急性心肌梗死后血浆神经内分泌激素水平与心功能的关系

目的　通过测定急性心肌梗死 (AMI)患者血浆中神经内分泌激素水平 ,探讨AMI后神经内分泌系统的激活与心功能的关系。方法　 5 7例AMI患者 ,依据左心室射血分数 (LVEF)将AMI患者分为A、B两组 ,A组 :31例 ,LVEF≥5 0 % ;B组 :2 6例 ,LVEF <5 0 %。另选 2 0例健康人作为正常对照组。分别采血检测血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )浓度、血浆醛固酮 (ALD)浓度、血浆去甲肾上腺素 (NE)和肾上腺素 (E)浓度。结果　AMI后心功能较差的B组患者血浆PRA、AngⅡ、NE、E水平较正常对照组升高 ,其中尤以NE升高最为显著 (P <0 .0 0 1)。结论　AMI后心功能减退会进一步增强神经内分泌系统的活性。     

卡维地洛对慢性心衰患者部分血管活性肽的影响及意义

目的:探讨慢性心力衰竭(CHF)患者经卡维地洛治疗血清血管紧张素Ⅰ(Ang Ⅰ)、Ang Ⅱ、心钠素 (ANP)和醛固酮(ALD)水平的变化及其临床意义。方法:放射免疫法测定86例慢性心力衰竭(CHF)组和40例对照组血清Ang Ⅰ、AngⅡ、ANP和ALD水平,对其中56例子卡维地洛治疗,并测定治疗后上述血管活性肽变化, 进行统计分析。结果:CHF组血清Ang Ⅰ、AngⅡ和ALD水平显著高于对照组(t=5．461,t=4．736,t=12．40,P 均<0．01),ANP则显著低于对照组(t=2．813,P<0．05)。Ang Ⅰ与Ang Ⅱ,ALD与AngⅡ间呈显著正相关(r= 0．471,P<0．01;r=0．309,P<0．05)。NYHA Ⅱ、Ⅲ、Ⅳ级组间血清AngⅡ和ALD水平方差检验依次显著递增 (FAngⅡ=3．866,FALD=3．957,P均<0．05)．Ang Ⅰ和ANP则无显著性改变(P均>0．05)。住院死亡组与好转出院组间改变无显著差异(P均>0．05)。56例经卡维地洛治疗,血清AngⅠ、AngⅡ和ALD水平显著下降(t=3．212, P<0．05;t=5．301,P<0．01;t=9．382,P<0．01),但ANP水平无明显变化(P>0．05)。结论:CHF患者血清- Ang Ⅰ、AngⅡ和ALD水平显著升高,ANP水平显著下降,卡维地洛能使血清Ang Ⅰ、AngⅡ、ALD水平显著下降。     

美托洛尔对充血性心力衰竭患者神经内分泌活性及心功能的影响

目的 :观察美托洛尔对应用血管紧张素转换酶抑制剂 (ACEI)等基础治疗的充血性心力衰竭 (CHF)患者神经内分泌激活及心功能的影响 ,探讨其治疗CHF的机制。方法 :入选的 95例CHF患者均接受基础治疗(洋地黄、利尿剂、ACEI)。并随机分为治疗组和对照组 ,治疗组加用美托洛尔 ,随访至 6个月时治疗组为 5 7例 ;对照组 2 6例。并分别于治疗前和治疗后 1、3、6个月测定血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )和去甲肾上腺素 (NE)水平。结果 :治疗组应用美托洛尔后PRA、NE明显下降 ,同治疗前相比二者均P <0 .0 1;而对照组PRA、AngⅡ、NE与基线相比均明显升高 (P <0 .0 1,P <0 .0 1,P <0 .0 5 )。美托洛尔组同对照组相比 ,对神经内分泌的抑制加强 ,同时伴有左室射血分数 (LVEF)的升高。结论 :单纯ACEI等基础治疗仍存在PRA、AngⅡ和NE等神经内分泌的激活 ,美托洛尔可抑制神经内分泌的激活 ,同时伴LVEF的升高     

