重组人脑利钠肽的临床应用进展
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摘要
重组人脑利钠肽(Recombinant Human Brain Natriuretic Peptide,rh-BNP)是利用基因重组技术制成的冻干粉制剂,与内源性脑利钠肽具有相同的氨基酸排序、分子结构,具有促进尿钠排泄、利尿、舒张动静脉系统平滑肌、抑制肾素-血管紧张素-醛固酮系统等作用,在使心力衰竭特别是急性失代偿性心力衰竭(acute decompensated heart failure,ADHF)患者获益的同时不增加肾功能恶化的风险,因此亦被应用于心肾综合征,急性心肌梗死伴心力衰竭行急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者,能有效减少肾功能恶化的发生。多项研究表明rh-BNP无益于降低远期再入院率和死亡率,但联合应用左西孟旦、参附注射液等能有效改善远期预后,并减少严重低血压等不良事件的发生。此文目的在于阐述rh-BNP的临床应用进展。
Recombinant Human Brain Natriuretic Peptide(rh-BNP) is a lyophilized powder preparation made by genetic recombination technology.It has the same amino acid sequence and molecular structure as endogenous brain natriuretic peptide,and has the functions of promoting urinary sodium excretion,diuresis,diastolic arteriovenous smooth muscle,and inhibition of renin-angiotensin-aldosterone system.It does not increase the risk of worsening renal function while benefiting patients with heart failure,especially acute decompensated heart failure(ADHF).Therefore,it is also used in patients with cardio-renal syndrome,acute myocardial infarction and heart failure undergoing emergency percutaneous coronary intervention(PCI),which can effectively reduce the occurrence of renal function deterioration.Multiple studies have shown that rh-BNP is not conducive to reducing long-term readmission rates and mortality.However,the combined application of levosimendan and Shenfu injection can effectively improve the long-term prognosis and reduce the occurrence of adverse events such as severe hypotension.The purpose of this article is to illustrate the clinical application of rh-BNP.
Recombinant Human Brain Natriuretic Peptide(rh-BNP) is a lyophilized powder preparation made by genetic recombination technology.It has the same amino acid sequence and molecular structure as endogenous brain natriuretic peptide,and has the functions of promoting urinary sodium excretion,diuresis,diastolic arteriovenous smooth muscle,and inhibition of renin-angiotensin-aldosterone system.It does not increase the risk of worsening renal function while benefiting patients with heart failure,especially acute decompensated heart failure(ADHF).Therefore,it is also used in patients with cardio-renal syndrome,acute myocardial infarction and heart failure undergoing emergency percutaneous coronary intervention(PCI),which can effectively reduce the occurrence of renal function deterioration.Multiple studies have shown that rh-BNP is not conducive to reducing long-term readmission rates and mortality.However,the combined application of levosimendan and Shenfu injection can effectively improve the long-term prognosis and reduce the occurrence of adverse events such as severe hypotension.The purpose of this article is to illustrate the clinical application of rh-BNP.
引文
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[14]Jinming Liu,Yanan Xie,Fang He,et.al.Recombinant Brain Natriuretic Peptide for the Prevention of Contrast-Induced N e p h r o p a t h y i n P a t i e n t s w i t h C h r o n i c K i d n e y D i s e a s e Undergoing Nonemergent Percutaneous Coronary Intervention or Coronary Angiography:A Randomized Controlled Trial[J].BioMed Research International,2016,2016(1):1-7.
[15]Bo Xiong,Chunbin Wang,Yuanqing Yao,et.al.The DoseDependent Effect of Nesiritide on Renal Function in Patients with Acute Decompensated Heart Failure:A Systematic Review and Meta-Analysis of Randomized Controlled Trials[J].Plos One,2015,10(6):e0131326.
[16]洪秀敏,陈松深,邱浩强.新活素治疗心肾综合征顽固性心力衰竭的疗效观察[J].临床医学工程,2015,22(11):1459-1460.
[17]Zhi Jia,Mu Guo,Li-Yuan Zhang.et.al.Levosimendan and Nesiritide as a Combination Therapy in Patients With Acute Heart Failure[J].Am J Med Sci,2015,349(5):398-405.
[18]王宇彤.重组人脑利钠肽联合参附注射液治疗急性心肌梗死并心力衰竭的近期疗效和安全性观察[J].世界中西医结合杂志,2018,13(1):108-115.
[19]Ling-Ge Kong,Chun-Li Wang,Dan Zhao,et.al.Nesiritide Therapy Is Associated With Better Clinical Outcomes Than Dobutamine Therapy in Heart Failure[J].American Journal of Therapeutics,2017,24(2):e181.
[20]Bojun Gong,Zhineng Wu,Zicheng Li.Eficacy and safety of nesiritide in patients with decompensated heart failure:a meta-analysis of randomized trials[J].BMJ Open,2016,6(1):e008545.
[21]Bin Yan,Liyuan Peng,Xiaojing Zhao.Nesiritide fails to reduce the mortality of patients with acute decompensated heart failure:An updated systematic review and cumulative meta-analysis[J].International Journal of Cardiology,2014.177(2):505-509.
[22]Sackner-Bernstein JD.Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure[J].Circulation,2005,111(12):1487-1491.
