Effect of recombinant human brain natriuretic peptide on hemodynamics in patients with severe heart failure

doi:10.3877/cma.j.issn.1674-6880.2019.05.006

Abstract

Abstract:

Objective

To observe the effect of recombinant human brain natriuretic peptide(rhBNP) on hemodynamics in patients with severe heart failure.

Methods

Totally 52 patients with severe heart failure admitted to the General ICU of Shanghai Pudong Hospital between February 2016 and March 2019 were randomly divided into the control group (n = 26) and rhBNP group (n = 26). Five cases in the control group and 4 cases in the rhBNP group were excluded as they did not meet the standard of case study, so the final control group and rhBNP group respectively included 21 and 22 cases. Both groups were treated with routine drugs and nutritional support in order to treat their primary basic diseases and improve cardiac function. On this basis, patients in the control group were treated with isosorbide dinitrate, while those in the rhBNP group were given rhBNP, all for 5 days. The general data of patients in the two groups were recorded. The hemodynamic indices, such as global ejection fraction (GEF), cardiac index, global end-diastolic volume index (GEDI), systemic vascular resistance index (SVRI), extravascular lung water index (ELWI), mean arterial pressure and central venous pressure, N-terminal pro-brain natriuretic peptide (NT-proBNP) and 24 h urine volume were compared before treatment and 1, 3, 7 d after treatment between the two groups.

Results

The differences of GEF, cardiac index, GEDI, SVRI, ELWI, mean arterial pressure, central venous pressure, NT-proBNP and 24 h urine volume before treatment and 1, 3, 7 d after treatment were statistically significant between these two groups (F = 20.864, 8.982, 89.286, 102.485, 43.824, 12.562, 10.189, 123.848, 89.264; all P < 0.05). Further pairwise comparison showed that there were significant differences in GEF, cardiac index, GEDI, SVRI, ELWI, mean arterial pressure and central venous pressure 3, 7 d after treatment, and NT-proBNP and 24 h urine volume 1, 3, 7 d after treatment between the rhBNP group and control group (all P < 0.05). In the rhBNP group, the expression levels of GEF [(20.6 ± 5.2)%, (28.7 ± 5.2)%, (12.2 ± 4.2)%], cardiac index [(2.88 ± 0.36), (3.68 ± 0.42), (2.02 ± 0.46) L·min^-1·m^-2] 3, 7 d after treatment and the 24 h urine volume [(1 680 ± 220), (1 868 ± 246), (2 198 ± 228), (1 568 ± 248) mL] 1, 3, 7 d after treatment were much higher than those in the same group before treatment, and were highest on 7 d after treatment (all P < 0.05). The expression levels of GEDI [(947 ± 110), (791 ± 110), (1 108 ± 100) mL/m²], SVRI [(2 642 ± 508), (2 218 ± 568), (3 289 ± 510) dyn·sec·cm^-5·m²], ELWI [(9.3 ± 2.5), (8.6 ± 2.1), (12.3 ± 2.7) mL/kg], mean arterial pressure [(73 ± 6), (69 ± 5), (80 ± 6) mmHg] and central venous pressure [(8.7 ± 1.4), (7.1 ± 1.3), (12.3 ± 2.1) mmHg] 3, 7 d after treatment, and NT-proBNP [(4 829 ± 326), (3 029 ± 298), (2 006 ± 300), (6 979 ± 469) ng/L] 1, 3, 7 d after treatment of patients in the rhBNP group were much lower than those in the same group before treatment, and were lowest on 7 d after treatment (all P < 0.05).

Conclusion

Compared with isosorbide dinitrate, rhBNP can be more effective in improving the hemodynamics and cardiac function of patients with severe heart failure, which is worthy of promotion in ICU.

