利钾尿肽与心钠素摩尔比在阵发心房纤颤时的作用

目的：探讨利钾尿肽（KP）及KP与心钠素（ANP）摩尔比在阵发心房纤颤时的意义。方法：用放射免疫分析法测定23例阵发房颤患者血浆中KP与ANP的水平，并以正常人对照， 结果：房颤患者血浆中KP与ANP的水平明显高于对照组（P＜0．01），而血浆中KP／ANP摩尔比显著低于正常对照组（P＜0．01）。结论：KP含量与ANP的比例关系的变化在阵发房颤的发病中起一定的作用。     

利钾尿肽与心钠素摩尔比值在高血压性脑血管病的临床意义

目的探讨利钾尿肽(KP)与心钠素(ANP)摩尔比值在高血压性脑血管疾病中的意义.方法用放射免疫分析方法测定40例脑血管疾病(CVD)患者血浆KP和ANP含量.结果高血压性CVD患者血浆KP水平(3.72±0.80)μg/L与单纯CVD患者比较显著降低(P<0.01),血浆ANP含量(0.32±0.10)μg/L明显高于单纯CVD组(P<0.01),高血压CVD患者,病程中KP与ANP摩尔比值(4.30±1.13)显著低于对照组(5.32±1.10)及单纯CVD组(5.19±2.30),P均<0.01.结论KP、ANP含量及KP与ANP比值关系的改变在CVD及高血压性CVD病理生理中起着一定的作用.     

N—心钠素在无症状性心力衰竭中的诊断价值

目的 :评价N 心钠素 (N ANP)对无症状性心力衰竭的诊断价值。方法 :通过放射性核素门控心血池显像 ,筛选无症状性心力衰竭患者 3 2例 ,心力衰竭患者 3 2例 ,并选取心功能正常健康人 3 2例作为对照组 ;采用放射免疫法测定三组血浆N ANP水平。结果 :无症状性心力衰竭组血浆N ANP [( 13 82 .2 5± 5 49.5 1)ng/L ]水平显著高于对照组[( 4 2 2 .0 6± 2 5 5 .3 8)ng/L ,P <0 .0 5 ] ,却显著低于心力衰竭组 [( 4 0 2 0 .43± 2 0 90 .95 )ng/L ,P <0 .0 5 ] ;以血浆N ANP >92 3 .0 0ng/L(对照组的 x± 1.96s ) ,诊断无症状心力衰竭 ,敏感度为 75 % ,特异度为 94%。结论 :N ANP可用来诊断无症状性心力衰竭且以N ANP >92 3 .0 0ng/L作为诊断无症状性心力衰竭的指标较为合适。     

洛沙坦与络活喜对老年自发性高血压鼠利钾尿肽与心钠素摩尔比值的影响

目的探讨利钾尿肽(KP)与心钠素(ANP)摩尔比值变化在老年自发性高血压鼠(SHR)治疗中的意义.方法30只老年SHR随机分为洛沙坦组(L组)、络活喜组(A组)及模型组(S组),每组10只;10只同龄Wistar-Kyoto(WKY) 大鼠(W组)作为对照组.用放射免疫分析方法分别测定模型各组治疗后老年SHR血浆、心房及主动脉组织的KP和ANP含量.结果治疗结束时,各组大鼠血浆KP、ANP水平均无差异(P均>0.05),但未经治疗的S组SHR血浆KP/ANP摩尔比值较对照组及两个治疗组水平均显著降低(P<0.05或P<0.01),S组心房中KP/ANP摩尔比值高于其它3组(P<0.05或P<0.01).结论KP与ANP比例关系的改变在老年SHR的治疗中可能发挥着重要作用.     

