心房利钠肽与心血管疾病

心房利钠肽属于利钠肽家族,其通过与受体结合激活鸟苷酸环化酶,促进细胞内环鸟苷酸水平升高而发挥生物学功能。心房利钠肽具有利钠、利尿、舒张血管平滑肌、抑制细胞增殖等多种作用,在维持血压,水、钠平衡以及在心血管疾病的病理生理过程中发挥重要作用。     

肥厚型心肌病患者心血管事件与血浆心房利钠肽水平

已经报道 ,心衰患者血浆心房利钠肽 (ANP)水平升高 ;心房纤颤时 ANP亦升高。然而 ,肥厚性心肌病 (HC)患者血浆ANP水平与心房纤颤的关系未明。本文评价 HC患者 ANP与心房纤颤关系及 ANP水平的预后意义。测定 4 6例 HC患者血浆 ANP水平 ,平均随访 2 .1± 0 .9年。随访期间发生心血管事件者 8例 :3例猝死 ,1例心衰 ,3例缺血性卒中 ,1例外周血管栓塞。猝死者平均年龄 6 8± 6岁 ,均于休息时猝死。缺血性卒中者均有心房纤颤 ,CT证实是栓塞所致大面积脑梗死。心血管事件组与无心血管事件组比较 ,前者年龄偏大 (6 6± 6岁 vs5 7± 13岁 …     

人工心脏起搏对血浆利钠肽的影响

人工心脏起搏包括生理性起搏与非生理性起搏 ,因起搏部位、工作方式不同 ,对心脏功能与血流动力学产生不同程度的影响。心脏利钠肽包括心房利钠肽 (ANP)及脑利钠肽 (BNP) ,具有利钠、利尿、扩张血管、抑制肾素 醛固酮分泌等多种生物性活性 ,在调节心血管内环境及液体容量中起重要作用 ,可反映不同起搏方式引起的血流动力学改变。     

心房利钠肽与心血管疾病的临床研究进展

心房利钠肽(ANP)是由28个氨基酸共同组成的一种多功能活性肽,是近年的临床研究热点。由于ANP在机体内功能众多,因而根据其功能的不同又称为利尿素、心钠素、血管舒张素和利钠素。ANP常用于临床利尿、利钠、调控细胞增殖、舒张血管平滑肌,有极佳的水、钠、血压维持效果,在心血管临床中使用广泛。本文对最新的ANP与心血管疾病临床研究进展进行了综述,以期为心血管临床ANP的使用提供参考依据。     

心房利钠因子对自发性高血压大鼠主动脉条血管反应性的影响

自发性高血压大鼠(包括卒中易感型)的胸主动脉条对心房利钠因子-(103-126)的舒张作用的敏感性显著降低,提示可能与高血压的发病有关。初步探讨了它的发生机制。     

高血压病左室肥厚患者血浆脑利钠肽与心房利钠肽的变化

目的研究高血压病左心室肥厚患者血浆利钠肽水平的变化，探讨肥厚的左心室心脏内分泌的病理生理改变。方法106例高血压患者人选，其中56例伴左心室肥厚(LVH)，50例无LVH，另有30例健康个体为参照。放射免疫法测定脑利钠肽(BNP)和心房利钠肽(ANP)。结果高血压LVH组在排血分数属正常范围时，即有血浆BNP和ANP显著高于无LVH组，无LVH的高血压病人血浆ANP与BNP与健康人相似。结论LVH的高血压患者在心脏功能失代偿前，心脏利钠肽已出现代偿性合成和分泌增加。     

心房利钠多肽与肺

木文综述肺内心房利钠多肽存在的依据与生理作用,并探讨其在肺和血浆内的变化对某些肺疾病的临床意义.     

肾血管性高血压大鼠心脏肥厚不同时期血浆及组织心钠素、内皮素含量变化

目的了解高血压心脏病左室结构、功能变化时血浆及心肌组织中心钠素(atrial natriuretic peptide ANP)、内皮素(endothelin ET)含量变化.方法应用放免法监测二肾一夹意义型(2K1C)肾血管性高血压大鼠(RHR)血浆及心肌组织中ANP、ET含量变化,并根据超声心动图评价高血压大鼠心脏结构、功能动态变化,将高血压大鼠进行分组.结果高血压左室向心性肥厚期血浆及心肌组织(左心室)中ANP、ET含量明显升高;左室离心性肥厚期血浆ET较向心性肥厚期组更高,但心肌组织中ET含量与其无显著差别,而血浆及心肌组织中ANP含量均较向心性肥厚期组低.结论 2K1C型高血压大鼠血浆及心肌组织中ANP、ET含量均升高;血浆ET与ANP含量变化在左室肥厚中可能起着更为重要作用.     