Key words: Recombinant human brain natriuretic peptide, Severe heart failure, Hemodynamics, ICU

Bo Zhang, Ying Sheng, Qifang Shi, Guangyao Yang, Jinfang Cai, Jing'en Wang, Shuyun Wang. Effect of recombinant human brain natriuretic peptide on hemodynamics in patients with severe heart failure[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(05): 317-322.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhwzzyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6880.2019.05.006

https://zhwzzyxzz.cma-cmc.com.cn/EN/Y2019/V12/I05/317

Figures/Tables 3

References 21

1	Fu S, Ping P, Wang F, et al. Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure[J]. J Biol Eng, 2018, (12): 2.
2	Miao ZL, Hou AJ, Zang HY, et al. Effects of recombinant human brain natriuretic peptide on the prognosis of patients with acute anterior myocardial infarction undergoing primary percutaneous coronary intervention: a prospective, multi-center, randomized clinical trial[J]. J Thorac Dis, 2017, 9 (1): 54-63.
3	Wang Y, Gu X, Fan W, et al. Effects of recombinant human brain natriuretic peptide on renal function in patients with acute heart failure following myocardial infarction[J]. Am J Transl Res, 2016, 8 (1): 239-245.
4	颜成敏，葛赟，周瑜，等.重组人脑利钠肽对急性失代偿性心功能衰竭合并急性肾功能损伤的临床疗效观察[J].中华急诊医学杂志，2018，27(9):1041-1043.
5	王德良，李然，李建强，等.复方丹参滴丸应用于稳定型心绞痛的疗效观察及对CRP和BNP的影响[J].世界中医药，2017，12(9):2043-2046.
6	Sarzani R, Spannella F, Giulietti F, et al. NT-proBNP and its correlation with in-hospital mortality in the very elderly without an admission diagnosis of heart failure[J]. PLoS One, 2016, 11 (4): e0153759.
7	中华医学会心血管病学分会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志，2014，42(2):98-122.
8	陈灏珠，林果为，王吉耀.实用内科学[M]. 14版.北京：人民卫生出版社，2013：1345.
9	中华医学会心血管病学分会，中华心血管病杂志编辑委员会.急性心力衰竭诊断和治疗指南[J].中华心血管病杂志，2010，38(3):195-208.
10	中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018，46(10):760-789.
11	Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)[J]. Eur J Heart Fail, 2017, 19 (7): 821-836.
12	Zhang W, Danzeng Q, Feng X, et al. Sequential Organ Failure Assessment predicts outcomes of pulse indicator contour continuous cardiac output-directed goal therapy: a prospective study[J]. Medicine (Baltimore), 2017, 96 (39): e8111.
13	金光勇，林乐清，梁栋诚，等.全心舒张末期容积指数对心功能不全并脓毒性休克患者液体复苏的应用价值[J/CD].中华危重症医学杂志（电子版），2018，11(6):377-381.
14	尹海燕，邱海珊，马永辉，等.重组人脑利钠肽对脓毒症合并心功能不全患者的治疗作用[J].中国急救医学，2016，36(8):673-678.
15	张海珍，李翠莲.重组人脑利钠肽治疗急性失代偿心力衰竭的临床疗效及对炎症因子的影响[J].重庆医学，2016，45(34):4850-4851,4889.
16	Lv MY, Deng SL, Long XF. rhBNP therapy can improve clinical outcomes and reduce in-hospital mortality compared with dobutamine in heart failure patients: a meta-analysis[J]. Br J Clin Pharmacol, 2016, 81 (1): 174-185.
17	Harjola VP, Giannakoulas G, von Lewinski D, et al. Use of levosimendan in acute heart failure[J]. Eur Heart J Suppl, 2018, 20 (Suppl Ⅱ): I2-I10.
18	Silvetti S, Belletti A, Fontana A, et al. Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials[J]. ESC Heart Fail, 2017, 4 (4): 595-604.
19	肖大宴.左西孟旦治疗老年扩张型心肌病急性心力衰竭的疗效及对免疫功能的影响[J].中国老年学杂志，2019，39(16):3873-3875.
20	张宇辉，卿恩明，张健，等.国产左西孟旦与多巴酚丁胺治疗急性失代偿性心力衰竭患者血液动力学和疗效对比观察[J].中华医学杂志，2012，92(8):555-558.
21	吴淑彬，丁力平，靳志涛，等.左西孟旦与重组人脑利钠肽治疗急性失代偿性心力衰竭效果对比研究[J].天津医药，2016，44(6):789-792.

