目的 探讨不同疗程新活素（rhBNP）对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后并发心力衰竭（HF）的临床疗效。 方法 收集196例STEMI经急诊PCI后并发HF的患者，随机分为对照组（53例）、短程rhBNP组（47例）、中程rhBNP组（50例）、长程rhBNP组（46例）。观察各组患者HF治疗后30 d、半年心血管病死率、因HF再住院率以及24 h、3 d、1周、30 d、半年血清氨基末端脑钠肽前体（NT-proBNP）、基质金属蛋白酶（MMP）-9、组织抑制因子（TIMP）-1、左室舒张末期内径（LVEDD）以及左室射血分数（LVEF）。 结果 长程rhBNP组较对照组、短程rhBNP组及中程rhBNP组30 d、半年心血管死亡率、因HF再住院率降低（P < 0.05）；中程rhBNP组较对照组、短程rhBNP组30 d、半年因HF再住院率降低（P < 0.05）。短程rhBNP组较对照组治疗后24 h NT-proBNP、MMP-9、LVEDD降低（P < 0.05），TIMP、LVEF升高（P < 0.05）；中程rhBNP组较短程rhBNP组治疗后3 d、1周、30 d、半年NT-proBNP、MMP-9、LVEDD降低（P < 0.05），TIMP、LVEF升高（P < 0.05）；长程rhBNP组较中程rhBNP组治疗后1周、30 d、半年NT-proBNP、MMP-9、LVEDD降低（P < 0.05），TIMP、LVEF升高（P < 0.05）。不良反应方面，对照组、短程rhBNP组、中程rhBNP组、长程rhBNP组低血压发生率依次升高（P < 0.05）。 结论 rhBNP治疗STEMI经PCI术后并发HF随着疗程延长其临床疗效逐步提高，但是低血压发生率也逐渐增加。

Objective To investigate the therapeutic effects of varying treatment durations of recombinant human brain natriuretic peptide （rhBNP） on heart failure following percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods A total of 196 STEMI patients with heart failure （HF） following emergency percutaneous coronary intervention （PCI） were enrolled and randomly assigned to one of four groups： control group （n = 53）， short-course rhBNP group （n = 47）， medium-course rhBNP group （n = 50）， and long-course rhBNP group （n = 46）. The rates of cardiovascular mortality and HF-related rehospitalization were evaluated at 30 days and 6 months post-treatment. Serum levels of N-terminal pro-B-type natriuretic peptide （NT-proBNP）， matrix metalloproteinase-9 （MMP-9）， tissue inhibitor of matrix metalloproteinase-1 （TIMP-1）， left ventricular end-diastolic diameter （LVEDD）， and left ventricular ejection fraction （LVEF） were measured at 24 hours， 3 days， 1 week， 30 days， and 6 months after HF treatment initiation. Results Compared with the control group， both the short- and medium-term rhBNP groups showed a significant reduction in cardiovascular mortality and HF-related rehospitalization rates in the long-term rhBNP group at 30 days and 6 months （P < 0.05）. Additionally， the medium-term rhBNP group exhibited lower HF-related rehospitalization rates than both the control and short-term rhBNP groups （P < 0.05）. Serum levels of NT-proBNP， MMP-9， and LVEDD significantly decreased in the short-term rhBNP group within 24 hours compared to the control group （P < 0.05）， while TIMP and LVEF levels increased （P < 0.05）. In comparison with the short-term rhBNP group， the medium-term rhBNP group demonstrated sustained reductions in NT-proBNP， MMP-9， and LVEDD levels at 72 hours， 1 week， 30 days， and 6 months （P < 0.05）， accompanied by increases in TIMP and LVEF （P < 0.05）. Furthermore， the long-term rhBNP group showed greater improvements than the medium-term group， with significantly lower NT-proBNP， MMP-9， and LVEDD levels and higher TIMP and LVEF values at 1 week， 30 days， and 6 months （P < 0.05）. In terms of the adverse reactions， the incidence of hypotension in the control group， short course rhBNP group， medium course rhBNP group and long course rhBNP group increased successively （P < 0.05）. Conclusion The clinical efficacy of rhBNP in STEMI patients with HF following PCI gradually improved as the treatment duration increased， but the incidence of hypotension also rose accordingly.