Renal, haemodynamic and hormonal interactions between atrial natriuretic factor and arginine vasopressin in patients with congestive heart failure.

1. Nine patients with compensated heart failure were infused with synthetic arginine vasopressin at a rate of 0.1 m-units min-1 kg-1 for 60 min to increase their plasma arginine vasopressin concentration. Synthetic human atrial natriuretic factor (3 pmol min-1 kg-1) or placebo was co-infused with the arginine vasopressin in random order in a single-blind cross-over design. 2. The resultant plasma concentrations of arginine vasopressin and atrial natriuretic factor fell to within the upper range observed in congestive heart failure. Compared with the infusion of arginine vasopressin alone, atrial natriuretic factor co-infusion enhanced both the urine flow rate and the sodium excretion rate (both P less than 0.05) without significant haemodynamic and hormonal effects. 3. Systematic blood pressure was elevated by arginine vasopressin infusion (P less than 0.05) without any change in heart rate. Co-infusion of atrial natriuretic factor did not affect these haemodynamic parameters. 4. These results suggest that an increased release of atrial natriuretic factor maintains water and sodium excretion in the presence of arginine vasopressin-induced renal modulations, and that the pressor effect of arginine vasopressin is not antagonized by the increased plasma level of atrial natriuretic factor in patients with congestive heart failure.     

The relationship between atrial granularity and circulating atrial natriuretic peptide in hamsters with congestive heart failure

The BIO 14.6 strain of hamster is a model of familial cardiomyopathy complicated by congestive heart failure, sodium retention, and edema. In previous studies, bioassay techniques have demonstrated that the cardiac content of atrial natriuretic peptide (ANP) is reduced in these animals. On the basis of this observation, the syndrome of congestive heart failure has been hypothesized to be due to a deficiency in ANP. The current study was designed to correlate the cardiac content of ANP (determined by immunohistochemical techniques) with plasma circulating ANP (determined by radioimmunoassay). alpha-ANP antibodies were used for both determinations. The content of ANP in the atria was based on the degree of immunoreactive staining present (1 = lowest; 5 = highest), as graded by two observers. The mean granularity score of the cardiomyopathic hamsters was decreased (2.1 +/- 0.3) in comparison with that of age- and sex-matched control animals (3.5 +/- 0.5; P less than 0.05). In contrast, circulating immunoreactive ANP was higher in the hamsters with congestive heart failure than in the control animals--185.5 +/- 27.2 pg/ml versus 77.7 +/- 10.8 pg/ml (P less than 0.005). This study demonstrates that an inverse relationship exists between ANP content in the atria and circulating ANP. Furthermore, this study suggests that these hamsters with congestive heart failure are not deficient in ANP; rather, secretion of ANP is stimulated and storage of the peptide, represented by atrial granularity, is reduced.     

Atrial natriuretic factor in normal subjects and heart failure patients. Plasma levels and renal, hormonal, and hemodynamic responses to peptide infusion.

We investigated atrial natriuretic factor (ANF) in humans, measuring plasma immunoreactive (ir) ANF (in femtomoles per milliliter), and renal, hormonal, and hemodynamic responses to ANF infusion, in normal subjects (NL) and congestive heart failure patients (CHF). Plasma irANF was 11 +/- 0.9 fmol/ml in NL and 71 +/- 9.9 in CHF (P less than 0.01); the latter with twofold right ventricular increment (P less than 0.05). In NL, ANF infusion of 0.10 microgram/kg per min (40 pmol/kg per min) induced increases (P less than 0.05) of absolute (from 160 +/- 23 to 725 +/- 198 mueq/min) and fractional (1-4%) sodium excretion, urine flow rate (from 10 +/- 1.6 to 20 +/- 2.6 ml/min), osmolar (from 3.2 +/- 0.6 to 6.8 +/- 1.2 ml/min) and free water (from 6.8 +/- 1.6 to 13.6 +/- 1.6 ml/min) clearances, and filtration fraction (from 20 +/- 1 to 26 +/- 2%). Plasma renin and aldosterone decreased 33% and 40%, respectively (P less than 0.01). Systolic blood pressure fell (from 112 +/- 3 to 104 +/- 5 mmHg, P less than 0.05) in seated NL; but in supine NL, the only hemodynamic response was decreased pulmonary wedge pressure (from 11 +/- 1 to 7 +/- 1 mmHg, P less than 0.05). In CHF, ANF induced changes in aldosterone and pulmonary wedge pressure, cardiac index, and systemic vascular resistance (all P less than 0.05); however, responses of renin and renal excretion were attenuated. ANF infusion increased hematocrit and serum protein concentration by 5-7% in NL (P less than 0.05) but not in CHF.     

