降钙素基因相关肽和内皮素在充血性心力衰竭中的作用

采用同位素放射免疫法同时检测30例充血性心力衰竭（CHF）患者的血浆降钙素基因相关肽（CGRP）和内皮素（ET）浓度，求出ET／CGRP比值，并与30例健康人对照，结果显示CHF患者血浆CGRP和ET浓度以及ET／CGRP比值较对照组明显增高（P＜0．05和P＜0．01）。提示在CHF时血浆CGRP和ET浓度均增高，且失去ET和CGRP的正常平衡，这对CHF的防治可能具有重要意义。     

坎地沙坦对老年充血性心力衰竭患者利钾尿肽、心房钠尿肽和内皮素水平的影响

目的: 探讨血管紧张素II受体拮抗剂（ARB）坎地沙坦治疗充血性心力衰竭（CHF）时对外周血中利钾尿肽（KP）、心房钠尿肽（ANP）和内皮素（ET）水平的影响。方法: 94例老年CHF患者随机分为常规治疗组（硝酸酯类药物+利尿剂+地高辛）和坎地沙坦组（常规治疗药物+坎地沙坦）,随访12 周,采用放射免疫分析方法测定两组治疗前后和34例健康者（正常对照组）外周血浆中KP、ANP和ET水平。同时用核素心室显像测定CHF患者左心室射血分数（LVEF）。结果: CHF患者的血浆KP、ANP和ET水平较正常对照组显著升高,随着病情的好转其水平逐渐降低,且不同的心功能分级之间有显著差异（P<0.05）。治疗后,坎地沙坦组外周血中KP、ANP和ET水平较常规治疗组下降更显著。结论: 坎地沙坦有抑制CHF患者神经内分泌的过度激活和肾素-血管紧张素-醛固酮(RAAS)系统亢进的作用。     

充血性心力衰竭患者的血浆一氧化氮及内皮素的临床研究

目的探讨充血性心力衰竭（CHF）患者的血浆一氧化氮（NO）及内皮素（ET）含量及其在CHF发生发展中所起的作用。方法分别采用比色分析法及放射免疫分析法测定了42例CHF患者的血浆NO及ET。结果CHF患者的血浆NO及ET（64．47±21．42μmol／L及59．71±17．26pg／ml）显著高于正常对照组（51．62±13．62μmol／L及50．83±7．50pg／ml），且心功能Ⅲ－Ⅳ级患者的血浆NO及ET显著高于心功能Ⅱ级者。结论CHF患者的血浆NO及ET含量增高，且与病情严重程度相关。     

苯那普利对充血性心力衰竭患者心功能及内皮素水平的影响

目的观察苯那普利对充血性心力衰竭（CHF）患者血浆内皮素（ET）水平及心功能变化的影响，并探讨其相关机制。方法86例CHF患者随机分为苯那普利组和常规治疗组，另有38例健康受试者选为对照组，采用放射免疫法检测苯那普利组及常规治疗对照组患者治疗前和治疗12周后ET水平，同时采用超声心动图检测左室射血分数（LVEF）和二尖瓣血流最大流速E峰和A峰比值（E／A）。结果CHF患者ET水平显著高于对照组。苯那普得治疗12周后，CHF患者的ET水平显著降低，LVEF、E／A值显著提高。结论CHF患者ET水平增高可作为判断CHF病情的指标之一；苯那普利可降低CHF患者的ET水平，改善CHF患者的心脏功能。     

充血性心力衰竭治疗前后血浆肿瘤坏死因子变化的研究

为探讨肿瘤坏死因子(TNF)在充血性心力衰竭(CHF)发生、发展过程中的意义,我们测定了40例CHF患者治疗前后外周血中的TNF、血浆内皮素(ET)、心钠素(ANP)、前列环素(PGI_2)的浓度.其中风湿性心脏病28例,冠状动脉粥样硬化性心脏病7例,扩张型心肌病3例;先心病2例;平均年龄42±11.1岁.心功能Ⅱ级9例,Ⅲ级22例,Ⅳ级9例.并与30例正常人作对照.结果发现TNF、ET、ANP浓度均显著高于对照组(P<0.01),CHF治疗前的TNF、ET、ANP浓度与治疗后比较均有非常显著差异(P<0.01),且与CHF的严重程度相一致.TNF与ET、ANP呈显著正相关.PGI_2在CHF患者治疗前后及与对照组比较差异无显著性(P>0.05).提示TNF参与了CHF的发生和发展过程,TNF可作为CHF的一个重要指标.     