依那普利与缬沙坦治疗充血性心力衰竭的疗效比较

目的探讨依那普利、缬沙坦治疗充血性心力衰竭(CHF)的疗效及其对肾素-血管紧张素-醛固酮系统(RAAS)的影响.方法将46例心力衰竭病人随机分为依那普利组(22例)和缬沙坦组(24例);治疗3个月～5个月;观察治疗前后的心功能、血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)及醛固酮(ALD)水平的变化.结果两组病人治疗后心功能(NYHA分级)均有改善,治疗后左室射血分数(LVEF)值均显著提高(P<0.01),左室舒张末期内径(LVIDd)显著缩短(P<0.01);两组比较无统计学意义(P＞0.05).依那普利组治疗后PRA、AngⅡ、ALD水平无变化,缬沙坦组AngⅡ水平升高(P<0.05),ALD水平降低(P<0.01);两组病人治疗后血尿素氮、肌酐水平均无显著变化.结论缬沙坦与依那普利治疗充血性心力衰竭,疗效相近.必要时可作为依那普利的替代药物.     

收缩性心力衰竭病人血清钠水平与肾素、血管紧张素及醛固酮的关系探讨

目的探讨收缩性心力衰竭病人血清钠水平对血浆肾素-管紧张素-醛固酮系统的影响。方法 62例收缩性心力衰竭病人按血清钠水平分为正常血钠组(32例)和低钠血症组(28例),测定并比较两组病人的血浆肾素(PRA)、血管紧张素(AngⅡ)、醛固酮(ALD)水平。结果低钠血症组病人血浆ALD、PRA、AngⅡ水平均较正常血钠组显著升高(P0.01);血钠与血浆ALD、PRA、AngⅡ呈显著负相关。结论低钠血症可能促进慢性心力衰竭病人血浆PRA、AngⅡ、ALD分泌增加,心力衰竭伴低钠血症病人的神经内分泌水平激活更明显。     

心力衰竭合并肺部感染病人血清AngⅡ、ALD、NE变化及与心功能分级的关系

目的观察心力衰竭合并肺部感染病人血清血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及肾素(NE)的变化,分析AngⅡ、ALD及NE与心功能分级的关系。方法将2017年1月—2017年5月我院接诊的33例心力衰竭合并感染病人作为观察组,同期33例心力衰竭无感染病人作为对照组。比较两组AngⅡ、ALD、NE、B型钠尿肽(BNP)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、左室射血分数(LVEF)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESDVI)水平。结果观察组血清AngⅡ、ALD和NE水平均高于对照组(P0.05);随着心功能分级的增加,血清AngⅡ、ALD及NE水平呈现上升趋势,两两比较差异有统计学意义(P0.05)。血清AngⅡ、ALD和NE水平与病人心功能分级呈正相关。观察组BNP、IL-6、TNF-α、LVEDVI和LVESDVI水平均高于对照组(P0.05);观察组LVEF水平低于对照组(P0.05)。结论肺部感染会造成心力衰竭病人血清中AngⅡ、ALD及NE表达上升,且与病人心功能分级呈正相关,使病人免疫功能和心肌功能损伤加重,从而加重病情。     

慢性心力衰竭患者耐量运动训练后体内神经激素的变化

目的　研究耐量运动训练能否对慢性心力衰竭 (CHF)患者血浆中精氨酸血管加压素 (AVP) ,心钠素 (ANP) ,血管紧张素Ⅱ (AngⅡ )和醛固酮 (Aldo)水平有影响 ,延缓病程进展。方法　 12例CHF患者 (冠心病 ,心功能为Ⅱ～Ⅲ级 ,NYHA)隔天在监护下进行耐量运动训练 ,为期 12 0d。在进行耐量运动训练之前和之后 ,采用放射免疫法检测每一患者血浆中在静息状态下和极量平板运动后上述神经激素的水平。结果　经 12 0d的耐量运动训练后 ,静息状态下上述血浆神经激素水平较耐量运动训练前显著降低 (P <0 .0 5 ) ,但极量平板运动后与耐量运动训练前比较则差异无显著性意义 (P >0 .0 5 )。结论　耐量运动训练可降低CHF患者在静息状态下血浆AVP、ANP、AngⅡ和Aldo的水平 ,因此 ,可能有益于延缓CHF患者病程进展。     

