Page 90 - 2020年21期

Analysis of Clinical Efficacy of Recombinant Human Brain Natriuretic Peptide Combined with
Levosimendan in the Treatment of Acute Decompensated Heart Failure Complicated with Renal
Insufficiency
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CHEN Gong ，YANG Fang ，WEI Gang ，LI Xiaoping ，LI Ming ，ZHANG Yaling（1. Dept. of Cardiology，the
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Affiliated Hospital of Southwest Medical University，Sichuan Luzhou 646000，China；2. Dept. of Cardiology，
Yibin Nanxi District People’s Hospital，Sichuan Yibin 644100，China；3. Dept. of Cardiology，Sichuan Provincial
People’s Hospital，Chengdu 610072，China；4. Dept. of Nephrology，East Hospital，Sichuan Provincial People’s
Hospital，Chengdu 610101，China）
ABSTRACT OBJECTIVE：To observe the clinical effect and safety of recombinant human brain natriuretic peptide（rhBNP）
combined with levosimendan in the treatment of acute decompensated heart failure（ADHF）complicated with renal insufficiency.
METHODS：A total of 156 patients with ADHF complicated with renal insufficiency admitted to the Dept. of Cardiology in the
Affiliated Hospital of Southwest Medical University during Jan.-Dec. 2019 were randomly divided into rhBNP group，levosimendan
group and combination group，with 52 patients in each group. All patients received rountine treatment. On this basis，rhBNP group
was given rhBNP for injection [after 1.5 μg/kg intravenous pulse injection，intravenous dripping for 24 h with 0.007 5 μg/（kg·
min）]；leosimendan group was given Leosimendan injection 12.5 mg [intravenous dripping for 1 h with 6-12 μg/（kg·min），then
intravenous dripping for 23 h with 0.1 μg/（kg·min）]. Combination group received drug combination according to the administration
method of single drug group. Three groups received treatment for consecutive 7 d. Cardiac function indexes [heart rate（HR），left
ventricular ejection fraction（LVEF），left ventricular end-diastolic diameter（LVEDD）]，mean arterial pressure（MAP），pulmonary
capillary pressure（PCWP），renal function indexes [estimated glomerular filtration rate（eGFR），serum creatinine（Scr）]，serum
levels of cystatin C（Cys-c）and amino-terminal brain natriuretic peptide precursor（NT-proBNP）were observed in 3 groups before
and after treatment. Clinical efficacy and the occurrence of ADR were recorded. RESULTS：Three cases withdrew from the study in
rhBNP group and 1 case in levosimendan group；152 cases completed the study. Before treatment，there was no statistical
significance in cardiac function indexes，MAP，PCMP，renal function indexes or serum levels of Cys-C and NT-proBNP among 3
groups（P＞0.05）. After treatment，the HP，MAP，PCWP and serum level of NT-proBNP in 3 group as well as serum level of Cys-C
in combination group were decreased significantly （P＜0.05）；the LVEF in 3 group as well as the eGFR and Scr level in
levosimendan group and combination group were significantly increased （P＜0.05），compared with before treatment；above
indexes of combination group were significantly better than those of rhBNP group and levosimendan group （P＜0.05）. Total
effective rate of combination group was 94.23％ ，which was significantly higher than those of rhBNP group （77.55％） and
levosimendan group（76.47％）（P＜0.05）. There was no significant difference in the incidence of ADR among 3 groups（P＞
0.05）. CONCLUSIONS：rhBNP combined with levosimendan in the treatment of ADHF complicated with renal insufficiency can
significantly increase the clinical efficacy，and improve cardiac and renal function but don’t increase the incidence of ADR.
KEYWORDS Recombinant human brain natriuretic peptide； Levosimendan； Acute decompensated heart failure； Renal
insufficiency；Therapeutic efficacy；Safety

急性失代偿性心力衰竭（Acute decompensated heart 药物，可以降低患者肺毛细血管楔压（PCWP）、改善其呼
failure，ADHF）是心血管疾病患者住院和死亡的最常见 吸困难症状 。但目前关于rhBNP对肾功能的影响仍存
[7]
[1]
原因之一 。ADHF 的主要问题是体液潴留，临床上表 在争议：早期的研究显示，该药无法明显改善急性心力
[8]
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现为全身和肺充血 。ADHF的肾功能恶化通常被描述 衰竭患者的肾功能 ；但也有研究报道称，rhBNP可改善
为“心肾综合征1型”，超过一半的患者在入院时因ADHF 心力衰竭或心肾综合征患者的肾功能指标，对肾脏具有
[3]
而出现肾功能障碍 。这种肾脏功能障碍会导致患者对 一定保护作用 [9-10] 。左西孟旦作为一种正性肌力药物，
[4]
利尿剂的反应性降低，即利尿剂抵抗 。利尿剂抵抗主 其治疗心力衰竭的作用已得到临床充分认可，近年来亦
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要与肾功能恶化和心肾综合征有关 ，因此临床通常会 发现其对肾功能不全具有一定的治疗作用，且可很好地
提高肾功能受损患者的利尿剂用药剂量 。然而，这种 缓解患者的利尿剂耐受 。已有相关研究指出，rhBNP
[11]
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治疗方向可能会陷入一个恶性循环：高剂量利尿剂的使 与左西孟旦联用在急性心力衰竭中取得了较好的疗
用与肾素-血管紧张素-醛固酮系统和交感神经系统的激 效 [12-13] ，但对合并肾功能不全的 ADHF 患者的作用效果
活有关，两者都会导致患者肾血流量减少，从而引起更 尚不完全清楚。基于此，本课题组选取2019年1－12月
严重的并发症，如肾衰竭、尿毒症等 。 西南医科大学附属医院（以下简称“我院”）心内科收治
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重组人脑利钠肽（rhBNP）是临床常用的ADHF治疗 的ADHF合并肾功能不全住院患者作为研究对象，在检

·2640 · China Pharmacy 2020 Vol. 31 No. 21 中国药房 2020年第31卷第21期