目的 探討常規(guī)治療無效的心力衰竭（心衰）伴心房顫動(dòng)（房顫）患者應(yīng)用注射用重組人腦利鈉肽（新活素）治療后血清半乳糖凝集素-3（Gal-3）、結(jié)締組織生長因子（CTGF）水平變化及其與房顫復(fù)發(fā)的相關(guān)性。方法 選取2018年4月—2020年4月邢臺(tái)市第三醫(yī)院收治的148例經(jīng)常規(guī)治療無效的心衰伴房顫患者作為研究對(duì)象，所有患者均給予注射用重組人腦利鈉肽治療，具體用法為500 μg注射用重組人腦利鈉肽＋50 mL 0.9%氯化鈉注射液，先采用負(fù)荷劑量1.5～2.0 μg·kg^-1靜脈推注3～5 min，之后以0.007 5～0.015 0 μg·kg^-1·min^-1靜脈滴注24～72 h，根據(jù)患者體質(zhì)量調(diào)節(jié)負(fù)荷量和靜脈滴注速率。評(píng)價(jià)治療效果，檢測并比較治療前、用藥30 min、用藥24 h、用藥結(jié)束后患者的心率、收縮壓、舒張壓、血氧飽和度、24 h尿量，檢測并比較患者治療前、治療后7 d、治療后30 d的左心室舒張末期內(nèi)徑（LVEDD）、左心室收縮末期內(nèi)徑（LVESD）、左心房內(nèi)徑（LAD）、左室射血分?jǐn)?shù)（LVEF）和血清N-末端腦利鈉肽前體（NT-proBNP）、超敏C反應(yīng)蛋白（hs-CRP）、腫瘤壞死因子-α（TNF-α）、Gal-3、CTGF水平，記錄患者治療過程中不良反應(yīng)發(fā)生情況，隨訪治療后3個(gè)月的房顫復(fù)發(fā)情況。根據(jù)治療后3個(gè)月房顫復(fù)發(fā)情況將入選患者分為復(fù)發(fā)組（n=27）和未復(fù)發(fā)組（n=121），比較兩組患者治療前血清Gal-3、CTGF水平，應(yīng)用Pearson相關(guān)分析進(jìn)行線性相關(guān)性分析，單因素和多因素Logistic回歸分析患者治療后房顫復(fù)發(fā)的相關(guān)危險(xiǎn)因素。結(jié)果 148例心衰伴房顫患者中有122例（82.43%）用藥24 h內(nèi)轉(zhuǎn)復(fù)為竇性心律。與治療前比較，患者用藥30 min、用藥24 h后、用藥結(jié)束后的心率、收縮壓、舒張壓均明顯降低，血氧飽和度和24 h尿量明顯增加，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后7 d、治療后30 d患者的LVEF明顯升高，LAD、LVEDD、LVESD和血清NT-proBNP、hs-CRP、TNF-α、Gal-3、CTGF水平均明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。Pearson相關(guān)性分析結(jié)果顯示，心衰伴房顫患者的血清Gal-3、CTGF水平與NT-proBNP和心功能指標(biāo)LAD、LVEDD、LVESD、LVEF均有明顯相關(guān)性（P<0.05）。復(fù)發(fā)組與未復(fù)發(fā)組患者年齡、病程、LAD、LVEF及治療前NT-proBNP、hs-CRP、TNF-α、Gal-3、CTGF水平比較均有顯著性差異（P<0.05），Logistic回歸分析顯示，LAD、病程時(shí)間、NT-proBNP、hs-CRP、TNF-α、Gal-3、CTGF水平均是影響房顫復(fù)發(fā)的危險(xiǎn)因素。結(jié)論 應(yīng)用注射用重組人腦利鈉肽治療心力衰竭伴房顫效果確切，不良反應(yīng)發(fā)生率低，其能及時(shí)有效緩解患者呼吸困難癥狀，降低血清NT-proBNP和炎癥因子水平，明顯改善心功能指標(biāo)和全身炎癥狀態(tài)，此外其還能明顯降低血清Gal-3、CTGF水平。血清Gal-3、CTGF水平與NT-proBNP和心功能指標(biāo)呈明顯相關(guān)性，這2個(gè)指標(biāo)可作為心衰伴房顫患者治療后房顫復(fù)發(fā)的預(yù)測指標(biāo)。

