治疗，观察组采用左西孟旦联合rh-BNP治疗。比较2组急性生理与慢性健康评分(acute physiology and chronic health evaluation Ⅱ, APACHEⅡ)、心功能指标[左室收缩末期内径(left ventricular end systolic diameter, LVESD)、左室舒张末期内径(left ventricular end diastolic diameter, LVEDD)、左室射血分数(left ventricular ejection fraction, LVEF)、左心室短轴缩短率(left ventricular fraction shortening, LVFS)]、心肌酶谱[乳酸脱氢酶(lactate dehydrogenase，LDH)、肌酸激酶(creatine kinase, CK)、肌酸激酶同工酶(creatine kinase-MB, CK-MB)]、外周血miR-132、miR-31及不良反应。结果治疗后，观察组APACHE Ⅱ评分[(14.62±1.74)分]低于对照组[(16.96±2.73)分，t=5.575，P＜0.05]；观察组LVEDD[(48.93±4.28)mm]、LVESD[(39.42±4.16)mm]、LVFS[(22.31±1.75)%]低于对照组[(52.18±3.95)mm、(42.28±3.74)mm、(24.97±1.89)%，t=4.257、3.898、7.905，均P＜0.05)]；治疗后，观察组血清LDH、CK、CK-MB低于对照组(均P＜0.05)。患者外周血miR-31相对表达量与LVEDD、LVESD、LDH、CK以及CK-MB呈正相关关系(均P＜0.05)。结论重组人脑利钠肽联合左西孟旦治疗脓毒症心力衰竭可有效改善临床症状、心功能，同时可改善患者外周血miR-132及miR-31表达水平。
- 重组人脑利钠肽 /
- 左西孟旦 /
- 脓毒症 /
- 心力衰竭 /
- 临床疗效 /
- 相关性
Abstract: Objective To explore and analyse the efficacy and safety of recombinant human brain natriuretic peptide (rh-BNP) combined with levosimendan in the treatment of septic heart failure, and analyse its effect on miR-132 and miR-31 levels in patients' peripheral blood. Methods A total of 117 patients with sepsis and heart failure who were admitted at the Affiliated Hospital of Hangzhou Normal University from March 2017 to June 2019 were selected. The random number table method was used to divide the observation group (61 cases) and the control group (56 cases). The control group was treated with levosimendan, and the observation group was treated with levosimendan combined with rh-BNP. The APACHE Ⅱ score, cardiac function indexes, myocardial enzyme spectrum, peripheral blood miR-132 and miR-31 and adverse reactions were compared between the two groups. Results After treatment, the APACHE Ⅱ score of the observation group[(14.62±1.74) points] was lower than that of the control group[(16.96±2.73) points, t=5.575, P < 0.05]. The LVEDD[(48.93±4.28) mm], LVESD[(39.42±4.16) mm] and LVFS[(22.31±1.75)%] of the observation group were lower than those of the control group[(52.18±3.95) mm, (42.28±3.74) mm, (24.97±1.89)%, respectively, t=4.257, 3.898, 7.905, all P < 0.05]. The serum LDH, CK and CK-MB levels in the observation group were lower than those in the control group (all P < 0.05). The relative expression of miR-31 in the peripheral blood of patients was positively correlated with LVEDD, LVESD, LDH, CK and CK-MB (all P < 0.05). Conclusion rh-BNP combined with levosimendan in the treatment of septic heart failure can effectively improve the clinical symptoms and cardiac function, and it can also improve the expression of miR-132 and miR-31 in the peripheral blood of patients.
- Recombinant human brain natriuretic peptide /
- Levosimendan /
- Sepsis /
- Heart failure /
- Clinical efficacy /
- Correlation

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图 1 miR-132与心功能及心肌酶谱各指标的相关性分析

Figure 1. Correlation analysis of miR-132 with cardiac function and cardiac enzymes

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图 2 miR-31与心功能及心肌酶谱各指标的相关性分析

Figure 2. Correlation analysis of miR-31 with cardiac function and cardiac enzymes

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表 1 2组脓毒症并发心力衰竭患者临床资料比较

Table 1. Comparison of clinical data of two groups of patientswith sepsis complicated with heart failure

组别	例数	性别(例)		年龄(x±s, 岁)	心功能分级(例)
组别	例数	男性	女性	年龄(x±s, 岁)	Ⅲ	Ⅳ
观察组	61	36	25	65.61±8.32	42	19
对照组	56	31	25	64.11±7.21	36	20
统计量		0.160^a		1.032^b	0.274^a
P值		0.689		0.304	0.601
注：^a为χ²值，^b为t值。

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表 2 2组脓毒症并发心力衰竭患者治疗前后APACHE Ⅱ评分比较(x±s, 分)

Table 2. Two groups of patients with sepsis complicatedwith heart failure before and after treatment comparisonof APACHE Ⅱ scores (x±s, points)

组别	例数	治疗前	治疗后
观察组	61	21.74±3.18	14.62±1.74^a
对照组	56	21.94±3.62	16.96±2.73^a
t值		0.318	5.575
P值		0.751	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组脓毒症并发心力衰竭患者治疗前后心功能指标比较(x±s)

Table 3. Comparison of cardiac function indexes in the two groups of patients with sepsis complicatedwith heart failure before and after treatment (x±s)

组别	例数	LVEDD(mm)		LVESD(mm)		LVEF(%)		LVFS(%)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	61	61.27±5.39	48.93±4.28^a	47.28±4.75	39.42±4.16^a	42.29±3.24	43.96±3.21^a	26.85±2.44	22.31±1.75^a
对照组	56	60.97±5.84	52.18±3.95^a	48.02±4.39	42.28±3.74^a	41.75±3.64	45.69±3.80^a	27.10±2.79	24.97±1.89^a
t值		0.289	4.257	0.873	3.898	0.849	3.500	0.517	7.905
P值		0.773	＜0.001	0.385	＜0.001	0.397	0.001	0.606	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组脓毒症并发心力衰竭患者治疗前后心肌酶谱变化(x±s, U/L)

Table 4. Changes of myocardial enzyme spectrum in patients with sepsis complicated with heart failure beforeand after treatment in two groups (x±s, U/L)

组别	例数	LDH		CK		CK-MB
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	61	277.64±56.38	167.28±31.65^a	209.74±23.17	160.87±16.48^a	61.27±6.19	21.31±3.42^a
对照组	56	272.61±49.70	203.46±44.27^a	207.64±28.46	185.62±22.02^a	61.75±6.85	30.46±4.22^a
t值		0.510	5.116	0.439	6.919	0.398	12.931
P值		0.611	＜0.001	0.661	＜0.001	0.691	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 5 2组脓毒症并发心力衰竭患者治疗前后外周血miR-132、miR-31相对表达量比较(x±s)

Table 5. Peripheral blood of two groups of patients with sepsiscomplicated with heart failure before and aftertreatment comparison of relative expressionlevels of miR-132 and miR-31 (x±s)

组别	例数	miR-132		miR-31
组别	例数	治疗前	治疗后	治疗前	治疗后
观察组	61	0.97±0.25	2.19±0.77^a	4.47±0.68	2.31±0.83^a
对照组	56	0.88±0.31	1.74±0.69^a	4.62±0.82	2.95±0.90^a
t值		1.735	3.318	1.080	4.001
P值		0.085	0.001	0.282	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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