组别	例数	年龄（岁，±s）	性别比（例，男/女）	APACHEⅡ评分（分，±s）	心功能分级（例）		原发疾病（例）		机械通气（例，是/否）	CRRT （例，是/否）
组别	例数	年龄（岁，±s）	性别比（例，男/女）	APACHEⅡ评分（分，±s）	Ⅲ级	Ⅳ级	冠状动脉粥样硬化性心脏病	高血压	机械通气（例，是/否）	CRRT （例，是/否）
rhBNP组	22	74 ± 8	10/12	10 ± 4	8	14	20	2	6/16	2/20
对照组	21	73 ± 7	11/10	11 ± 3	7	14	19	2	6/15	2/19
t/χ²值	?	0.386	0.206	0.400	0.043		0.227		0.009	0.227
P值	?	0.702	0.650	0.691	0.835		0.633		0.924	0.634

组别	例数	年龄（岁，±s）	性别比（例，男/女）	APACHEⅡ评分（分，±s）	心功能分级（例）		原发疾病（例）		机械通气（例，是/否）	CRRT （例，是/否）
组别	例数	年龄（岁，±s）	性别比（例，男/女）	APACHEⅡ评分（分，±s）	Ⅲ级	Ⅳ级	冠状动脉粥样硬化性心脏病	高血压	机械通气（例，是/否）	CRRT （例，是/否）
rhBNP组	22	74 ± 8	10/12	10 ± 4	8	14	20	2	6/16	2/20
对照组	21	73 ± 7	11/10	11 ± 3	7	14	19	2	6/15	2/19
t/χ²值	?	0.386	0.206	0.400	0.043		0.227		0.009	0.227
P值	?	0.702	0.650	0.691	0.835		0.633		0.924	0.634

组别		例数	GEF（%）	心脏指数（L·min^-1· m^-2）	GEDI（mL/m²）	SVRI（dyn·sec· cm^-5·m²）	ELWI（mL/kg）	平均动脉压（mmHg）	中心静脉压（mmHg）
rhBNP组		?	?	?	?	?	?	?	?
?	治疗前	22	12.2 ± 4.2	2.02 ± 0.46	1 108 ± 100	3 289 ± 510	12.3 ± 2.7	80 ± 6	12.3 ± 2.1
?	治疗后1 d	22	13.1 ± 5.6	2.14 ± 0.38	1 089 ± 110	3 199 ± 469	11.9 ± 3.4	78 ± 6	11.9 ± 2.2
?	治疗后3 d	22	20.6 ± 5.2^abc	2.88 ± 0.36^abc	947 ± 110^abc	2 642 ± 508^abc	9.3 ± 2.5^abc	73 ± 6^abc	8.7 ± 1.4^abc
?	治疗后7 d	22	28.7 ± 5.2^abcd	3.68 ± 0.42^abcd	791 ± 110^abcd	2 218 ± 568^abcd	8.6 ± 2.1^abcd	69 ± 5^abcd	7.1 ± 1.3^abcd
对照组		?	?	?	?	?	?	?	?
?	治疗前	21	12.2 ± 4.7	2.10 ± 0.56	1 110 ± 102	3 280 ± 508	12.2 ± 2.1	82 ± 7	12.3 ± 2.2
?	治疗后1 d	21	12.9 ± 5.9	2.12 ± 0.44	1 100 ± 108	3 198 ± 569	12.0 ± 3.4	81 ± 5	11.9 ± 2.9
?	治疗后3 d	21	17.0 ± 6.0^bc	2.58 ± 0.29^bc	969 ± 109^bc	2 799 ± 462^bc	10.2 ± 2.8^bc	77 ± 5^bc	9.9 ± 2.2^bc
?	治疗后7 d	21	25.1 ± 5.4^bcd	3.28 ± 0.51^bcd	810 ± 98^bcd	2 446 ± 510^bcd	9.0 ± 2.2^bcd	72 ± 6^bcd	8.2 ± 1.1^bcd
F值		?	20.864	8.982	89.286	102.485	43.824	12.562	10.189
P值		?	<0.001	0.002	<0.001	<0.001	<0.001	0.008	0.006

