厄贝沙坦氢氯噻嗪联合重组人脑利钠肽治疗急性心力衰竭的短期疗效研究

Short-Term Efficacy of Irbesartan/Hydrochlorothiazide Combined with Recombinant Human Brain Natriuretic Peptide in Patients with Acute Heart Failure

摘要

目的 评估厄贝沙坦氢氯噻嗪联合重组人脑利钠肽（recombinant human brain natriuretic peptide，rhBNP）治疗急性心力衰竭（acute heart failure，AHF）的短期疗效与安全性。方法 选取2022年10月至2023年9月首都医科大学附属北京康复医院收治的82例AHF患者，采用随机数字表法分为对照组与研究组，各41例。对照组给予厄贝沙坦氢氯噻嗪治疗，研究组在对照组基础上加用rhBNP。比较2组短期临床疗效、急性生理与慢性健康状况评分Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）、心功能指标、心率变异性、24 h尿量和免疫功能变化，并记录不良反应发生情况。结果 研究组总有效率高于对照组（P< 0.05），住院天数及症状改善时间缩短，APACHE Ⅱ降低，6 min步行距离延长（ P< 0.05）；24 h尿量、左室射血分数（left ventricular ejection fraction，LVEF）及心率变异性指标均优于对照组，左室舒张末期内径（left ventricular end-diastolic diameter，LVEDD）和左室收缩末期内径（left ventricular end-systolic diameter，LVESD）较对照组降低（ P< 0.05）；治疗14 d后，2组CD4⁺、CD4⁺/CD8⁺均高于治疗前，CD8⁺降低（P< 0.05），研究组和对照组治疗14 d后的免疫功能指标组间比较差异无统计学意义（ P> 0.05）。2组不良反应发生率比较差异无统计学意义（ P> 0.05）。结论 厄贝沙坦氢氯噻嗪联合rhBNP治疗AHF可改善心功能及心率变异性，安全性良好，临床应用价值高。

Abstract

Objective To evaluate the short-term efficacy and safety of irbesartan/hydrochlorothiazide combined with recombinant human brain natriuretic peptide (rhBNP) for acute heart failure (AHF).Methods A total of 82 patients with AHF admitted to Beijing Rehabilitation Hospital, Capital Medical University from October 2022 to September 2023 were enrolled and randomly divided into a control group and a study group, with 41 cases in each group. The control group received irbesartan/hydrochlorothiazide, while the study group was additionally treated with rhBNP on the basis of the control regimen. The two groups were compared in terms of short-term clinical efficacy, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, cardiac function parameters, heart rate variability, 24-hour urine output and changes in immune function. Adverse drug reactions were also recorded. Results The study group had a significantly higher total response rate than the control group (P< 0.05), accompanied by shorter hospital stay and shorter time to symptom relief, lower APACHE Ⅱ score, and longer 6-minute walking distance ( P< 0.05). Furthermore, the study group achieved superior outcomes in 24-hour urine output, left ventricular ejection fraction (LVEF) and heart rate variability indexes, as well as decreased left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) relative to the control group ( P< 0.05). After 14 days of treatment, CD4⁺ levels and the CD4⁺/CD8⁺ ratio increased whereas CD8⁺ levels declined in both groups versus baseline ( P< 0.05). No intergroup differences in these immune parameters were found at day 14 between the two groups ( P> 0.05). No significant difference in the incidence of adverse drug reactions was detected between groups ( P> 0.05). Conclusion Irbesartan/hydrochlorothiazide combined with rhBNP can effectively improve cardiac function and heart rate variability in patients with AHF, featuring favorable safety and promising clinical application value.

关键词

厄贝沙坦氢氯噻嗪 / 重组人脑利钠肽 / 急性心力衰竭 / 心功能

Key words

irbesartan/hydrochlorothiazide / recombinant human brain natriuretic peptide / acute heart failure / cardiac function

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