| BackgroundHeart failure is a serious or late stage of a variety of heart diseases,with high mortality and rehospitalization rates,and the prevalence of heart failure in developed countries is 1.5% to 2.0%.The epidemiological survey in 2003 showed that the prevalence rate of heart failure in adults aged 35 to 74 years old in China was 0.9%.The incidence of chronic diseases such as coronary heart disease,hypertension,diabetes mellitus and other chronic diseases shows an increasing trend and the improvement of medical treatment level prolonges the survival time of patients with heart disease,leading to a continuous increase in the prevalence of heart failure in China.Refractory heart failure is a common manifestation of end-stage heart diseases and often accompanied by cardiac cachexia and needs to be hospitalized repeatedly.The clinical symptoms or signs of patients with refractory heart failure have not been effectively improved or progressive aggravated after strictly optimized medical treatment.At present,heart failure is considered to be a chronic,progressive disease.The activation of neuroendocrine system leads to cardiac remodeling,which is the key factor in the occurrence and development of heart failure.In decompensated heart failure patients,renal perfusion is reduced due to decreased cardiac systolic function,activation of renin-angiotensin-aldosterone receptor system(RAAS),increased aldosterone secretion,resulting in water and sodium retention,and aggravating cardiac preload,resulting in hemodynamic disorders,and water and sodium retention further activates RAAS.At the same time,the activation of RAAS promotes cardiac and vascular remodeling,aggravates myocardial injury and deterioration of cardiac function,which further leads to deterioration of renal function.The activation of RAAS plays an important role in the occurrence and development of heart failure and renal insufficiency.A Meta analysis of 16 studies showed a relationship between the renal damage and the mortality in patients with heart failure.The one-year mortality rate was increasing within the range of renal function.For every 10 mL/min reduction in glomerular filtration rate(GFR),the risk was increased by 7%.Therefore,to some extent,renal protection plays an important role in the treatment of refractory heart failure.Recombinant human B-type brain natriuretic peptide(rh-BNP)was included in the guidelines for diagnosis and treatment of heart failure by the European College of Cardiology in 2005.Recombinant human B-type brain natriuretic peptide inhibits the RAAS system,inhibits the process of ventricular remodeling in patients with heart failure,increases renal blood flow and glomerular filtration rate,promotes sodium excretion in proximal and distal convoluted tubules,and reduces renin and aldosterone secretion.It also resists the effects of vasopressin of posterior lobe and sympathetic nerve on preserving sodium and water,which results in natriuretic and urination effects,thus improving hemodynamic disorders and clinical symptoms.At present,there are many reports about the effects of brain natriuretic peptide on acute decompensated heart failure and acute renal injury,coronary intervention therapy and contrast medium nephropathy in patients with acute myocardial infarction,and so on.However,it is still unclear whether recombinant human B-type brain natriuretic peptide can improve or worsen renal function.The purpose of this study was to investigate the effect of recombinant human brain natriuretic peptide on cardiac and renal function and inflammatory factors in patients with refractory heart failure.Objective(1)to investigate the effect of freeze-dried recombinant human B-type brain natriuretic peptide on cardiac function and renal function in patients with refractory heart failure;(2)to investigate the effect of freeze-dried recombinant B-type brain natriuretic peptide on clinical efficacy and inflammatory factors in patients with refractory heart failure.MethodsA retrospective analysis of 162 patients with refractory heart failure in the coronary care unit(CCU)was made in The First Affiliated Hospital of Zhengzhou University from September 2016 to January 2018.According to whether freeze-dried recombinant human B-type brain natriuretic peptide was used,the patients were divided into two groups:observation group(83 cases)and control group(79 cases).On the basis of routine treatment,the observation group was given rh-BNP.The indexes of renal function and cardiac function were monitored before treatment and 1,3,7 days after treatment and the indexes of inflammatory factors were evaluated before treatment.The patients were folloewd up in our hospital.The indexes of cardiac function,renal function and inflammatory factors were evaluated after 30 days of administration and the clinical efficacy was monitored before and after treatment.Results1.Renal function evaluation: within 3 days after treatment,the BUN and Scr of the two groups showed an increasing trend,and glomerular filtration rate(GFR)showed an decreasing trend,and there was no significant difference between the two groups(P > 0.05).On the 7th day after treatment,the two indexes showed a decreasing trend and GFR showed an increasing trend.There was a significant difference between the two groups(P < 0.05),and the peak value in the observation group decreased earlier than that of the control group.The BUN and Scr of the observation group were significantly higher than those of the pre-treatment within 3 days after treatment(P < 0.05).The BUN and Scr in the observation group on the 30 th day after treatment were significantly lower than those before the treatment.The difference was statistically significant(P < 0.05).Within 3 days after treatment,the urine volume of patients with heart failure in the two groups increased compared with that before treatment,but the urine volume of patients in the observation group increased more significantly than that in the control group within 3 days after treatment,the difference was statistically significant(P < 0.05).The urine volume of patients in two groups decreased 7,30 days after treatment than before.The urine volume of patients in the observation group increased more significantly than that in the control group 7,30 days after treatment,the difference was statistically significant(P < 0.05).2.Cardiac function evaluation: the NT-proBNP decreased in the observation group on the 24 h after treatmentthere was no significant difference between the two groups(P > 0.05).Compared with the control group,the CVP decreased significantly in the observation group on the 24 h after treatment and the NT-proBNP,HR,BP and CVP decreased significantly in the observation group on the 72 h after treatment.The LVEDD decreased significantly and the LVEF increased significantly 30 days after treatment in the observation group.There was a significant difference between the two groups(P < 0.05).3.Assessment of inflammatory factors: the level of TNF-α,IL-6,CRP in the observation group decreased more significantly than those in the control group 30 days after treatment,the difference was statistically significant(P < 0.05).4.Clinical efficacy: the total effective rate of observation group was 89.1%,which was significantly higher than that of control group(69.6%),the difference was statistically significant(P < 0.05).ConclusionsRombinant human B-type brain natriuretic peptide has a protective effect on renal function in patients with refractory heart failure,and can significantly improve the heart function,can alleviate the inflammation reaction and improve the prognosis of patients with refractory heart failure. |
