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目的探讨老年慢性肺心病伴心力衰竭时血浆脑钠素(BNP)、内皮素-1(ET-1)水平变化及前列地尔脂微球载体注射液(Lipo-PGE1,商品名:凯时)对其影响。方法老年慢性肺心病伴心力衰竭患者28例,随机分为治疗组(14例)和常规治疗组(14例)。常规治疗组为降肺动脉压、强心、利尿剂、血管扩张剂等药物并加用鼻导管给氧治疗。治疗组在常规内科治疗同时加用Lipo-PGE1注射液治疗,分别观察治疗10～14d后2组患者临床症状、体征、心率(HR)、呼吸频率(RR)、血压、血氧饱和度(SaO2)、肺动脉压(PAP)和左室射血分数(LVEF)以及血浆BNP、ET-1变化。结果与常规治疗组比较,治疗组治疗10～14d后,患者临床症状与体征改善明显,其SaO2和LVEF显著升高(P<0.05),PAP、HR、RR显著下降(P<0.05)。Lipo-PGE1治疗后血浆BNP、ET-1水平随心衰的纠正而显著降低(P<0.01),与LVEF呈显著负相关(P<0.01),与PAP呈显著正相关(P<0.05)。结论 Lipo-PGE1在改善老年慢性肺心病伴心力衰竭患者心功能和降低PAP的同时,也降低患者血浆BNP、ET-1水平,提示Lipo-PGE1可通过多环节对老年慢性肺心病心力衰竭治疗过程发挥作用。
Objective To investigate the changes of plasma brain natriuretic peptide (BNP) and endothelin-1 (ET-1) levels in elderly patients with chronic pulmonary heart disease and heart failure and the changes of plasma lipoprotein (Lipo-PGE1) Impact on it. Methods A total of 28 elderly patients with chronic pulmonary heart disease and heart failure were randomly divided into treatment group (n = 14) and conventional treatment group (n = 14). Conventional treatment for pulmonary artery pressure, cardiac, diuretics, vasodilators and other drugs plus nasal catheter oxygen therapy. The patients in the treatment group were treated with Lipo-PGE1 injection in the routine medical treatment. The clinical symptoms, signs, heart rate (HR), respiratory rate (RR), blood pressure and blood oxygen saturation ), Pulmonary arterial pressure (PAP), left ventricular ejection fraction (LVEF) and plasma BNP and ET-1 levels. Results Compared with the conventional treatment group, the clinical symptoms and signs of the treatment group improved significantly after 10 ~ 14d. The SaO2 and LVEF of the treatment group were significantly increased (P <0.05), while the PAP, HR and RR were significantly decreased (P <0.05). The levels of BNP and ET-1 in plasma after Lipo-PGE1 treatment were significantly decreased with the correction of heart failure (P <0.01), negatively correlated with LVEF (P <0.01), and positively correlated with PAP (P <0.05). Conclusions Lipo-PGE1 can decrease the level of plasma BNP and ET-1 in senile patients with chronic pulmonary heart disease and heart failure, meanwhile, reduce the level of plasma BNP and ET-1, suggesting that Lipo-PGE1 can reduce the level of PAP in elderly patients with chronic cor pulmonale Play a role.