rhBNP 在心力衰竭合并肾功能不全中的应用前景

心力衰竭同时合并肾功能不全或肾功能恶化,也称为心肾综合征,是临床心血管疾病的终末阶段,患者的死亡率及再住院率较高。重组人脑利钠肽是利用重组DNA技术制成的人脑利钠肽,与内源性脑利钠肽具有相同的药理作用:扩张血管,降低右房压力及肺毛细血管楔压,减轻心脏负荷,可以选择性扩张冠状动脉,增加冠状动脉的血流量;通过激活心肌细胞内c GMP依赖的蛋白激酶PKG-1,产生细胞应激性保护,降低心肌耗氧量;抑制RAAS及SNS,抑制反射性心动过速和血管收缩,无正性肌力作用和正性心率作用,抑制心脏重塑。重组人脑利钠肽作用于肾脏可以改善肾脏血流灌注,提高肾小球滤过率。虽然重组人脑利钠肽治疗心力衰竭取得了很好地效果,但其对心力衰竭患者肾功能的影响仍存在争议。重组人脑利钠肽具有多重活性且不良反应少,已被许多专家视为很有应用前景的新药。

Application Prospect of rhBNP in Heart Failure and Renal Insufficiency

Heart failure with renal insufficiency is the end stage of clinical cardiovascular disease, which will lead to complexclinical syndrome. Thus the high mortality and readmission rates are often seen in those patients. Recombinant human brain natriureticpeptide (rhBNP) has the same pharmacological effects with endogenous natriuretic peptide on vasodilation, increased natriuresis anddieresis. All these mechanism focus on vasodilation production, physical blood pressure and fluid reduction, which result in a reduction inboth preload and afterload. Finally, it relieve various symptoms such as dyspnea or edema and improve haemodynamic functions inpatients who treated with rhBNP beside standard therapy. There is no side-effect like increased heart rate or myocardial contractility.Although recombinant human brain natriuretic peptide in treatment of heart failure has obtained good curative effect, there''s a lot ofdebates about whether it will get the same effect on those with renal insufficiency. rhBNP has multiple activity and fewer adversereactions, had been considered a very promising drug by many experts.