天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (4): 372-376.doi: 10.11958/20161435

• 临床研究 • 上一篇    下一篇

重组人脑型钠尿肽对急性射血分数降低心衰患者 血清 ACE2 水平的影响

闫杰， 赵红， 刘艳军， 苏鹏宇   

  1. 河北唐山， 华北理工大学附属医院心内科 （邮编 063000）
  • 收稿日期:2016-11-30 修回日期:2017-01-25 出版日期:2017-04-15 发布日期:2017-04-15
  • 作者简介:闫杰 （1980）， 男， 副主任医师， 主要从事冠心病、 高血压病和心力衰竭相关研究

The effect of brain natriuretic peptide on serum angiotensin-converting enzyme 2 levels in acute heart failure patients with reduced ejection fraction

YAN Jie, ZHAO Hong, LIU Yan-jun, SU Peng-yu   

  1. Department of Cardiology， North China University of Science and Technology Affiliated Hospital, Tangshan 063000， China
  • Received:2016-11-30 Revised:2017-01-25 Published:2017-04-15 Online:2017-04-15

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摘要： 目的 研究重组人脑型钠尿肽对急性射血分数降低心衰 （HFrEF） 患者血清血管紧张素转换酶 2 （ACE2） 水 平的影响。方法 符合条件的 HFrEF 患者 106 例， 随机均分为 2 组接受治疗。对照组给予一般常规治疗， 试验组在 对照组治疗基础上给予冻干重组人脑型钠尿肽 （新活素） 治疗 24 h。2 组分别于入院时、 入院后第 7 日行超声心动图 检查评估心功能。酶联免疫吸附试验法分别于入院时、 新活素治疗结束后 （即入院后次日）、 入院后第 7 日分别检测 2 组血清 ACE2、 氨基末端脑型钠尿肽前体 （NT-proBNP） 水平。结果 最终共纳入 103 例患者， 对照组 52 例， 试验组 51 例。治疗前， 2 组阿司匹林等用药比例， 心肌肌钙蛋白 I、 肌酐等生化指标差异均无统计学意义。与治疗前相比， 入院次日， 2 组患者收缩压（SBP）均降低， 入院第 7 日左室射血分数（LVEF）均有所升高（P ＜0.05）。2 组间治疗前 SBP、 舒张压 （DBP） 及 LVEF 差异均无统计学意义 （P＞0.05）； 入院次日试验组较对照组 SBP 降低 （P ＜0.05）， 但 2 组 入院次日 DBP 及入院第 7 日 LVEF 差异均无统计学意义。2 组的 NT-proBNP 水平、 对照组的 ACE2 水平随时间的 延长均呈降低趋势， 而试验组 ACE2 水平呈先增后降趋势， 但第 7 日时仍高于入院时水平 （P ＜0.05）。2 组间入院时 NT-proBNP 和 ACE2 水平差异均无统计学意义， 次日和第 7 日时对照组 NT-proBNP 水平均高于试验组， 而对照组 ACE2 水平均低于试验组 （P ＜ 0.05）。结论 新活素或许能通过提高循环 ACE2 水平而使心衰患者获益。

关键词: 心力衰竭, 射血分数, 肾素-血管紧张素系统, 血管紧张素转换酶 2, 脑型钠尿肽

Abstract: Objective To investigate the effect of brain natriuretic peptide (BNP) on serum angiotensin- converting enzyme (ACE) 2 levels in acute heart failure patients with reduced ejection fraction (HFrEF). Methods A total of 106 patients with acute HFrEF were selected, and were divided randomly into control group and trial group. The control group was under routine treatment, while the trial group was under routine treatment combined with lyophiluzed recombinant human BNP for 24-hour. Cardiac functional parameters were measured by echocardiography both at the enrollment and the end of 7-day treatment. Serum levels of ACE2 and N-terminal pro-BNP (NT-proBNP) were determined using commercially available ELISA kits at the enrollment, the end of 24- hour treatment, and the end of 7- day treatment， respectively. Results A total of 103 patients with acute HFrEF were enrolled (control group=51, trial group=52). There were no significant differences in the use of drugs (e.g., aspirin) and serum biochemical indices (e.g. cardiac troponin I, creatinine) before treatment between these two groups. Compared to systolic blood pressure (SBP) at admission, SBP on the second day after treatment were significantly decreased in two groups (P ＜ 0.05). Compared to left ventricular ejection fraction (LVEF) at admission, LVEF values were significantly elevated on the seventh day after treatment in two groups (P ＜ 0.05). There were no significant differences in SBP, diastolic blood pressure (DBP), and LVEF at admission between these two groups (P ＞ 0.05); there were also no significant differences in DBP on the second day after treatment, and LVEF on the seventh day after treatment (P ＞ 0.05), while SBP was significantly higher on the second day after treatment in control group than that of trial group (P ＜ 0.05). Serum levels of NT- proBNP were decreased with the prolongation of time in two groups. Serum levels of ACE2 were decreased with the prolongation of time in control group, while were increased initially following decreased (which were still higher on the seventh day after treatment than that at admission) with the prolongation of time in trial group. Serum levels of NT-proBNP were higher after 2 days treatment or 7 days of treatment in control group than those of trial group, while serum levels of ACE2 were decreased after 2 days of treatment or 7 days of treatment in control group than those of trial group (P ＜ 0.05). Conclusion Patients with acute HFrEF may benefit from BNP by increasing serum ACE2 levels.

Key words: heart failure, ejection fraction, renin- angiotensin system, angiotensin- converting enzyme 2, brain natriuretic peptide