慢性肺原性心脏病患者血浆心钠素、C型利尿利钠因子的测定及临床意义

目的观察慢性肺原性心脏病患者血浆心钠素 (ANP)和 C型利尿利钠因子 (CNP)的变化及与 Pa O2 的关系。方法采用放射免疫分析法 ,检测 30例肺心病急性发作期及缓解期患者血浆 ANP和 CNP的水平 ,同时行动脉血气分析 ,并和 2 0例健康体检者对照。结果肺心病患者急性加重期和缓解期血浆 ANP水平 (6 0 9.2 1± 16 6 .6 5 )ng/L,(2 87.0 6± 10 9.0 6 ) ng/L、CNP水平 (73.38± 33.2 9) ng/L,(4 3.18± 9.6 8) ng/L 明显高于对照组 (5 0 .77±2 6 .89) ng/L,(16 .89± 9.16 ) ng/L(P值均 <0 .0 0 1) ;急性加重期血浆 ANP、CNP水平显著高于缓解期 (P值均 <0 .0 0 1) ;肺心病组动脉血氧分压 (Pa O2 )急性加重期 (5 0 .82± 15 .2 3) m m Hg明显低于缓解期 (77.5 7± 10 .0 8) m m Hg(P<0 .0 0 1) ;肺心病组急性加重期和缓解期血浆 ANP、CNP水平与 Pa O2 均呈显著负相关 (r=- 0 .6 0 ,P<0 .0 0 1;r=- 0 .5 7,P<0 .0 1;r=- 0 .48,P<0 .0 1,r=- 0 .79,P<0 .0 0 1) ;肺心病组急性加重期和缓解期血浆 ANP与 CNP水平均呈显著正相关 (r=0 .5 7,P<0 .0 1;r=0 .49,P<0 .0 1)。结论 ANP和 CNP间彼此相互作用 ,在肺心病发生和发展中起重要的作用。     

Toll样受体2、基质金属蛋白酶9、低氧诱导因子1α与心房颤动发生和维持的关系

目的 探讨Toll样受体2(TLR2)、基质金属蛋白酶9(MMP-9)、低氧诱导因子1α(HIF-1α)作为免疫炎症因子与心房颤动(房颤)发生和维持的关系.方法 入选125例房颤患者,其中阵发性房颤34例,持续性房颤49例,永久性房颤42例,选择窦性心律者38例作为对照组.比较各组患者血清中TLR2、MMP-9、HIF-1α的表达水平,同时测量左心房内径及射血分数.结果 TLR2表达水平在永久房颤组和持续房颤组明显高于对照组847.3(1 047.7) ng/L、757.2(1 032.5)ng/L vs 744.8(652.3) ng/L(P＜0.05);永久房颤组TLR2高于阵发房颤组847.3(1 047.7) ng/L vs 796.6(849.1) ng/L(P＜0.05).MMP-9表达水平在永久房颤组明显高于对照组447.1(491.9)ng/L vs 308.9(200.7) ng/L(P＜0.05);永久性房颤组和持续房颤组MMP-9高于阵发房颤组447.1(491.9) ng/L、307.7(678.0) ng/L vs 264.2(303.3) ng/L(P＜0.05).HIF-1α表达水平在永久房颤组和持续房颤组高于对照组57.2(48.8) ng/L、61.4(46.3) ng/L vs 46.7(29.6) ng/L(P＜0.05);永久性房颤组和持续房颤组HIF-1α高于阵发房颤组57.2(48.8) ng/L、61.4(46.3) ng/Lvs 52.5(42.8) ng/L(P＜0.05).永久房颤组和持续房颤组左心房内径较对照组和阵发性房颤组增加(45.70±6.71) mm、(42.67±6.83)mmvs (38.55±4.51)mrn、(40.82±5.45) mm(P ＜0.05).而持续房颤组左心室射血分数较对照组和阵发性房颤组明显降低(49.47±7.14)％vs(54.89±6.25)％、(53.90±8.02)％(P＜0.05);永久性房颤组左心室射血分数较持续性房颤组明显降低(45.60±8.02)％vs(49.47±7.14)％(P＜0.05).结论 TLR2、HIF-1α、MMP-9作为免疫炎症因子水平的升高可能与房颤的发生及维持有关,提示炎症参与了房颤的发生与维持.     