肾血管性高血压大鼠心脏肥厚不同时期血浆及组织心钠素、内皮素含量变化

目的 了解高血压心脏病左室结构、功能变化时血浆及心肌组织中心钠素(atrial natriuretic peptide ANP)、内皮素(endothelin ET)含量变化。方法 应用放免法监测二肾一夹意义型(2K1C)肾血管性高血压大鼠(RHR)血浆及心肌组织中ANP、ET含量变化，并根据超声心动图评价高血压大鼠心脏结构、功能动态变化，将高血压大鼠进行分组。结果 高血压左室向心性肥厚期血浆及心肌组织(左心室)中ANP、ET含量明显升高；左室离心性肥厚期血浆ET较向心性肥厚期组更高，但心肌组织中ET含量与其无显著差别，而血浆及心肌组织中．ANP含量均较向心性肥厚期组低。结论 2K1C型高血压大鼠血浆及心肌组织中ANP、ET含量均升高；血浆ET与．ANP含量变化在左室肥厚中可能起着更为重要作用。     

血浆脑利钠肽与房颤病人复律和复发的临床研究

目的研究阵发性或持续性房颤(Af)病人转复窦性心律时,血浆脑利钠肽(BNP)水平及其临床意义。方法选取62例心功能(1~3)级病人,采用放免法测定房颤及窦性心律时病人血浆中BNP的浓度,观察两组BNP水平、房颤发作次数。结果病人房颤发生时BNP浓度为(88.36±22.32)pg/mL,比复律后窦性心律时(57.48±20.32)pg/mL明显增高(P<0.05),高BNP水平病人组房颤发生次数较低BNP水平病人多。多因素分析显示血浆BNP水平与Af持续时间是转律后窦性心律维持的独立影响因子。结论血BNP浓度增高是发生心房颤动的预告因子,高水平的BNP更容易复发房颤,血浆BNP水平低或Af持续时间短者转律后窦性心律较易维持。     

腹主动脉结扎大鼠心房纤维化的实验研究

高血压患者有较高心律失常的发生率，房性心律失常可能与左房扩大或心房纤维化有关。为观察压力负荷增高大鼠中心房纤维化的发生情况，将Ｗｉｓｔａｒ大鼠随机分成假手术组和手术组，手术组大鼠行肾上腹主动脉部分结扎。术后４，８，１２周分别测定大鼠颈动脉压及心房胶原容积分数（ＣＶＦ），结果发现：①手术组左室舒张压明显高于假手术组（４，８，１２周分别为１８．５±２．５ｋＰａｖｓ１５．７±１．９ｋＰａ，１８．６±２．７ｋＰａｖｓ１５．３±１．３ｋＰａ，１９．６±３．１ｋＰａｖｓ１５．２±１．９ｋＰａ，Ｐ＜０．０５或０．０１）。②手术组心房ＣＶＦ明显高于假手术组（４，８，１２周左、右房分别比较：４．２３±０．７６％ｖｓ２．９３±０．８７％，４．６５±１．４５％ｖｓ３．１１±１．０７％，５．６２±１．６２％ｖｓ３．２３±１．２８％；３．８８±１．１５％ｖｓ２．５１±０．８４％，４．２４±１．６５％ｖｓ２．５１±０．８４％，５．３４±１．３２％ｖｓ２．３３±１．１４％；Ｐ＜０．０５或０．０１），手术组心房ＣＶＦ有逐渐上升趋势。③左房ＣＶＦ与左室舒张压之间无直线相关关系（ｒ＝０．１６９１，Ｐ＞０．０５）。提示在高血压大鼠模型中存在心房?     

Plasma Levels of Atrial Natriuretic Peptide in Patients with Chronic Liver Disease

The plasma levels of atrial natriuretic peptide were determined by radioimmunoassay in 24 patients with chronic liver disease, including three patients with alcoholic liver disease, four with chronic active hepatitis, 13 with liver cirrhosis, and four with hepatocellular carcinoma. When compared with normal subjects (180 +/- 12 pg/ml), the plasma levels of atrial natriuretic peptide in cirrhotic patients (349 +/- 64 pg/ml) were significantly elevated (p less than 0.001) but not in other disease groups. In patients with chronic liver disease the plasma levels of atrial natriuretic peptide were correlated significantly with plasma renin activity but not with plasma aldosterone, and furthermore showed a negative correlation with indocyanine green disappearance rate. These results suggest that the increased plasma levels of atrial natriuretic peptide, which appear to be associated with an increase in plasma renin activity and with hepatic dysfunction, may participate in maintaining homeostasis of sodium and fluid volume in patients with chronic liver disease.     