急性心肌梗死患者血浆肾上腺髓质素浓度与心功能的关系

目的 :探讨急性心肌梗死 (AMI)患者血浆肾上腺髓质素 (AM)浓度与心功能的关系。方法 :用放射免疫法测定 2 0例 AMI患者在发病后第 2 4小时及 15例正常人血浆 AM和心房利钠肽 (ANP)浓度 ,AMI患者还同时用超声心动图测左室射血分数 (L VEF)。结果 :AMI患者血浆 AM浓度无论在心力衰竭组 [(15 .6± 2 .1) pmol/L]或无心力衰竭组 [(7.4± 1.1) pm ol/ L]都显著高于对照组 [(2 .3± 0 .3) pmol/ L,P <0 .0 1,P <0 .0 5 ],而且心力衰竭组显著高于无心力衰竭组 (P <0 .0 5 )。 AMI患者血浆 AM浓度与 ANP浓度 (r =0 .47,P <0 .0 5 )及L VEF(r =- 0 .5 3,P <0 .0 5 )呈相关关系。结论 :血浆 AM参与了 AMI后心功能的调节 ,是对 AMI后心功能下降的一种代偿性反应     

卡维地洛对慢性心力衰竭病人神经激素及镁代谢的影响

目的观察卡维地洛对慢性心力衰竭病人神经激素及镁代谢的影响.方法 57例慢性心力衰竭病人随机分为两组,分别予常规治疗、合用卡维地洛治疗,8周后评定疗效,两组均于治疗前后测定血浆去甲肾上腺素(NE)、肾素(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、血浆镁浓度(PMC)、外周血单核细胞镁含量(MMC)及24 h 尿镁排泄量(UME)指标,并选择26名健康者为正常组.结果病例组与正常对照组比较,心力衰竭病人血浆NE、PRA、AngⅡ、ALD及尿UME均明显升高,MMC降低(P<0.01),UME分别与ALD、AngⅡ、PRA呈正相关(r为0.41、0.42、0.38,P<0.01).经卡维地洛治疗后,血浆ALD、PRA、AngⅡ及尿UME降低(P<0.05),MMC增加(P<0.01).结论卡维地洛阻断神经激素激活,同时减少尿镁排泄,增加细胞内镁水平.     

溶血反应对高血压患者肾素－血管紧张素－醛固酮系统检测的影响

目的 探讨溶血反应对高血压患者血浆中肾素活性(PRA)、血管紧张素Ⅰ(Ang Ⅰ)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及醛固酮/肾素活性比值(ARR)检测结果的影响.方法 将60例高血压患者血标本每例分成2份,每例标本各取l份施行模拟溶血,将溶血及非溶血样本离心后,分别取血浆,应用放射免疫法检测血浆PRA、Ang Ⅰ、AngⅡ、ALD及ARR水平,并对溶血组及非溶血组结果进行统计分析.结果 溶血样本PRA、Ang Ⅰ、AngⅡ、ALD水平均明显低于非溶血样本(P＜0.01),ARR假阳性率升高(P＜0.05).结论 溶血对血浆PRA、Ang Ⅰ、AngⅡ、ALD及ARR检测结果有显著影响,严重干扰临床诊断,在实际工作中应予以重视.     