放免法测定N-心钠素诊断无症状性心力衰竭

目的　评价N 心钠素 (N ANP)对无症状性心力衰竭的诊断价值。方法　通过放射性核素门控血池显像 ,筛选无症状心力衰竭患者 32例 ,心力衰竭患者 32例 ,并选取心功能正常健康人 32例作为对照组 ;采用放射免疫法测定三组N ANP水平。结果　无症状性心力衰竭组血浆N ANP[(1382 .2 5± 5 49.5 1)ng/L]水平显著高于对照组[(42 2 .0 6± 2 5 5 .38)ng/L ,P <0 .0 5 ],却显著低于心力衰竭组 [(40 2 0 .43± 2 0 90 .95 )ng/L ,P <0 .0 5 ];按血浆N ANP >92 3 .0 0ng/L(对照组的 x +1.96s) ,诊断无症状心力衰竭 ,敏感性为 75 % ,特异性为 94%。结论　N ANP可用来诊断无症状性心力衰竭 ;且以N ANP >92 3 .0 0ng/L作为诊断无症状性心力衰竭的指标较为合适     

蛛网膜下腔出血时血浆心钠素与低钠血症的关系

目的　研究蛛网膜下腔出血 (SAH)后血浆心钠素 (ANP)的水平变化及其与SAH后低钠发生的相关性。方法　采用放射免疫分析技术和离子选择性电极法检测 2 6例SAH患者不同病程的血浆ANP水平和血清钠水平。根据血清钠水平将 2 6例SAH患者分为SAH低钠组和SAH正常钠组 ,与健康对照组的血浆ANP水平进行比较。结果　SAH低钠组发病后 0～ 3d ,7～ 9d ,14～ 16d的血浆ANP水平均显著高于健康对照组 (P <0 0 1) ,且发病 7～ 9d ,14～ 16d的血浆ANP水平高于SAH正常钠组 (P <0 0 1) ;SAH低钠组血浆ANP水平与血清钠之间呈显著负相关。结论　血浆ANP参与SAH后低钠血症的发生 ;临床上对于SAH后血浆ANP水平显著高值的患者 ,需注意低钠的发生和加重可能     

血浆心房钠尿肽的变化与急性脑卒中的关系

目的:探讨急性脑卒中患者血浆心房钠尿肽(ANP)的变化及其临床意义。方法:对76例脑梗死患者(脑梗死组)和16例脑出血患者(脑出血组)于发病后第1、2、3周采用放射免疫法测定血浆ANP水平,以30例健康体检者(对照组)的血浆ANP水平作为对照。结果:在发病后各时间点,脑梗死组和脑出血组血浆ANP水平均明显高于对照组(P<0.01)。发病后第1周脑出血组血浆ANP水平明显高于脑梗死组(P<0.05),第2、3周仍高于脑梗死组,但差异均无显著性意义。2组发病后第1周与第2周比较差异均无显著性意义。结论:血浆ANP水平的增高在一定程度上反映了脑组织受损的严重程度,也与高血压和机体的应激反应有关。     

环肺静脉隔离术对阵发性心房颤动患者血浆心房钠尿肽水平的影响

目的 探讨环肺静脉隔离术(PVI)对阵发性心房颤动(简称房颤)患者心房钠尿肽(ANP)水平的影响.方法 连续19例接受PVI治疗的阵发性房颤患者,分别在术前、术后第1天及术后3个月时于稳定的窦性心律下取血测定血浆ANP浓度.结果 共16例患者完成了全部3次ANP测定.PVI术后第1天的血浆ANP浓度(14±8 pg/mL)显著低于PVI术前(26±12 pg/mL,P<0.01)和PVI术后3个月时(24±17 pg/mL,P<0.01),而后两者之间差异无显著性(P>0.05).结论 对于阵发性房颤,PVI仅在术后早期显著降低患者的血浆ANP水平,提示该术对心房内分泌功能的影响是一过性的.     