Immunoreactive N-terminal pro-atrial natriuretic peptide in human plasma: plasma levels and comparisons with alpha-human atrial natriuretic peptide in normal subjects, patients with essential hypertension, cardiac transplant and chronic renal failure

1. Plasma levels of immunoreactive N-terminal pro-atrial natriuretic peptide (N-terminal ANP) have been measured in 25 normal subjects, 29 patients with essential hypertension, six cardiac transplant recipients, seven patients with dialysis-independent chronic renal failure and 11 patients with haemodialysis-dependent chronic renal failure. Plasma was extracted on Sep-Pak cartridges and N-terminal ANP immunoreactivity was measured using an antibody directed against pro-ANP (1-30). 2. Plasma levels of N-terminal ANP (means +/- SEM) were 235.3 +/- 19.2 pg/ml in normal subjects and were significantly raised in patients with essential hypertension (363.6 +/- 36.3 pg/ml), in cardiac transplant recipients (1240.0 +/- 196.2 pg/ml), in patients with chronic renal failure not requiring dialysis (1636.6 +/- 488.4 pg/ml) and patients with chronic renal failure on maintenance haemodialysis (10336.1 +/- 2043.7 pg/ml). 3. There were positive and significant correlations between the plasma levels of N-terminal ANP and alpha-human ANP (alpha-hANP) with individual correlation coefficients of 0.68 within the normal subjects, 0.47 in patients with essential hypertension, 0.78 in patients with dialysis-independent chronic renal failure and 0.68 in patients with haemodialysis-dependent chronic renal failure (P less than 0.05 in every case).(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性心力衰竭患者血浆肾上腺升压素和心钠素的变化

目的 观察慢性充血性心力衰竭(CHF)患者血浆肾上腺升压素(ADT)和心钠素(ANP)的变化,以探讨CHF发生发展的病理生理机制.方法 采用特异性放射免疫法检测了45例CHF患者治疗前后和20例正常人ADT和ANP的血浆浓度.结果 治疗前,ADT血浆浓度在心功能Ⅱ级为(29.98±3.56)ng/L、Ⅲ级为(33.45±3.54)ng/L,Ⅳ级为(20.71±3.37)ng/L,心功能Ⅲ级时达到高峰,心功能Ⅳ级时明显下降,并且低于正常对照组(24.89±2.19)ng/L,心力衰竭各亚组与正常对照组比较,差异均有统计学意义(均P＜0.05);经1周药物治疗后,心力衰竭各亚组患者血浆ADT含量下降.治疗前ANP血浆含量在心力衰竭各亚组较对照组明显升高(P＜0.05),心力衰竭各亚组间比较差异亦有统计学意义(均P＜0.05);治疗后,心力衰竭各亚组均下降,Ⅳ级组与治疗前相比差异有统计学意义(P＜0.05),余两组差异无统计学意义(P＞0.05).治疗前ADT和ANP在Ⅱ级组和Ⅳ级组无相关关系,Ⅲ级组有负相关关系(r=-0.46,P=0.04).结论 ADT和ANP共同参与了心力衰竭的病理进程,表明缩血管和舒血管活性肽分子间平衡被打破,反映了心力衰竭的严重程度;短期药物治疗可降低其血浆水平.     

Decreased density of binding sites for atrial natriuretic peptide on platelets of patients with severe congestive heart failure

1. Binding sites for atrial natriuretic peptide (ANP) with a specificity similar to that of vascular ANP receptors have been demonstrated previously in human platelets. The density of these binding sites for ANP on platelets is decreased after increased dietary sodium intake, when plasma ANP levels increase. ANP-binding sites were investigated in patients with severe congestive heart failure (CHF), a condition in which there is an increase in the concentration of ANP in plasma. 2. In 24 patients with a clinical diagnosis of functional class III-IV CHF, plasma ANP (90.3 +/- 13.4 fmol/ml, mean +/- SEM) was significantly higher (P less than 0.001) than in 16 age-matched patients without cardiac disease (15.4 +/- 2.0 fmol/ml). The density of ANP-binding sites on platelets was significantly lower (P less than 0.01) in the 24 CHF patients (6.3 +/- 0.8 fmol/10(9) cells) than in the non-cardiac patients (11.8 +/- 1.4 fmol/10(9) cells). There was no significant difference in affinity of the ANP-binding sites between both groups. There was a significant non-linear inverse correlation of the density of ANP-binding sites on platelets with plasma ANP concentration. These results could not be explained by prior receptor occupancy secondary to the elevated concentration of circulating ANP. 3. In conclusion, ANP-binding sites on platelets are decreased in patients with severe CHF and with significantly elevated concentration of ANP in plasma.     

