中文摘要：

目的研究重组人B型利钠肽（rhBNP）治疗急性前壁心肌梗死（AAMI）伴收缩性心力衰竭（SHF）老年患者的临床疗效和安全性。方法连续住院的发病72h内AAMI-SHF老年患者（〉60岁）87例,随机分为rhBNP组和硝酸甘油（NTG）组,在常规治疗的基础上,分别给予持续静脉滴注rhBNP或NTG24h。记录呼吸困难改善情况、测定BNP、血肌酐和肾小球滤过率（GFR）,观察治疗后心脏功能改变和30d内的主要不良心脏事件（MACE）的发生情况。结果rhBNP组患者呼吸困难缓解时间显著短于NTG组（P〈0.05）,左室射血分数（LVEF）、左室舒张末容积（LVEDD）以及血浆BNP水平的改善在rhBNP组显著优于NTG组（P〈0.01）。两组GFR均下降,第3天GFR回升,第7天时,GFR水平已经显著高于基线水平,两组各时间点比较均无显著性差异。用药后7d内rhBNP组室性心律失常发生率显著少于NTG组（P〈0.05）。14和30dMACE事件发生率rhBNP组均显著少于NTG组（P〈0.05）。结论rhBNP可有效改善老年急性心肌梗死合并SHF患者的心脏功能,降低30dMACE事件发生率,对患者肾功能无显著影响。

英文摘要：

Objective To investigate the efficacy and safety of recombinent human B-type natriuretic peptide （rhBNP） on systolic heart failure （SHF） resulted from acute anterior myocardial infarction （AAMI） in the elderly. Methods 87 patients with AAMI-SHF were randomly divided into the rhBNP and nitroglycerin （NTG） groups. rhBNP was given at 1.5 μg/kg intravenously and then infused intravenously （0.007 5~0.030 μg·kg-1·min-1）. NTG was used intravenously in NTG group as control （10~100 μg/min）. Both drugs were administered for 24 h. Blood samples were collected at different time points to investigate TnI,BNP,serum creatinine and other biochemic parameters. Glomerular filtration rate （GFR） was calculated according to the simplified equation of MDRD formula.Ultrasonic cardiography （UCG） was performed before the initiation of the infusion,at day 1,14 and 30 after the infusion. All patients were followed up for 1 month to record the main adverse cardiac events （MACEs）. Results Clinical characteristics of heart failure were all improved much more in rhBNP group than that of NTG group. Left ventricular ejection fraction （LVEF） was raised at 24 h in both groups and it was raised much more in rhBNP group. Left ventricular end-diastolic dimension （LVEDD） was decreased significantly at 24 h in both groups and it was decreased much more in rhBNP group. Concentration of plasma BNP was significantly reduced in both groups and there was significant difference between 2 groups. GFR was lowered in both 2 groups at 1 day. At 3 day,GFR rebounded to baseline value. At 7 day,GFR was higher than baseline. There was no difference between 2 groups at different time point. The rate of ventricular arrhythmia was fewer within 7 days in rhBNP group than that of NTG group. MACEs were lower in rhBNP group at 14 and 30 d than those of NTG group. Conclusions rhBNP can improve the heart function of old patients with AAMI-SHF,reduce the rate of the MACEs of AAMI-SHF within 30 days,and has no significant effect