血浆心房钠尿肽水平、右心压力及心功能分级的相关性

目的 :观察血浆心房钠尿肽 （ANP）浓度、各部位压力及心功能分级之间的关系。方法 :对 2 0例充血性心力衰竭（CHF）患者通过漂浮导管 （Swan- Ganz导管 ）同时测定肺动脉、右心室、右心房的压力 ,并用放射免疫法测定上述三个部位血浆心房钠尿肽 （ANP）浓度。结果 :CHF患者心功能级别不同 ,心血管各部位的压力及血浆 ANP浓度也不同 ;心血管内各部位的压力和血浆 ANP浓度与心功能不全的严重程度相平行 ;股静脉及肺动脉血浆 ANP浓度均与上述三个部位压力呈正相关 ;在心功能分级相同时 ,各部位血浆 ANP浓度基本相同。结论 :有可能通过测定外周血浆心房钠尿肽浓度判断心功能不全程度 ,或估计肺动脉、右心房、股静脉处的压力。     

老年高血压病患者肾素系统和血管活性肽的变化

目的 :探讨老年原发性高血压 （EH ）患者肾素 （RA） -血管紧张素 （AT） -醛固酮 （AL D）系统 （RAAS）及心房钠尿肽 （ANP）、内皮素 （ET）、降钙素基因相关肽 （CGRP）等血管活性肽的变化。方法 :放射免疫方法检测 96例健康老年人和 10 4例老年 EH患者血浆肾素活性 （PRA） ,AT ,AL D,ANP,ET,CGRP浓度。结果 :1两组 PRA,AT ,AL D浓度均随年龄增长而降低 （P<0 .0 5或 P <0 .0 1） ,但老年 EH患者明显高于健康老年人 （P<0 .0 5或 P<0 .0 1） ;2健康老年人各年龄组的 ANP,ET和 CGRP无明显差异 （P>0 .0 5 ） ;老年 EH患者血浆 ANP,ET浓度随年龄增长而明显增高 （P<0 .0 5或 P<0 .0 1） ,CGRP浓度随年龄增长而明显减低 （P<0 .0 1） ;各年龄组老年 EH患者血浆 ANP,ET均明显高于健康老年人 （P<0 .0 5或 P<0 .0 1） ,CGRP浓度均明显低于健康老年人 （P<0 .0 5或P<0 .0 1）。 3老年 EH患者血浆 AT 与 ANP,ET呈正相关 （r=0 .6 0 ,0 .79,P<0 .0 1） ,与 CGRP呈负相关 （r=-0 .5 9,P<0 .0 1）。结论 :老年人随着年龄的增长 ,在生理状态下传统的 RAAS的作用减弱 ,更多的是血管活性肽（ANP,ET,CGRP）参与心血管活性的调节 ,老年 EH患者缩血管肽 ET的活性增高、舒血管肽 CGRP活性减弱。     

慢性心力衰竭患者血浆心钠素水平的变化及人工合成心钠素的干预作用

目的探讨慢性心力衰竭（CHF）时血浆心钠素（ANP）水平的变化及人工合成心钠素对慢性CHF患者的治疗效果。方法慢性CHF患者80例随机分为心钠素治疗组和常规治疗组各40例。常规治疗组常规使用强心剂、利尿剂、硝酸酯类药物。心钠素治疗组在常规治疗措施基础上给予心钠素220mg静脉滴注，每日1次，治疗2周。结果治疗前CHF组血浆ANP水平为（198．5±68．9）pg／ml，LVEF为（36．8±8．7）％，明显低于对照组的（289．8±0．2）pg／ml和（63．2±10．8）％（P〈O．01）。NYHAⅡ级、Ⅲ级、Ⅳ级患者血浆ANP浓度分别为（235．7±73．8）pg／ml、（200．3±67．9）pg／ml和（156．7±69．1）pg／ml，均明显低于对照组（P〈0．01）。冠心病CHF、高血压心脏病CHF、瓣膜病CHF和扩张型心肌病CHF患者血浆ANP浓度分别为（200．9±57．2）pg／ml、（195．6±75．3）pg／ml、（190．1±82．6）pg／ml和（193．6±79．8）pg／ml，不同病因组患者的ANP水平差异无统计学意义（P〉0．05）。治疗后心钠素治疗组HR、SBP、DBP较治疗前及常规治疗组明显降低（P〈0．05），LVEF、ANP、BNP较治疗前及常规治疗组明显升高（P〈0．05）。心钠素治疗组总有效率为87．5％，高于常规治疗组的62．5％（P〈O．01）。结论慢性CHF患者血浆心钠素水平明显降低，且随心衰程度的加重明显降低。人工合成的心钠素有助于改善心衰患者的临床症状和心功能。     