Plasma levels of atrial natriuretic peptide at rest and during exercise in heart failure—influence of cardiac rhythm and haemodynamics

Summary. The relationship between plasma levels of immunoreactive atrial natriuretic peptide (ir-ANP), arginine vasopressin (AVP), cardiac rhythm and different haemodynamic variables were studied at rest and during exercise in 16 patients with heart failure undergoing heart catheterization for clinically indicated reasons. Even though there was no significant relationship between pulmonary capillary wedge pressure (PCW) and ir-ANP at rest (r= 0·39; P= 0·14) changes in these variables with exercise correlated well (r= 0·71; P= 0·002). Change in right atrial mean pressure, heart rate, mean arterial blood pressure or cardiac index did not significantly influence change in plasma levels of ir-ANP. The correlation between PCW and AVP at rest (r= 0·92; P<<0·001) disappeared during exercise. Calculated ir-ANP/PCW ratios decreased slightly during exercise, but were not influenced by initial atrial pressures or atrial fibrillation. These observations provide evidence for a similar responsiveness of ANP in patients with sinus rhythm and atrial fibrillation. The ability of rapid change in ANP plasma levels during exercise was preserved and proportional to changes in PCW over a wide pressure range in the studied patient group. This finding indicates that left atrium distension rather than right atrium distension is the major determinant for the release of ANP in patients with congestive heart failure. The observed rapid responsiveness of ANP to change in left atrial pressure may allow the hormone to modulate haemodynamic response during short periods of exercise.     

AV nodal ablation and pacemaker implantation improves hemodynamic function in atrial fibrillation

In drug refractory and highly symptomatic atrial fibrillation (AF) patients, hemodynamic effects of AV node ablation and pacing therapy (APT) were evaluated. Thirty-eight patients with drug refractory and symptomatic AF, underwent APT in eight centers in Japan. The outcome of this therapy was assessed in terms of quality-of-life, cardiac performance measured by echocardiogram, and plasma ANP and BNP levels before and after APT. Quality-of-life assessed by self-administered semi-quantitative questionnaires: WHO QOL 26 (3.0 +/- 0.5 vs 3.4 +/- 0.6, P < 0.01) and the Symptom Checklist: Frequency Scale (1.6 +/- 0.6 vs 0.7 +/- 0.7, P < 0.01) and Severity Scale (1.3 +/- 0.4 vs 0.6 +/- 0.6, P < 0.01), improved significantly 6 months after APT. Ejection fraction (EF) by echocardiogram improved 1 week after APT (59.0% +/- 13.3% vs 63.3% +/- 11.6%, P = 0.02). Plasma ANP levels in the group of ANP > 40 pg/mL at enrollment significantly decreased 1 month later (P = 0.03), and plasma BNP levels in the group of BNP > 20 pg/mL at enrollment significantly decreased 1 month later (P < 0.01). In conclusion, APT has beneficial hemodynamic effects, and plasma BNP levels can predict the most optimal candidates for ablation and pacing therapy.     

Effects of posture and saline infusion on atrial natriuretic peptide and haemodynamics in patients with Bartter''s syndrome and healthy controls

In order to explore the role of atrial natriuretic peptide (ANP) in Bartter's syndrome, five patients and five healthy controls matched for age and sex were studied. The study was designed to stimulate and suppress ANP secretion by manipulation of right atrial pressure with different body positions and mild volume expansion with saline. Other vasoactive hormones were also measured, and heart rate and blood pressure were recorded at 5-min intervals. Plasma ANP levels increased after head-down tilt and returned to baseline in the upright position. Infusion of saline failed to increase plasma ANP both in the control group and in four of the patients. No significant differences were found in plasma atrial natriuretic peptide concentrations between both groups. In view of previously reported elevated plasma ANP levels, Bartter's syndrome may be heterogeneous in this respect. Plasma renin activity was higher in the patients, but plasma aldosterone, adrenaline and noradrenaline were similar in both groups. Mean arterial blood pressure was similar in both groups, but rose significantly in the upright position in the control group only, while changes in heart rate were similar in both groups. We conclude that atrial natriuretic peptide does not seem to play a causal role in our patients with Bartter's syndrome.     