Effects of atrial natriuretic peptide on acute renal impairment in patients with heart failure after cardiac surgery

Objective To investigate the effects of IV infusion of atrial natriuretic peptide (human ANP 1–28) on renal function in patients with acute heart failure and renal impairment after cardiac surgery.Design Pharmocodynamic, dose-effect investigation.Setting Cardiothoracic Intensive Care Unit of a university hospital.Patients Twelve patients (mean age 68 years, range 44–78 years) treated with inotropic drugs and an intra-aortic balloon pump (n=8) were studied 1–3 days after cardiac surgery. Patients had acute renal impairment, defined as a rise in serum creatinine of more than 50% compared to preoperative values. Patients were receiving dopamine and furosemide infusion to increase urine flow.Interventions Baseline measurements of glomerular filtration rate (GFR) and renal blood flow (⁵¹Cr-EDTA and PAH clearance) were first performed during two 30-min periods. ANP was then administered for two consecutive 30-min periods (25 and 50 ng/kg per min), followed by two control periods.Measurements and main results Mean arterial pressure decreased by 6% at the highest ANP dose. Urine flow, GFR and RBF increased 62%, 43% and 38%, respectively, while renal vascular resistance decreased 30%. At this dose level, circulating ANP concentrations were on the average eight fold higher than preinfusion levels.Conclusions ANP improved renal function and decreased elevated renal vascular resistance in patients with renal dysfunction after cardiac surgery. The improvement in renal blood flow and glomerular filtration rate may be of potential therapeutic value to prevent or treat exaggerated renal vasoconstriction in patients with acute renal impairment following cardiac surgery.This study was supported by grants from The Swedish Medical Research Council nos. 8682 and 8642), The Gothenburg Medical Association, Sahlgren's Hospital foundation and The Gothenburg Medical Faculty (LUA) and was presented in part at the Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists, Turku, Finland, June 1994     

Responses of atrial natriuretic peptide and brain natriuretic peptide to exercise in patients with chronic heart failure and normal control subjects

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are known to be elevated in patients with chronic heart failure at rest. While it is known that during exercise the circulating level of ANP increases in patients with heart failure, the response of BNP to exercise in these patients relative to control subjects is unclear. Ten patients with stable chronic heart failure and 10 normal control subjects performed symptom-limited exercise with respired gas analysis. All patients had depressed left ventricular ejection fractions (LVEF). Patients had lower peak oxygen consumption P V ˙ O ₂) than the control group [median (range) 1.18 (0.98–1.76) vs. 1.94 (1.53–2.31) L min⁻¹; P  < 0.001]. Circulating plasma levels of ANP and BNP were higher at rest in patients than in control subjects [ANP 335 (140–700) vs. 90 (25–500) pg mL⁻¹; BNP 42 (25–50) vs. 20 (10–20) pg mL⁻¹], and at peak exercise [ANP 400 (200–1000) vs. 130 (10–590); BNP 46 (40–51) vs. 20 (10–30)]. The rise in ANP at peak exercise was significant in patients compared with the resting level, but not in control subjects. For BNP, there was a significant rise in patients but no change in control subjects. The circulating plasma levels of both peptides showed a strong negative correlation with LVEF (ANP, P  < 0.005; BNP, P  < 0.0001) and, to a less extent, with RVEF. It is possible that BNP may give a better indication of cardiac function.     