组别		例数	GEF（%）	心脏指数（L·min^-1· m^-2）	GEDI（mL/m²）	SVRI（dyn·sec· cm^-5·m²）	ELWI（mL/kg）	平均动脉压（mmHg）	中心静脉压（mmHg）
rhBNP组		?	?	?	?	?	?	?	?
?	治疗前	22	12.2 ± 4.2	2.02 ± 0.46	1 108 ± 100	3 289 ± 510	12.3 ± 2.7	80 ± 6	12.3 ± 2.1
?	治疗后1 d	22	13.1 ± 5.6	2.14 ± 0.38	1 089 ± 110	3 199 ± 469	11.9 ± 3.4	78 ± 6	11.9 ± 2.2
?	治疗后3 d	22	20.6 ± 5.2^abc	2.88 ± 0.36^abc	947 ± 110^abc	2 642 ± 508^abc	9.3 ± 2.5^abc	73 ± 6^abc	8.7 ± 1.4^abc
?	治疗后7 d	22	28.7 ± 5.2^abcd	3.68 ± 0.42^abcd	791 ± 110^abcd	2 218 ± 568^abcd	8.6 ± 2.1^abcd	69 ± 5^abcd	7.1 ± 1.3^abcd
对照组		?	?	?	?	?	?	?	?
?	治疗前	21	12.2 ± 4.7	2.10 ± 0.56	1 110 ± 102	3 280 ± 508	12.2 ± 2.1	82 ± 7	12.3 ± 2.2
?	治疗后1 d	21	12.9 ± 5.9	2.12 ± 0.44	1 100 ± 108	3 198 ± 569	12.0 ± 3.4	81 ± 5	11.9 ± 2.9
?	治疗后3 d	21	17.0 ± 6.0^bc	2.58 ± 0.29^bc	969 ± 109^bc	2 799 ± 462^bc	10.2 ± 2.8^bc	77 ± 5^bc	9.9 ± 2.2^bc
?	治疗后7 d	21	25.1 ± 5.4^bcd	3.28 ± 0.51^bcd	810 ± 98^bcd	2 446 ± 510^bcd	9.0 ± 2.2^bcd	72 ± 6^bcd	8.2 ± 1.1^bcd
F值		?	20.864	8.982	89.286	102.485	43.824	12.562	10.189
P值		?	<0.001	0.002	<0.001	<0.001	<0.001	0.008	0.006

组别		例数	NT-proBNP（ng/L）	24 h尿量（mL）
rhBNP组		?	?	?
?	治疗前	22	6 979 ± 469	1 568 ± 248
?	治疗后1 d	22	4 829 ± 326^ab	1 680 ± 220^ab
?	治疗后3 d	22	3 029 ± 298^abc	1 868 ± 246^abc
?	治疗后7 d	22	2 006 ± 300^abcd	2 198 ± 228^abcd
对照组		?	?	?
?	治疗前	21	7 006 ± 500	1 560 ± 229
?	治疗后1 d	21	5 689 ± 408^b	1 620 ± 248
?	治疗后3 d	21	4 089 ± 400^bc	1 789 ± 208^bc
?	治疗后7 d	21	2 898 ± 390^bcd	1 986 ± 203^bcd
F值		?	123.848	89.264
P值		?	<0.001	<0.001

Please choose a citation manager

Content to export