Renal clearance of atrial natriuretic peptide during acute unilateral complete ureteral obstruction in the pig

Abstract. Renal extraction and renal plasma clearance of atrial natriuretic peptide from pigs with complete unilateral ureteral obstruction (UUO) and from intact anaesthetized pigs were determined from arterio-venous differences in plasma atrial natriuretic peptide and measured renal plasma flow. The effect of administration of either a cyclooxygenase inhibitor or an angiotensin converting enzyme inhibitor was examined during UUO. Renal extraction ratio and renal clearance rate of plasma atrial natriuretic peptide (ANP) in the intact pig was stable during the 15 h observation period. UUO resulted in a significant ( P <0.05) temporary increase in renal extraction ratio and a significant ( P <0.05) reduction in the renal clearance rate of atrial natriuretic peptide. During cyclooxygenase inhibition there was a significant increase in the renal extraction ratio of ANP. During angiotensin II converting enzyme inhibition, renal handling of atrial natriuretic peptide did not differ from that observed in control animals. The present data demonstrate that atrial natriuretic peptide is extracted by the obstructed kidney. Despite the significant reduction in renal blood flow during indo-methacin administration, renal clearance of ANP was unaltered. The increase in ipsilateral renal extraction of atrial natriuretic peptide immediately after ureteral obstruction and indomethacin administration could be explained either by a direct influence of PGE₂ on the renal haemodynamics altering renal extraction of ANP, or by a compensatory mechanism attempting to preserve renal function.     

No Correlation Between Atrial Natriuretic Peptide Concentrations and Echocardiographic Measurements of Left Atrial Size or Left Ventricular Size and Function in Patients with Persistent Atrial Fibrillation

Atrial fibrillation (AF) may be associated with activation of atrial natriuretic peptide (ANP). The exact trigger for the release of ANP is still being debated. Atrial volume, pressure, and wall stretch are considered to be the main determinants of ANP activation. The aim of the study was to evaluate plasma ANP concentrations in patients with persistent AF and to analyze the echocardiographic determinants of ANP concentration in this group. The study population included 67 patients, 59 ± 7 years of age, with a median AF duration of 5.5 months (range 0.1–12). The relationship between plasma ANP concentrations and echocardiographic left atrial (LA) diameter and volume, and left ventricular (LV) diameter and ejection fraction (EF) was analyzed by logistic regression analysis. The median baseline plasma ANP concentration was 63 pg/mL (range 21–126) in the study group versus 34 pg/mL (range 16–73) in a control group. The mean left antero-posterior atrial dimension, LA volume, LV enddiastolic diameter, and LVEF were 48 mm, 104 mL, 52 mm, and 54%, respectively. A significant linear positive correlation was found between plasma ANP concentration and maximal LA volume (r = 0.62, P < 0.01). A negative correlation was found between LVEF and plasma ANP concentration (r =−0.42, P = 0.01). However, by multivariate regression analysis, no echocardiographic parameter was an independent predictor of plasma ANP concentration. Plasma ANP concentrations were independent of echocardiographic measurements of LA size or LV size and function in patients with persistent AF.     

Renal and hormonal actions of atrial natriuretic peptide during angiotensin II or noradrenaline infusion in man