雷米普利对充血性心力衰竭患者脑钠肽水平的影响

目的 探讨充血性心力衰竭(CHF)患者血浆脑钠肽(BNP)水平的变化及雷米普利的干预作用.方法 89例CHF患者给予雷米普利2.5 mg/d,1周后增加至5～10 mg/d,疗程4周,检测用药前后血浆BNP含量的变化.同时选择30例健康体检者为对照组. 结果 CHF患者血浆BNP水平(492±316) pg/ml,较对照组(25±8) pg/ml明显增高(P<0.01),CHF组BNP水平升高与心力衰竭程度呈正相关,依次为Ⅳ级>Ⅲ级>Ⅱ级(r=0.753,P<0.01).雷米普利治疗后血浆BNP水平明显降低,与治疗前比较差异有统计学意义(P<0.01).结论 心力衰竭时血浆BNP水平明显增高,而雷米普利具有改善心脏功能的作用.     

Effect of alpha-human atrial natriuretic peptide on proteinuria in patients with primary glomerular diseases

1. The effects of synthetic alpha-human atrial natriuretic peptide (alpha-hANP) on urinary protein excretion were examined in nine healthy subjects and 20 patients with primary glomerular diseases who had proteinuria of 1.0 g or more per day. Synthetic alpha-hANP was intravenously infused into supine subjects at a rate of 8.3 pmol min-1 kg-1 for 40 min. 2. Before alpha-hANP infusion, the plasma concentration of immunoreactive alpha-hANP was significantly higher in the patients with glomerulonephritis than in the normal subjects (44.3 +/- 8.7 vs 19.4 +/- 3.0 pmol/l, mean +/- SEM, P less than 0.01) and it showed a positive correlation with mean arterial pressure (rs = 0.84, P less than 0.001) and a negative correlation with creatinine clearance (rs = -0.50, P less than 0.01). 3. During infusion of alpha-hANP, although the urinary excretion of protein did not change significantly in the normal subjects, it increased from 0.6 +/- 0.2 to 3.0 +/- 0.8 mg min-1 m-2 (P less than 0.001) in the patients with glomerulonephritis. The urinary protein/creatinine ratio did not change significantly in the former (from 0.18 +/- 0.05 to 0.22 +/- 0.06; NS), whereas it rose from 3.25 +/- 0.94 to 7.62 +/- 1.31 (P less than 0.001) in the latter. 4. The urinary excretions of albumin and of alpha 1-, alpha 2-, beta- and gamma-globulins, which were electrophoretically analysed, all increased in eight nephrotic patients during or immediately after infusion of alpha-hANP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic value of cardiac troponin T in patients with both acute and chronic stable congestive heart failure: comparison with atrial natriuretic peptide, brain natriuretic peptide and plasma norepinephrine

BACKGROUND: The prognostic value of cardiac troponin T (cTn-T) in a mixture of patients with both acute and chronic congestive heart failure (CHF), simultaneously assessed and compared with neurohormonal factors, has not yet been thoroughly evaluated. Thus, we focused on the prognostic value of cTn-T in comparison with atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and plasma norepinephrine (PNE) in this population. METHODS: Prognostic correlates of elevation of cTn-T, ANP, BNP, PNE were analyzed in 63 acute and chronic CHF patients followed up to record worsening CHF and cardiac death. RESULTS: cTn-T (> or =0.03 microg/L) was found in 17.4% (11 of 63) of patients. cTn-T correlated with ANP, BNP, PNE. Acute CHF patients were more positive for cTn-T and BNP. In our cohort, neither cTn-T (> or =0.03 microg/L) nor PNE were associated with increased mortality and worsening HF in CHF patients. After adjustment, BNP was the only independent predictor of cardiac events (RR, 3.23; p=0.01). CONCLUSIONS: BNP emerged as the only independent predictor of cardiac events in a mixture of patients with both acute and chronic CHF, suggesting that it is the analyte that best reflects long-term prognosis in a diverse population enrolled to mirror the "real world" situation.     

坎地沙坦对充血性心力衰竭的治疗作用及对内皮素和心钠素水平的影响

目的研究AngⅡ受体拮抗药坎地沙坦对充血性心力衰竭(CHF)的治疗作用以及对内皮素(ET)和心钠素(ANP)水平的影响。方法40例CHF患者随机分为两组,对照组(n=17)用强心剂和利尿剂治疗,坎地沙坦治疗组(n=23)在前者基础上加用坎地沙坦酯片(4~8mg/d)治疗8周,观察治疗前后NYHA分级、血压、心率、心胸比率、心脏超声指标、血浆ET和ANP浓度的变化。结果经8周治疗后,坎地沙坦治疗组血浆ET、ANP的水平明显降低(P<0·01),临床有效率优于对照组,但差异无统计学意义(P>0·05)。结论在常规治疗的基础上加用坎地沙坦可以更好地改善CHF患者的心功能。坎地沙坦能明显降低血浆ET、ANP的水平,这可能是血管紧张肽Ⅱ受体拮抗药治疗CHF的机制之一。     

