Xing Kun, Fu Xianghua, Wang Yanbo, Li Wei, Gu Xinshun, Hao Guozhen, Miao Qing, Li Shiqiang, Jiang Yunfa, Fan Weize, Geng Wei
Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Heart Vessels. 2016 Apr;31(4):490-8. doi: 10.1007/s00380-015-0642-8. Epub 2015 Jan 31.
This study aims to investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on renal function and contrast-induced nephropathy (CIN) incidence in ST-segment elevation myocardial infarction and heart failure (STEMI-HF) patients with mild renal insufficiency undergoing primary percutaneous coronary intervention (PCI). A total of 116 participants were randomized into rhBNP (rhBNP, n = 57) and nitroglycerin group (NIT, n = 59), receiving intravenous rhBNP or nitroglycerin from admission to 72 h after PCI. Renal function was assessed by serum creatinine (SCr), estimated glomerular filtration rate (eGFR), Cystatin-C (Cys-C) and β2-microglobulin before and after primary PCI, and calculated the incidence of CIN within 72 h after PCI. There were no significant differences in SCr, eGFR and β2-microglobulin between the two groups (P > 0.05, respectively). Compared with the NIT group, the total urinary volume within 72 h was higher while the level of Cys-C at 24 and 72 h after PCI was lower in the rhBNP group. rhBNP was associated with a decline in the incidence of CIN (12.28 vs. 28.81 %, P < 0.05). No differences were detected in mortality and re-hospitalization in 3 months between the two groups. The incidence of renal injury was not different between rhBNP and nitroglycerin in STEMI-HF patients with mild renal insufficiency. However, infusion of rhBNP was associated with a decline in incidence of CIN.
本研究旨在探讨重组人脑利钠肽（rhBNP）对行经皮冠状动脉介入治疗（PCI）的轻度肾功能不全的ST段抬高型心肌梗死合并心力衰竭（STEMI-HF）患者肾功能及对比剂肾病（CIN）发生率的影响。共116名参与者被随机分为rhBNP组（rhBNP，n = 57）和硝酸甘油组（NIT，n = 59），从入院至PCI术后72小时静脉输注rhBNP或硝酸甘油。在初次PCI前后通过血清肌酐（SCr）、估算肾小球滤过率（eGFR）、胱抑素C（Cys-C）和β2-微球蛋白评估肾功能，并计算PCI术后72小时内CIN的发生率。两组之间的SCr、eGFR和β2-微球蛋白无显著差异（P均> 0.05）。与NIT组相比，rhBNP组72小时内的总尿量较高，而PCI术后24小时和72小时的Cys-C水平较低。rhBNP与CIN发生率的降低相关（12.28%对28.81%，P < 0.05）。两组在3个月内的死亡率和再次住院率无差异。在轻度肾功能不全的STEMI-HF患者中，rhBNP和硝酸甘油所致肾损伤的发生率无差异。然而，输注rhBNP与CIN发生率的降低相关。