不同Na^＋浓度及热量食物对2型糖尿病患者醛固酮、心房利钠肽及内啡肽影响的研究

目的研究饮食中Na^＋浓度及热量对糖尿病患者醛固酮（ALD）、心房利钠肽（ANP）及内啡肽（EM）分泌的影响。方法57例T2DM患者,分别于禁食12h后的两个清晨给予高钠低热量及低钠高热量的食物,用放免法检测空腹和餐后2h血浆ALD、ANP及EM的浓度。结果在摄入高钠低热量食物2h后,血浆ALD、EM浓度无明显变化,ANP显著增高;而摄入低钠高热量食物2h后,血浆EM、ALD显著降低,ANP无明显变化。在两次试验中,空腹状态下EM均与ANP、ALD呈正相关。结论（1）T2DM患者血浆ALD对食物中摄入的Na^＋增加反应不敏感,ANP显著增高;（2）EM主要调节患者能量摄入,当患者摄入高热量食物后EM血浆浓度显著降低。     

利钾尿肽、心房钠尿肽在充血性心力衰竭患者中的变化

目的:研究利钾尿肽（KP）在和心房钠尿肽（ANP）充血性心力衰竭（CHF）中的变化及其意义。方法:用放射免疫分析方法测定50例患者发病不同时期血浆KP和ANP含量。结果:CHF患者在发病第1天血浆KP、ANP水平最高,随着病情的好转而逐渐降低,不同的心功能分级之间有显著差异,KP水平与左室射血分数呈显著负相关。结论:血浆KP水平在CHF病理生理中的改变有重要意义。     

慢性充血性心力衰竭患者血浆内皮素与心钠素间的关系

分析了40例慢性充血性心力衰竭患者治疗前后及不同心功能状态下内皮素及心钠素的变化。结果表明：治疗前内皮素明显增高为对照组2倍，内皮素的含量与心力衰竭的严重程度有明显的一致性，充血性心力衰竭时心钠素增高，血浆心钠素与内皮素呈显著正相关。     

老年脑出血患者血浆ET和ANP的变化及临床意义

目的测定老年脑出血患者血浆内皮素（ＥＴ）、心钠素（ＡＮＰ）浓度并探讨其临床意义。方法以放射免疫法测定老年和非老年健康人；老年及非老年脑出血患者不同时期血浆ＥＴ及ＡＮＰ水平。结果老年脑出血患者急性期血浆ＥＴ为１４８．１８ｎｇ／Ｌ，ＡＮＰ为５７．３３ｎｇ／Ｌ，较健康对照组明显升高（分别为Ｐ＜０．０１及Ｐ＜０．０５）。恢复期与对照组比较无明显差异。同期测定的非老年脑出血患者血浆ＥＴ和ＡＮＰ浓度与老年患者差异无显著意义（Ｐ＞０．０５），直线相关分析表明，老年脑出血患者急性期血浆ＥＴ与ＡＮＰ之间呈明显正相关。结论脑出血患者血浆ＥＴ、ＡＮＰ浓度的升高与脑出血的发生、病情的发展及转归有密切关系     

Responses of plasma concentrations of A type natriuretic peptide and B type natriuretic peptide to alacepril, an angiotensin-converting enzyme inhibitor, in patients with congestive heart failure.

BACKGROUND--Plasma concentrations of A type or atrial natriuretic peptide (ANP) and B type or brain natriuretic peptide (BNP) are increased in patients with congestive heart failure (CHF). OBJECTIVE--To examine the haemodynamic and hormonal responses, especially of ANP and BNP, to oral administration of an angiotensin-converting enzyme (ACE) inhibitor in patients with CHF and in controls. PATIENTS--12 patients with CHF and 11 controls. METHODS--Haemodynamic variables and plasma concentrations of ANP, BNP, and other hormones were serially measured for 24 hours after alacepril (37.5 mg) was given by mouth. RESULTS--Pulmonary capillary wedge pressure and systemic vascular resistance decreased significantly in both groups. The cardiac index increased only in the CHF group. In patients with CHF pulmonary capillary wedge pressure, systemic vascular resistance, and cardiac index were significantly changed from 1 to 12 hours after alacepril administration. Plasma ANP and BNP decreased significantly after alacepril was given to the CHF group: neither concentration changed in the control group. In the CHF group plasma ANP was significantly lower between 1 and 6 hours and was highly significantly correlated with pulmonary capillary wedge pressure. Plasma BNP, however, was significantly lower between 6 and 24 hours after alacepril and was not correlated with pulmonary capillary wedge pressure. CONCLUSIONS--The response of plasma BNP after alacepril administration occurred later and lasted longer than the plasma ANP response. This may indicate that the mechanisms of synthesis, secretion, or degradation of the two peptides are different.     