B型钠尿肽测定在心衰、高血压患者中的临床应用

目的探讨B型钠尿肽（BNP）在心力衰竭（简称心衰）、高血压者患中的应用价值。方法采用荧光免疫分析技术，对181例心衰患者、50例原发性高血压病患者及健康对照人群30例进行血浆BNP水平检测，同时以彩色多普勒超声心电动仪测定心衰患者左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF），并与BNP作相关性分析。结果心衰组患者血浆BNP水平高于高血压组，心衰组和高血压组均高于对照组，且差异有显著性（P〈0．05～0．01）。BNP水平与LVEF、LVESD、LVEDD的数值具有相关性（r分别为-0．57、0．65和0．68，P〈0．01）。结论BNP是反映心室功能的灵敏指标。     

B型钠尿肽测定在心衰、高血压患者中的临床应用

目的探讨B型钠尿肽(BNP)在心力衰竭(简称心衰)、高血压患者中的应用价值。方法采用荧光免疫分析技术,对181例心衰患者、50例原发性高血压病患者及健康对照人群30例进行血浆BNP水平检测,同时以彩色多普勒超声心电动仪测定心衰患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF),并与BNP作相关性分析。结果心衰组患者血浆BNP水平高于高血压组,心衰组和高血压组均高于对照组,且差异有显著性(P<0.05～0.01)。BNP水平与LVEF、LVESD、LVEDD的数值具有相关性(r分别为-0.57、0.65和0.68,P<0.01)。结论BNP是反映心室功能的灵敏指标。     

Abnormal rhythmic oscillations of atrial natriuretic peptide and brain natriuretic peptide in heart failure

The purpose of this study was to clarify whether the secretions of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are pulsatile in patients with chronic heart failure (CHF), and whether the rhythmic oscillations for ANP and BNP are abnormal in patients with CHF. Several reports have shown that ANP and especially BNP are valuable indicators of the prognosis in CHF. Previously, a pulsatile secretion has been described for ANP and BNP in healthy humans and for ANP in CHF patients. More information about the secretion pattern of BNP in heart failure is necessary to increase the clinical usefulness of BNP in patients with CHF. Patients with left ventricular systolic dysfunction and CHF ( n =12) and controls ( n =12) were investigated. Plasma ANP and BNP levels were determined every 2 min during a 2-h period by radioimmunoassay and analysed for pulsatile behaviour by Fourier transformation. All patients and controls had significant rhythmic oscillations in plasma ANP levels, and 11 patients with CHF and 10 controls had significant rhythmic oscillations in plasma BNP levels. The amplitude of the main frequency was considerably higher in patients with CHF than in controls (ANP: CHF, 4.76 pmol/l; controls, 0.75 pmol/l; P <0.01. BNP: CHF, 3.24 pmol/l; controls, 0.23 pmol/l; P <0.001; all values are medians), but the main frequency did not differ significantly between the group with CHF and the control group for either ANP or BNP. Patients with CHF demonstrate pulsatile secretion of ANP and BNP with a much higher absolute amplitude, but with the same main frequency as healthy subjects.     

Changes in atrial natriuretic factor during preload reduction with nitroglycerin in patients with congestive heart failure

Summary. Nine patients with congestive heart failure, New York Heart Association class II-III, were evaluated with right heart catheterization. Plasma atrial natriuretic factor (ANF) was determined in blood samples from the pulmonary artery simultaneously with recordings of right atrial, pulmonary arterial, pulmonary capillary wedge and systemic arterial pressures and heart rate during preload reduction with 0·5 mg nitroglycerin sublingually. Basal plasma ANF levels were higher in patients with congestive heart failure compared to normal controls, and correlated to right atrial, pulmonary arterial, and pulmonary capillary wedge pressures. After nitroglycerin all patients had reductions in right atrial, pulmonary arterial, and pulmonary capillary wedge pressures and a simultaneous decrease in plasma ANF concentrations, reaching lowest values after 10 min. Central pressures and plasma ANF rose to baseline values within 30 min. After nitroglycerin plasma ANF concentrations correlated to pulmonary arterial and pulmonary capillary wedge pressures, while changes in plasma ANF correlated to changes in right atrial and pulmonary arterial pressures. These results provide further evidence that ANF is released by a pressure-sensitive mechanism and demonstrates that ANF secretion in relation to central pressure variations is preserved in patients with congestive heart failure and that the response is rapid.     

