重组人脑利钠肽与多巴酚丁胺对不同血 BNP 水平的急性失代偿性心力衰竭患者的疗效比较。
Comparative effects of recombinant human brain natriuretic peptide and dobutamine on acute decompensated heart failure patients with different blood BNP levels.
机构信息
Department of Cardiology, Affiliated Hospital of Nantong University, and Institute of Cardiovascular Research, Nantong University, Jiangsu 226001, China.
出版信息
BMC Cardiovasc Disord. 2014 Mar 4;14:31. doi: 10.1186/1471-2261-14-31.
BACKGROUND
Recombinant human B-type natriuretic peptide (rhBNP) has been indicated for the treatment of acute decompensated heart failure (ADHF). However, the therapeutic efficacy of intravenous rhBNP is not always satisfactory in patients with extremely high blood BNP levels. In this study, we evaluated the effects of rhBNP on patients with different BNP levels.
METHODS
One hundred and five patients with ADHF whose left ventricular ejection fraction (LVEF) was <40%, were assigned to a high BNP group (BNP ≤ 3000 pg/mL) or an extra-high BNP group (BNP > 3000 pg/mL) , depending on their admission plasma BNP levels. Each group was then subdivided into rhBNP or dobutamine subgroups according to intravenous administration with either rhBNP or dobutamine for 24-72h. In the high BNP group, 58 patients were randomized to subgroup rhBNP (n = 28) and subgroup dobutamine (n = 30). In the extra-high BNP group, 47 patients were randomized to subgroup rhBNP (n = 24) and subgroup dobutamine (n = 23). The effects of rhBNP and dobutamine on patients in the high and extra-high BNP groups were compared.
RESULTS
In the high BNP group, rhBNP was more efficient than dobutamine at improving NYHA classification (P < 0.05), decreasing plasma BNP levels (P < 0.05), increasing LVEF (P < 0.05), and reducing hospital length of stay (P < 0.05). However, rhBNP displayed no superior therapeutic efficacy to dobutamine in the extra-high BNP group. Adverse cardiovascular events in patients treated with rhBNP were similar to adverse events in patients treated with dobutamine in both the high and extra-high BNP groups.
CONCLUSIONS
rhBNP was more efficient than dobutamine at improving heart function in patients with ADHF when plasma BNP was ≤3000 pg/mL. However, rhBNP treatment showed no advantages over dobutamine when plasma BNP reached extremely high levels (>3000 pg/mL).
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT01837849.
背景
重组人 B 型利钠肽（rhBNP）已被用于治疗急性失代偿性心力衰竭（ADHF）。然而，静脉内 rhBNP 在血 BNP 水平极高的患者中的治疗效果并不总是令人满意。在这项研究中，我们评估了 rhBNP 对不同 BNP 水平患者的影响。
方法
将 105 例左心室射血分数（LVEF）<40%的 ADHF 患者根据入院时的血浆 BNP 水平分为高 BNP 组（BNP≤3000pg/ml）或超高 BNP 组（BNP>3000pg/ml）。然后，根据静脉内给予 rhBNP 或多巴酚丁胺 24-72h，将每组再分为 rhBNP 或多巴酚丁胺亚组。在高 BNP 组中，58 例患者随机分为 rhBNP 亚组（n=28）和多巴酚丁胺亚组（n=30）。在超高 BNP 组中，47 例患者随机分为 rhBNP 亚组（n=24）和多巴酚丁胺亚组（n=23）。比较 rhBNP 和多巴酚丁胺对高和超高 BNP 组患者的影响。
结果
在高 BNP 组中，rhBNP 比多巴酚丁胺更有效地改善 NYHA 分级（P<0.05）、降低血浆 BNP 水平（P<0.05）、增加 LVEF（P<0.05）和缩短住院时间（P<0.05）。然而，rhBNP 在超高 BNP 组中并未显示出优于多巴酚丁胺的治疗效果。rhBNP 治疗组与多巴酚丁胺治疗组在高和超高 BNP 组中的心血管不良事件相似。
结论
当血浆 BNP 水平≤3000pg/ml 时，rhBNP 比多巴酚丁胺更有效地改善 ADHF 患者的心功能。然而，当血浆 BNP 水平达到极高水平（>3000pg/ml）时，rhBNP 治疗与多巴酚丁胺治疗相比没有优势。
临床试验注册
ClinicalTrials.gov 标识符：NCT01837849。
Zotero 插件