In order to study the renal and hormonal actions of atrial natriuretic peptide (ANP) during background infusions with angiotensin II (ANG II) or noradrenaline (NA), 69 healthy subjects were examined in three main groups receiving a 90-min infusion with either placebo, ANG II (1.5 ng kg^?1 min^?1), or NA (25 ng kg^?1 min^?1). Each of these three main groups were subdivided into two groups receiving an infusion with either placebo or ANP (10 ng kg^?1 min^?1) for the last 60 min of the background infusion. Lithium clearance was used to evaluate segmental tubular reabsorption. ANG II alone caused a decrease in glomerular filtration rate (GFR), renal plasma flow, urinary absolute and fractional excretion of sodium, both proximal and distal fractional tubular sodium reabsorption, and urinary flow. NA alone caused a decrease in renal plasma flow. ANP alone caused a decrease in renal plasma flow. Urinary absolute and fractional excretion of sodium were increased and the distal fractional tubular reabsorption of sodium decreased, whereas the proximal fractional tubular reabsorption was unchanged by ANP. ANG II + ANP: during a background ANG II infusion, ANP still increased fractional excretion of sodium. Proximal fractional reabsorption was decreased, whereas distal fractional reabsorption of sodium was unchanged by ANP during ANG II infusion. The ANP-induced decreases in proximal absolute (?147 vs. +714 μmol min^?1 1.73 m^?2P = 0.05) and fractional (?1.7% vs. +0.6%, P<0.01) tubular sodium reabsorption were more pronounced, and the decrease in distal fractional tubular reabsorption of sodium (?0.1% vs. ?1.4%, P<0.05) less pronounced compared with when ANP was given alone. NA + ANP: during a background NA infusion, ANP still increased urinary sodium excretion and decreased distal fractional reabsorption. None of the ANP-induced absolute changes seen during background infusion with NA were significantly different from the ANP-induced changes seen during placebo background infusion. It is concluded that the natriuretic action of low-dose ANP seems to be preserved during background infusions with ANG II and NA in man. Net sodium excretion during the combined infusion with ANG II and ANP seems to reflect the sum of the opposing influences of each peptide. Low-dose ANP had a very modest but significant inhibitory effect on proximal tubular sodium reabsorption prestimulated by ANG II infusion.     

特发性心房颤动患者的血浆心钠素水平的变化

目的：探讨特发性阵发性与持续性心房颤动患者的血浆心钠素（ANP）水平的变化及其原因。方法：采用放射免疫分析法检测21例特发性阵发性房颤患者房颤发作时（A1组）和房颤终止后7天（A2组）及28例特发性持续性房颤患者（B组）的血浆ANP水平，同时测定各组红细胞压积及血小板数，并与健康对照组（C组）进行比较。结果：特发性阵发性房颤患者房颤发作时及特发性持续性房颤患者的血浆心钠素水平及红细胞压积均显著高于正常对照组（P＜0．01），而A1组的血浆心钠素水平和红细胞压积显著高于A2组（P＜0．01），但血小板各组间差异无显著性（P＞0．05）。结论：特发性阵发性及特发性持续性心房颤动患者均存在血液浓缩，且与心钠素释放增加有关。     

心力衰竭并发心房颤动患者不同心室率与B型脑钠肽的关系探讨

目的探讨心力衰竭并发心房颤动患者不同心室率与B型脑钠肽(BNP)的相关性。方法入选本院心血管科62例心力衰竭患者,根据是否并发心房颤动分为3组:A组(n=20),为单纯心力衰竭患者;B组(n=20),并发慢性心房颤动(心室率小于100次/min);C组(n=22),并发快速心房颤动(心室率大于100次/min)。比较3组患者一般情况、心率及血浆BNP水平。结果 C组患者心率明显高于A组和B组,差异有统计学意义(P<0.01)。C组患者血浆BNP水平明显高于A组、B组,差异有统计学意义(P<0.01);B组患者血浆BNP水平明显高于A组,差异有统计学意义(P<0.01)。结论心房颤动患者心室率的加快会导致BNP水平的升高。     

Effect of β1-adrenoceptor blockade on plasma levels of atrial natriuretic peptide during exercise in normal man

Summary. Increased plasma levels of atrial natriuretic peptide (ANP) during exercise have been reported. To investigate the role of tachycardia as a stimulus for release of ANP during exercise the following study was undertaken. Graded exercise was performed in six healthy volunteers before and after β₁-adrenoceptor blockade. Plasma levels of ANP were determined at different workloads in both cases. At rest and at all workloads during exercise plasma levels of ANP were higher after β₁-adrenoceptor blockade than without. Therefore, it is unlikely that tachycardia is a major stimulus for secretion of ANP during exercise. It is suggested that increased right atrial pressure and/or pulmonary arterial blood pressure and increased plasma levels of catecholamines are important secretory stimuli for ANP during exercise.