心力衰竭患者血清钠对血浆肾素、醛固酮和心钠素的影响

目的　探讨充血性心力衰竭患者血清钠水平对肾素 血管紧张素 醛固酮系统和心钠素 (ANP)活性的影响。方法　将 12 5例住院心衰患者按血清钠水平分为正常血钠组 (4 7例 )和低钠血症组 (78例 ) ,测定并比较两组患者的血浆肾素 (PRA)、醛固酮 (ALD)和ANP ;低钠血症组患者经补盐和 (或 )限水纠正血钠后 ,采用自身对照的方法 ,观察治疗前后血浆PRA、ALD和ANP的变化。结果　①低钠血症组患者血浆PRA和ALD水平明显高于正常血钠组患者 (2 .6 7± 0 .2 8与 2 .18± 0 .2 0 ,4 6 1± 2 6 .3与 4 36± 12 .5 ,P <0 .0 1) ,血浆ANP水平前者低于后者 (14 8.0± 14 .5与 174 .0± 15 .1,P <0 .0 1)。② 78例血钠水平被纠正后的低钠血症组患者血浆ANP和ALD水平较补盐前下降 (2 .18± 0 .2 0与 2 .70± 0 .2 6、4 36 .0± 12 .5与 4 6 7.0± 2 5 .9,P <0 .0 1) ,血浆ANP水平较补盐前上升 (172 .0± 16 .2、14 8.0± 14 .5 ,P <0 .0 1)。③心衰患者血清钠水平与血浆PRA和ALD水平呈负相关 (r=- 0 .198,r=- 0 .75 3,P <0 .0 1) ,与ANP水平呈正相关 (r=0 .739,P <0 .0 1)。结论　充血性心衰患者宜适当补盐以维持正常血钠水平 ,这将有利于肾素 血管紧张素 醛固酮系统和ANP之间的平衡。     

老年充血性心力衰竭患者血浆脑钠肽前体水平与长期预后的关系

目的:血浆脑钠肽水平对于充血性心力衰竭的预后评估均具有重要意义,但脑钠肽前体的敏感性和特异性更高。分析血浆脑钠肽前体水平对老年充血性心力衰竭患者长期预后的预测价值。方法:选择2003-05/2005-07在桂林医学院附属医院心内科住院的心力衰竭患者208例及本科同期收住院的急性冠状动脉综合征组患者26例,另外选择正常对照组30例,为本院的医学生,以上观察对象均自愿参加观察。分别测定各组观察对象的血浆脑钠肽前体水平,均在入院的第1天完成,患者出院后不再测定脑钠肽前体。使用惠普500型心动图检测心力衰竭组患者的心脏各腔室直径及射血指数。对所有出院的心力衰竭患者均进行电话随访,每3个月随访1次,平均随访2年,只电话询问死亡还是健在。结果:心力衰竭患者208例、急性冠状动脉综合征患者26例及正常对照组30例全部进入结果分析,无脱落。①各组观察对象的血浆脑钠肽前体水平比较:心力衰竭组是正常对照组的150倍[(4.82±0.75)μg/L,(31.38±29.28)ng/L(P<0.01)],是急性冠脉综合征组的23倍[(208.80±120.13)ng/L(P<0.01)]。②不同年龄、性别、病种、心功能分级心力衰竭患者血浆脑钠肽前体水平比较:心力衰竭患者脑钠肽前体的水平随年龄的增加而升高(P<0.05～0.01);女性显著高于男性(P<0.01);心功能不同级别间脑钠肽前体的水平呈倍数增加(P<0.01),死亡者显著高于生存者(P<0.01)。③心力衰竭患者血浆脑钠肽前体水平与各临床指标的相关性分析:心力衰竭患者血浆脑钠肽前体水平与年龄、左心室直径及纽约心脏协会心功能分级呈正相关(r=0.310,0.283,0.647,P<0.05～0.01),与射血指数呈负相关(r=-0.327,P<0.01)。结论:老年心力衰竭患者的血浆脑钠肽前体水平明显增高,与之相关的预后不良危险因素包括心功能分级增高、射血分数降低、左心室直径扩大、老年及女性心力衰竭患者等。