Plasma Atrial Natriuretic Peptide (ANP) Concentration in Patients with Pheochromocytoma

The interaction between catecholamines (CA) and ANP is not clearly established. The effects of excess endogenous CA on ANP secretion can be investigated in patients with pheochromocytoma. We studied 27 patients with surgically and histologically proven pheochromocytoma (P) aged 19-70 years. In 16 of these patients plasma ANP study was repeated after surgical removal of the tumour. The control group (C) consisted of 20 healthy volunteers aged 21-48 years. Moreover, 42 patients with uncomplicated mild to moderate essential hypertension (EH) aged 18-48 years were also studied. In P higher plasma ANP concentration versus C, EH was found (51.9 ± 8.1; 25.5 ± 1.5; 19.3 ± 1.5 fmol/ml, respectively). In 16 patients with P, increased plasma ANP level (mean 63.3 ± 12.6 fmol/ml) declined after surgical removal of the tumour (mean 22.4 ± 2.9 fmol/ml). In the P patients no relationship was found between plasma ANP and hormonal patterns of the tumour or between plasma ANP and plasma catecholamines, whereas significant positive correlations between plasma ANP and both systolic and diastolic blood pressure and heart rate were demonstrated. These results suggest that excess CA produced by the chromaffin tumour induce ANP secretion via stimulation of adrenergic receptors. However, influence of the haemodynamic changes evoked by CA cannot be excluded. It is suggested that increased secretion of ANP may be of some importance in maintaining blood pressure homeostasis in patients with pheochromocytoma.     

Changes in Plasma Atrial Natriuretic Peptide during Exercise in Healthy Volunteers

ABSTRACT. Thamsborg G, Storm T, Keller N, Sykulski R, Larsen J (Departments of Clinical Chemistry and Internal Medicine, Sundby Hospital, Copenhagen, and Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark). Changes in plasma atrial natriuretic peptide during exercise in healthy volunteers. Acta Med Scand 1987; 221:441–4. Graded exercise was performed in three healthy volunteers. Plasma levels of immunoreactive atrial natriuretic peptide (iANP) were determined at different workloads. Unchanged or slightly decreased plasma levels of iANP were observed during light exercise, whereas at medium to high workloads a considerable increase in plasma levels of iANP was found. Factors responsible for the increase in plasma levels of iANP might include elevated right atrial pressure and increased plasma levels of epinephrine and norepinephrine.     

Hemodynamic Effects of Atrial Natriuretic Peptide in Conscious Sheep

ABSTRACT

The present study examines the effects of intravenous infusion of atrial natriuretic peptide (ANP) on blood pressure, heart rate, cardiac output, sodium excretion and urine output in conscious, chronically instrumented sheep. Human ANP (1–28) was infused into the jugular vein (I. V.) for 60 min at 20, 50, 100 and 500 μg/h. ANP caused a decrease in blood pressure at all doses which was associated with a reduction in stroke volume and cardiac output. There was also a decrease in right atrial pressure. At the two higher rates of infusion an increase in both heart rate and calculated total peripheral resistance was observed. These data are consistent with ANP acting on the venous side of the circulation to produce venodilatation, and a reduction in venous return, stroke volume and cardiac output. The increases in urinary sodium excretion and urine output observed when ANP was infused I. V. at 100 μ/h for 60 min were small. The data suggest that the minimum dose for effects on the cardiovascular system (20 μg/h) is less than that required to produce renal effects (100 μg/h). ANP has potent effects on the cardiovascular system in conscious sheep, exerting its effect on blood pressure primarily by its action on the venous circulation and on cardiac output.     

Effects of Captopril on Plasma Atrial Natriuretic Polypeptide and the Renin Angiotensin System in Rats

We investigated the effects of captopril on the plasma atrial natriuretic polypeptide (ANP) level and the renin angiotensin system in rats. A single oral administration of captopril decreased the plasma ANP level and increased the plasma renin activity (PRA). Chronic administration of captopril for 2 weeks caused no changes in plasma ANP level, but PRA was increased. This suggests the hypothesis that the hemodynamic changes rather than changes in the renin angiotensin system caused by captopril may affect the plasma ANP level.     

The Effects of Atrial Pacing and Ballooning on the Plasma Concentration of Atrial Natriuretic Peptide in Anesthetized Dogs with or Without Vagotomy

To study the mechanisms of release of atrial natriuretic peptide (ANP), the plasma concentration of ANP, atrial pressure and urinary sodium excretion were determined in anesthetized dogs during balloon inflation in the left atrium or during rapid atrial pacing. The effects of bilateral cervical vagotomy on these variables were also examined. Balloon inflation which elevated the left atrial pressure by more than 4 mmHg increased the plasma concentration of ANP (+40%, p<0.05). This increase in ANP concentration was not altered by vagotomy. Rapid atrial pacing at rates of more than 160 beats/min also significantly increased the left atrial pressure (+2.3 mmHg, p<0.02), urinary sodium excretion (+45%, p<0.05) and plasma concentration of ANP (+130%, p<0.05). Vagotomy did not affect these changes. The degree of the increase in plasma ANP concentration was significantly greater during rapid atrial pacing than during intraatrial ballooning. These results suggest that the release of ANP is stimulated in part by elevating the left atrial pressure and in part by increasing the frequency of atrial contractions and that the increase in the plasma ANP concentration is possibly involved in the so-called atrial natriuresis. Furthermore, the release of ANP was proven to be independent of the vagal nerve reflex.