【摘要】目的探讨老年难治性心力衰竭患者连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)的效果及对血清C 反应蛋白(Creactive protein，CRP)、半乳糖凝集素-3(galectin-3，Gal-3)、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)、人心型脂肪酸结合蛋白(heart fatty acid binding protein，H-FABP)、微管连接蛋白(Nexilin)水平的影响。方
法选取郑州市第三人民医院2016 年6 月～2018 年2 月收治的84 例难治性心力衰竭老年患者，采用随机数字表法分为研究组和对照组各42 例，2 组均予以常规治疗，研究组同时给予CRRT 治疗；对比2 组患者治疗前后的左心室射血分数(left ventricular ejection fraction,LVEF)、每搏输出量(stroke volume,SV)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、二尖瓣血流最大流速E 峰/A 峰(maximum flow velocity of mitral valve E peak/A peak,E/A)、血清CPP、Gal-3、NT-proBNP、H-FABP 及Nexilin、临床效果。结果治疗后，研究组的LVEF、SV、E/A 测定值高于对照组(t 值分别为3.081, 4.131. 3.043；P 值分别为0.003, ＜0.001，0.003)，研究组的LVEDD 测定值低于对照组(t=-3.520，P=0.001)；研究组的血清CPP、Gal-3、NT-proBNP、H-FABP 及Nexilin 测定值低于对照组(t 值分别为-7.468,-6.315,-5.008,-4.133,-5.361;P 值分别为＜0.001，＜0.001，＜0.001，＜0.001，＜0.001)；研究
组和对照组的临床疗效对比，研究组优于对照组(Z=-2.012、P=0.044)。结论CRRT 治疗难治性心力衰竭较常规治疗方法具有更好的效果，能有效的降低血清CPP、Gal-3、NT-proBNP、H-FABP 及Nexilin水平。

【Abstract】Objective To investigate the effect of continuous renal replacement therapy (CRRT) in the treatment of elderly patients with refractory heart failure and its effect on serum levels of C reactive protein (CRP), galectin-3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), heart fatty acid binding protein (H-FABP) and Nexilin. Methods We recruited 84 elderly patients with refractory heart failure admitted to our hospital from June 2016 to February 2018, and randomly divided them into study group (n=42) and control group (n=42). While all patients received the conventional treatment, patients in study group were also treated with CRRT. Left ventricular ejection fraction(LVEF), stroke volume(SV), left ventricular end-diastolic diameter (LVEDD), maximum mitral flow velocity E-peak/A-peak (E/A), serum levels of CRP, Gal-3, NTproBNP, H-FABP and Nexilin, and clinical effects were compared before and after CRRT between the two groups. Results After the treatment, LVEF, SV and E/A became higher in study group than in control group (t=3.081, 4.131 and 3.043 respectively; P=0.003, 0.000 and 0.003 respectively); LVEDD and the serum levels of CPP, Gal-3, NT-proBNP, H-FABP and Nexilin were lower in study group than in control group (t=-3.520, -7.468, -6.315, -5.008, -4.133 and -5.361 respectively; P=0.001, 0.001,＜0.001,＜0.001,＜0.001 and＜0.001 respectively). Clinical effects were also better in study group than in control group(Z=-2.012, P=0.044). Conclusion CRRT is better than the conventional therapy in the treatment of elderly patients with refractory heart failure. CRRT can also significantly reduce the serum levels of CRP, Gal-3, NT-proBNP, H-FABP and Nexilin.