Objective To investigate the changes of serum galectin-3 (Gal-3) and connective tissue growth factor (CTGF) levels and their correlation with the recurrence of atrial fibrillation in patients with heart failure and atrial fibrillation who failed to respond to conventional treatment. Methods Total 148 patients with heart failure with atrial fibrillation treated in Xingtai Third Hospital from April 2018 to April 2020 were selected as the research object. All patients were treated with Recombinant Human Brain Natriuretic Peptide for Injection, with a specific usage of 500 μg Recombinant Human Brain Natriuretic Peptide for Injection + 50 mL diluent (0.9% Sodium Chloride Injection), the loading dose was 1.5-2.0 μ g ·kg^-1 was injected intravenously for 3-5 min, followed by 0.007 5-0.015 0 μg·kg^-1·min-1 intravenous drip for 24-72 h, and the load and intravenous drip rate were adjusted according to the patient's body mass. Treatment effect was evaluated. The heart rate, systolic blood pressure, diastolic blood pressure, blood oxygen saturation and 24 h urine volume of patients were detected and compared before treatment, 30 min after treatment, 24 h after treatment, and the end of treatment. The left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), serum levels of N-terminal pro brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α), Gal-3, and CTGF were detected and compared before treatment, seven days after treatment and 30 days after treatment. The occurrence of adverse reactions during treatment and the recurrence of atrial fibrillation three months after treatment were recorded. According to the recurrence of atrial fibrillation three months after treatment, the selected patients were divided into recurrence group (n=27) and non recurrence group (n=121). The levels of serum Gal-3 and CTGF were compared between two groups before treatment. Pearson correlation analysis was used for linear correlation analysis, and univariate and multivariate Logistic regression analysis were used to analyze the risk factors of atrial fibrillation recurrence after treatment. Results Total 122 (82.43%) of 148 patients with heart failure and atrial fibrillation were converted to sinus rhythm within 24 h. Compared with before treatment, the heart rate, systolic blood pressure and diastolic blood pressure decreased significantly 30 min after treatment, 24 h after treatment, and the end of treatment, and the blood oxygen saturation and 24 h urine volume increased significantly (P < 0.05). LVEF, LAD, LVEDD, LVESD and serum NT-proBNP, hs-CRP and TNF-α increased significantly seven and 30 days after treatment. The levels of Gal-3 and CTGF decreased significantly (P < 0.05). Pearson correlation analysis showed that the levels of serum Gal-3 and CTGF were significantly correlated with NT-proBNP and cardiac function indexes LAD, LVEDD, LVESD and LVEF (P < 0.05). There were significant differences in Age, course of disease, LAD, LVEF, NT-proBNP, hs-CRP, TNF-α, Gal-3 and CTGF before treatment in recurrent group and non recurrent group (P < 0.05). Logistic regression analysis showed that LAD, duration of disease, NT-proBNP, hs-CRP and TNF-α, Gal-3 and CTGF are risk factors for the recurrence of atrial fibrillation. Conclusion Recombinant Human Brain Natriuretic Peptide for Injection is effective in the treatment of heart failure with atrial fibrillation, and the incidence of adverse reactions is low. It can timely and effectively alleviate the symptoms of dyspnea, reduce the levels of serum NT-proBNP and inflammatory factors, significantly improve the indexes of cardiac function and systemic inflammation, and significantly reduce the levels of serum Gal-3 and CTGF. Serum Gal-3 and CTGF levels were significantly correlated with NT-proBNP and cardiac function indexes. These two indexes can be used as predictors of atrial fibrillation recurrence in patients with heart failure and atrial fibrillation after treatment.

R972

邢臺(tái)市重點(diǎn)研發(fā)計(jì)劃項(xiàng)目（2020ZC178）