[2]Theilig F,Wu Q.ANP-induced signaling cascade and its implications in renal pathophysiology[J].Am J Physiol Renal Physiol,2015,308(10):F1047-55.
[3]Duda T.Atrial natriuretic factor-receptor guanylate cyclase signal transduction mechanism[J].Mol Cell Biochem,2010,334(1-2):37-51.
[4]Nieminen MS,Bhm M,Cowie MR,et al.Executive summary of the guidelines on the diagnosis and treatment of acute heart failure:the Task Force on Acute Heart Failure of the European Society of Cardiology[J].Eur Heart J,2005,26(4):384-416.
[5]Brunner-La Rocca HP,Kaye DM,Robyn L Woods,et al.Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects[J].J Am Coll Cardiol,2001,37:1221-7.
[6]Han B,Hasin Y.Cardiovascular effects of natriuretic peptides and their interrelation with endothelin-1[J].Cardiovasc Drugs Ther,2003,17(1):41-52.
[7]S h i g u a n L e 1,J i a n X i a o 1,W e i L i 1,e t.a l.C o n t i n u o u s administration of recombinant human B-type natriuretic peptide can improve heart and renal function in patients after cardiopulmonary bypass surgery[J].Journal of Thoracic Disease,2017,9(3):692-701.
[8]Hai-Yan Pan,Jian-Hua Zhu,Yong Gu.et.al.Comparative effects of recombinant human brain natriuretic peptide and dobutamine on acute decompensated heart failure patients with differsent blood BNP levels[J].BMC Cardiovascular Disorders,2014,14(1):1-8.
[9]Yee Weng Wong,Robert J.Mentz,G.Michael Felker,et.al.Nesiritide in patients hospitalized for acute heart failure:does timing matter?Implication for future acute heart failure trials[J].European Journal of Heart Failure,2016,18,(6):684-692.
[10]Xi-Min He,Lin Chen,Jiang-Bin Luo,et.al.Effects of rhBNPafter PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure[J].Asian Pacific Journal of Tropical Medicine,2016,9(8):791-795.
[11]Xin Gong,Zhengbin Mou,Li Shao,et.al.Human recombinantB-type natriuretic peptide protect ventricular function and structure in ST-elevation myocardial infarction[J].Int J Clin Exp Pathol,2015,8(9):11622-11628.
[12]Siu-Hin Wan,Paul M.McKie,ohn A.Schirger,et.al.Chronic Peptide Therapy with B-type Natriuretic-Peptide in Patients with Preclinical Diastolic Dysfunction(Stage B Heart Failure)[J].JACC Heart Fail,2016,4(7):539-547.
[13]Chaoyu Sun,Jixin Zhi,Xiaopeng Bai,et.al.Comparison of the efficacy of recombinant human brain natriuretic peptide with saline hydration in preventing contrast-induced nephropathy in patients undergoing coronary angiography with or without concomitant percutaneous coronary intervention[J].Int J Clin Exp Med,2015,8(8):14166-14172.
[14]Jinming Liu,Yanan Xie,Fang He,et.al.Recombinant Brain Natriuretic Peptide for the Prevention of Contrast-Induced N e p h r o p a t h y i n P a t i e n t s w i t h C h r o n i c K i d n e y D i s e a s e Undergoing Nonemergent Percutaneous Coronary Intervention or Coronary Angiography:A Randomized Controlled Trial[J].BioMed Research International,2016,2016(1):1-7.
[15]Bo Xiong,Chunbin Wang,Yuanqing Yao,et.al.The DoseDependent Effect of Nesiritide on Renal Function in Patients with Acute Decompensated Heart Failure:A Systematic Review and Meta-Analysis of Randomized Controlled Trials[J].Plos One,2015,10(6):e0131326.
[16]洪秀敏,陈松深,邱浩强.新活素治疗心肾综合征顽固性心力衰竭的疗效观察[J].临床医学工程,2015,22(11):1459-1460.
[17]Zhi Jia,Mu Guo,Li-Yuan Zhang.et.al.Levosimendan and Nesiritide as a Combination Therapy in Patients With Acute Heart Failure[J].Am J Med Sci,2015,349(5):398-405.
[18]王宇彤.重组人脑利钠肽联合参附注射液治疗急性心肌梗死并心力衰竭的近期疗效和安全性观察[J].世界中西医结合杂志,2018,13(1):108-115.
[19]Ling-Ge Kong,Chun-Li Wang,Dan Zhao,et.al.Nesiritide Therapy Is Associated With Better Clinical Outcomes Than Dobutamine Therapy in Heart Failure[J].American Journal of Therapeutics,2017,24(2):e181.
[20]Bojun Gong,Zhineng Wu,Zicheng Li.Eficacy and safety of nesiritide in patients with decompensated heart failure:a meta-analysis of randomized trials[J].BMJ Open,2016,6(1):e008545.
[21]Bin Yan,Liyuan Peng,Xiaojing Zhao.Nesiritide fails to reduce the mortality of patients with acute decompensated heart failure:An updated systematic review and cumulative meta-analysis[J].International Journal of Cardiology,2014.177(2):505-509.
[22]Sackner-Bernstein JD.Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure[J].Circulation,2005,111(12):1487-1491.