Diurnal change of plasma atrial natriuretic peptide concentrations in patients with congestive heart failure

Diurnal change of plasma atrial natriuretic peptide (ANP) concentration was observed in 14 patients with congestive heart failure (CHF) and in eight healthy control subjects. Blood pressure, heart rate, and plasma concentration of ANP were obtained at intervals of 4 hours beginning immediately after midnight. In the CHF group, plasma ANP concentrations at the time of blood sampling were all higher than those in the control group. Patients with severe CHF had higher plasma ANP concentrations than those in patients with less severe CHF. Plasma ANP concentration in the control group was highest at 4:00 AM and was lowest at 4:00 PM. The percent change of ANP secretion (% delta ANP): [(ANP at 4:00 AM-ANP at 4:00 PM)/ANP at 4:00 PM] x 100%, increased in the control group, while it decreased in the CHF group. Moreover, % delta ANP was much lower in patients with severe CHF than it was in patients with less severe CHF. There was a possible relation between the severity of CHF and the increase of ANP secretion associated with the relative diminution of nocturnal ANP secretion. Thus the present data imply that the diurnal change in ANP was lost in patients with CHF.     

Clinical application of atrial natriuretic polypeptide in patients with congestive heart failure: beneficial effects on left ventricular function

Synthetic alpha-human atrial natriuretic polypeptide was infused in patients with congestive heart failure (CHF) (New York Heart Association class III or IV) and in those without CHF. The infusion of atrial natriuretic polypeptide (ANP) at a rate of 0.1 microgram/kg/min significantly decreased pulmonary capillary wedge pressure and increased stroke volume index in all of the patients with CHF, whereas it decreased pulmonary capillary wedge pressure but caused no significant change in stroke volume index in the patients without CHF. Concomitant significant reductions in total systemic resistance were observed in both groups of patients. The ANP infusion significantly increased the urine volume, the excretion of sodium, and endogenous creatinine clearance in the patients without CHF. In the patients with CHF, it also showed a tendency to increase all these variables, but the urine volume did not correlate with the reduction in pulmonary capillary wedge pressure. The ANP infusion also decreased plasma aldosterone concentrations in these patients, although no significant difference was observed in the decrement of the plasma aldosterone concentration in the patients with and those without CHF. These findings indicate that the ANP infusion improves left ventricular function in patients with CHF, and suggest that this improvement results mainly from the vasodilating activity of ANP.     

Increased plasma levels of atrial natriuretic peptide in patients with congestive heart failure

Atrial natriuretic peptide (ANP) is a recently discovered hormone,originating from atrial myocardium. The peptide (or family ofpeptides) induces potent diuretic/natiuretic, vasorelaxing andaldosterone inhibitory effects. We have investigated plasmaconcentrations of immunoreactive ANP in 10 patients with congestiveheart failure (CHF). Mean plasma ANP concentrations were morethan three times higher in CHF patients than in a matched controlgroup. High plasma ANP concentrations in pathophysiologicalconditions with a high preload combined with salt and waterretention is consistent with a physiological role of this hormoneto correct hypervolemia by causing natriuresis and diuresis.It is concluded that ANP homeostasis is altered in patientswith CHF and that this hormone may be of importance in the pathophysiologyof CHF.     

Limitations of compensation by endogenous atrial natriuretic peptide in heart failure.

To evaluate the role of endogenous atrial natriuretic peptide (ANP) in patients with congestive heart failure (CHF), the relationship between plasma ANP and cyclic guanosine monophosphate (cGMP) levels and the prognosis of patients with CHF was examined. In patients with chronic mild to moderate CHF, there was a positive correlation between plasma ANP and cGMP levels (r = 0.81, p less than 0.001). However, there was no significant correlation between these plasma levels in patients with chronic severe CHF, in whom the cGMP concentration reached a plateau in spite of high levels of ANP. The ANP extraction level and the cGMP production level in the pulmonary and systemic circulation correlated significantly in patients with mild CHF. In contrast, there was no significant correlation between the 2 parameters in patients with severe CHF, and the molar ratios of cGMP production to ANP extraction in the pulmonary and systemic circulation were significantly lower than those in patients with mild CHF. In 44 patients with chronic severe CHF who were followed up over 2 years, plasma ANP levels provided more sensitive and specific prognostic information than any other parameters. These results indicate that ANP receptors coupled to guanylate cyclase may be down-regulated in patients with chronic severe CHF, suggesting that high plasma ANP levels as a prognostic predictor may be associated with limitations of compensation by endogenous ANP.