阿托伐他汀聯合rhBNP在AMI合并心力衰竭中的療效及對心腎功能、PⅢNP和hs—CRP水平的影響

阿地力江·托呼提　阿力木江·阿不來提　李杰　李國慶

[摘要] 目的 探究阿托伐他汀聯合重組人腦鈉肽（rhBNP）在治療急性心肌梗死（AMI）合并心力衰竭（HF）中的臨床效果及對患者心腎功能、Ⅲ型前膠原氨基端肽（PⅢNP）和高敏C反應蛋白（hs-CRP）水平的影響。 方法 選擇2015年10月～2016年10月于武警新疆總隊醫院就診的AMI合并HF患者90例，按照隨機數字表法將其分為對照組（45例）和治療組（45例）。在常規治療的基礎上，對照組給予阿托伐他汀鈣片，治療組給予阿托伐他汀鈣片和rhBNP。比較兩組患者治療前后的心腎功能指標、N末端腦鈉肽前體（NT-proBNP）、PⅢNP和hs-CRP水平，以及主要心血管事件（MACE）和不良反應發生情況。 結果 治療前，兩組患者左心室射血分數（LVEF）、左心室收縮末期容積（LVESV）和左心室舒張末期容積（LVEDV）比較差異無統計學意義（P > 0.05）；治療后，兩組LVEF較治療前顯著升高（P < 0.05），LVESV和LVEDV均較治療前顯著降低（P < 0.05），且治療組變化幅度較對照組更大（P < 0.05）。治療前，兩組患者血清中肌酐（Cr）、胱抑素C（Cys-C）、血尿素氮（BUN）和尿酸（UA）水平比較差異均無統計學意義（P > 0.05）。治療后，治療組Cr、Cys-C水平較治療前明顯下降（P < 0.05），兩組治療后BUN、UA水平與治療前比較差異無統計學意義（P > 0.05），且兩組治療后組間Cr、Cys-C、BUN及UA水平比較差異無統計學意義（P > 0.05）。治療前，兩組NT-proBNP、PⅢNP和hs-CRP比較差異無統計學意義（P > 0.05）；治療后，兩組NT-proBNP、PⅢNP和hs-CRP均較治療前顯著降低（P < 0.05），治療組的降低幅度較對照組更大（P < 0.05）。治療組MACE發生風險和全因死亡風險明顯低于對照組（P < 0.05），兩組不良反應發生率比較差異無統計學意義（P > 0.05）。 結論 對AMI合并HF患者應用阿托伐他汀聯合rhBNP治療能夠顯著改善患者的心腎功能，有效調節PⅢNP和hs-CRP水平，明顯降低患者MACE發生風險和死亡風險。

[關鍵詞] 心肌梗死；心力衰竭；阿托伐他汀；心腎功能

[中圖分類號] R541.6 [文獻標識碼] A [文章編號] 1673-7210（2018）09（b）-0038-05

[Abstract] Objective To explore the clinical effect of Atorvastatin combined with recombinant human brain natriuretic peptide （rhBNP） in the treatment of acute myocardial infarction （AMI） with heart failure （HF）， and its effects on cardiorenal function and levels of procollagen Ⅲ N-terminal peptide （PⅢNP） and high sensitive C reactive protein （hs-CRP）. Methods Ninety cases of patients with AMI and HF in Xinjiang General Hospital of Armed Police Forces from October 2015 to October 2016 were divided into control group （45 cases） and treatment group （45 cases） by random number table method. On the basis of routine treatment， control group was treated by Atorvastatin Calcium Tablets， treatment group was treated by Atorvastatin Calcium Tablets and rhBNP. The cardiorenal function， levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）， PⅢNP and hs-CRP as well as major adverse cardiovascular events （MACE） and adverse reactions before and after treatment were compared. Results Before treatment， there were no statistically significant differences of left ventricular ejection fractions （LVEF）， left ventricular end systolic volume （LVESV） and left ventricular end diastolic volume （LVEDV） between the two groups （P > 0.05）. After treatment， the levels of LVEF in the two groups were significantly higher than those before treatment （P < 0.05）， while the levels of LVESV and LVEDV were significantly lower than those before treatment （P < 0.05）， and the variation range of the treatment group was greater than that of the control group （P < 0.05）. Before treatment， there were no significant differences in the levels of creatinine （Cr）， cystatin-C （Cys-C）， blood urea nitrogen （BUN） and uric acid （UA） between the two groups （P > 0.05）. After treatment， the levels of Cr and Cys-C in treatment group were significantly lower than those before treatment （P < 0.05） ， while there were no signfiicant differences of the levels of BUN and UA in the two groups compared with those before treatment （P > 0.05）. And the levels of Cr， Cys-C， BUN and UA also showed no significant differences between the two groups after treatment （P > 0.05）. Before treatment， there were no significant differences of NT-proBNP， PⅢNP and hs-CRP between the two groups （P > 0.05）. After treatment， the levels of NT-proBNP， PⅢNP and hs-CRP in the two groups were significantly lower than those before treatment （P < 0.05）， and the variation range of the treatment group was greater than that of the control group （P < 0.05）. The risk of MACE and all-cause death in the treatment group were significantly lower than those of the control group （P < 0.05）， and there was no significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion Atorvastatin combined with rhBNP in treatment of patients with AMI and HF can significantly improve the cardiorenal function of the patients， effectively regulate the levels of PⅢNP and hs-CRP， and significantly reduce the risk of MACE and death of the patients.