The Comparative Study Of Recombinant Human Brain Natriuretic Peptide And Sodium Nitroprusside Curative Effect On The Disease Of Severe Chronic Congestive Heart Failure

Congestive heart failure is the complex clinical syndrome with heart failure, neuroendocrine activation and abnormal blood flow distribution. The flowing sympathetic activity is increased and the system of rennin, angiotensin and aldosterone is activated, which manifests symptoms as high blood pressure, rapid heart rate, increasing respiratory rate, breathing difficulties and so on. Among cardiovascular diseases it is the most important reason for causing death. Brain natriuretic peptide (BNP), a natriuretic peptide, was isolated and purified from the porcine brain in 1988. Ventricular cells secrete BNP under the ventricular pressure or increasing volume load. The ventricular load and the change of ventricular wall tension are the major factors that stimulate the synthesis and secretion of BNP which not only can expand blood vessels but also is natriuretic, diuretic and so on. In recent years, the value of BNP for the diagnosis, treatment and prognosis of heart failure is becoming the focus of attention. Numerous studies have confirmed that, in the early period of asymptomatic heart failure, the BNP level of CHF patients is significantly higher than that of normal persons although the BNP level in plasma is elevated. The mechanism of BNP plays a role in activating guanylate cyclase through the vessel wall of the NPR-A receptor to raise intracellular cyclic guanosine monophosphate levels so as to cause the relaxation of vascular smooth muscle. In the year of 2005, European Society of Cardiology included BNP in guidelines on the treatment of CHF.Objective:This experiment shows that the application of recombinant human brain natriuretic peptide (rhBNP) can significantly improve the neuro-endocrine activation of patients with heart failure. The diuretic and natriuretic effect of rhBNP can relax blood vessels and inhibit secretion activities of aldosterone and rennin, which has a great influence on the regulation of body fluid volume, pressure and electrolyte balance in blood vessels. It can improve not only clinical symptoms of patients with heart failure but the level of body norepinephrine, endothelin, anti-diuretic hormone, and BNP as well. Congestive heart failure is treated by recombinant human brain natriuretic peptide which blocks the neuro-endocrine activation, prevents the development of heart failure and reverses the vicious cycle of heart failure development in order to improve heart failure, relieve symptoms, cause the survival rate higher and better the prognosis of the outcome.Research Methods:The inclusion criteria is NYNH and the cardiac function grade is IH and above.100 patients are randomly divided into the experimental group of 50 and the contrast group of 50. All patients are observed in terms of symptoms before and after taking medicine and in plasma the changes of BNP, Noradrenaline, Endothelin, Anti-diuretic Hormone during one week after taking the medicine. The levels of BNP, Norepinephrine, Endothelin, Anti-diuretic Hormone are sampled by the enzyme-linked immunosorbent assay. The changes of these above factors in the group ofrhBNP and Sodium Nitroprusside before and after the treatment are compared. The exclusion criteria are acute myocardial infarction, atrial fibrillation, primary pulmonary hypertension, right heart failure, acute and chronic infection, sepsis, malignancy, plasma creatinine concentration 20μmol/L, end-stage renal disease, liver cirrhosis, the original fat aldosteronism, chronic obstructive pulmonary disease, adult respiratory distress syndrome, cushing syndrome and hyperthyroidism.Results:The cardiac function is improved after the treatment with rhBNP and Sodium Nitroprusside, which has a statistical significance (p<0.05). In plasma, the amount of BNP, Norepinephrine(NE), Endothelin(ET) and Antidiuretic Hormone(ADH) is lower on average. Among them, the amount of BNP,Norepinephrine(NE),Endothelin(ET) and Antidiuretic Hormone (ADH) has a noticeable difference after the treatment (P<0.01). After a comparison, there is a striking difference between the levels of BNP and NE in the experimental group and those in the contrast group, which also has a statistical significance (P<0.05).Conclusion:The application ofrhBNP treatment of severe heart failure patients can greatly improve the patients'systolic and diastolic ventricular function and their cardiac output and also can slow the ventricular remodeling. Therefore, it is a safe and effective drug for treatment of CHF.