慢性心力衰竭患者血浆利钠肽水平的变化

目的 :研究慢性心力衰竭 (CHF)患者血浆利钠肽 (ANP、BNP、CNP)水平的变化及其与心功能状态、心脏结构的关系 ,探讨其用于CHF诊断的价值。方法 :4 8例CHF患者为心力衰竭组 ,心功能按HYHA标准分级 :Ⅱ级 15例 ,Ⅲ级 2 4例 ,Ⅳ级 9例 ,基本病因为冠心病、扩张型心肌病、高血压性心脏病 ;对照组 10例 ,为健康体检者。用同位素放射免疫法和免疫放射法测定血浆ANP、BNP、CNP水平 ,心脏彩色多普勒超声诊断仪测量左室结构和功能。结果 :心力衰竭组血浆ANP、BNP水平均较对照组显著增高(P均 <0 0 1) ,并与心功能严重程度有关 ,但不同病因的CHF患者之间血浆ANP、BNP、CNP水平均无明显差异 (P均 >0 0 5 )。其中LVEF <4 5 %的患者 4 1例 ,其血浆BNP水平和LVEF负相关 (r=- 0 37,P <0 0 5 ) ,和左室舒张末期内径 (LVEDD)、左室心肌重量指数 (LVMI)呈正相关 (r均为 0 36 ,P均 <0 0 5 ) ,血浆ANP、BNP水平和肺动脉收缩压正相关 (P <0 0 5或P <0 0 1)。血浆CNP水平在CHF患者无明显升高 (P >0 0 5 )。结论 :血浆ANP、BNP水平可作为反映心功能状态的指标 ,其中血浆BNP水平更为敏感、特异并且和心脏结构相关 ,可作为CHF诊断及鉴别诊断的指标     

心力衰竭患者Copeptin、BNP、NT-proBNP、ANP 分子的检测及其临床意义

 目的 观察心力衰竭患者血浆和肽素（Copeptin）、ANP、BNP与NT-proBNP水平变化,探讨检测指标与心功能的关系。 方法 连续选择2012年3月1日～2013年3月31日本院心内科收治的102例心力衰竭患者（心衰组）,根据依据纽约心脏协会（NYHA）心功能分级标准,分为心功能Ⅱ级31例,Ⅲ级36例,Ⅳ级35例,以同期住院心功能正常的患者50例作为对照组。所有患者均空腹抽取静脉血,采用酶联免疫吸附测定法（ELISA）测定血清CRP;自动生化仪测定总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）等相关生化指标;Copeptin、BNP、NT-proBNP与ANP等水平应用化学发光法检测;应用SPSS13.0统计软件分析各指标间的关系。 结果  ①心衰患者血浆Copeptin、BNP、NT-proBNP、ANP水平显著高于对照组（P＜0.01）。在心衰组中,血浆Copeptin水平在心功能Ⅳ级明显高于心功能Ⅲ级患者,心功能Ⅲ级高于心功能Ⅱ级,各组间差异均有统计学意义（P＜0.05）。 ②心衰患者血浆Copeptin与BNP、NT-proBNP、ANP呈明显正相关。 结论 心衰患者血浆 Copeptin、BNP、NT-proBNP、ANP水平随NYHA分级逐级增高,且与心衰严重程度有良好的相关性,Copeptin、BNP、NT-proBNP和ANP水平均可作为临床诊断心衰、评估心功能的敏感检测指标。     

心力衰竭患者血清脑钠素浓度的变化

目的:探讨脑钠素(BNP)对心衰诊断及心功能评估的价值。方法:40例心衰患者,根据心功能分级(NYHA)分为三组:Ⅰ～Ⅱ级组8例,Ⅲ级组20例,Ⅳ级组12例;于入院时和抗心衰治疗2周后检测各组心衰患者晨起空腹血BNP水平以及左室射血分数(LVEF),左室舒张末期内径(LVEDd),并进行比较分析。结果:心力衰竭患者BNP水平随NYHA分级增高而升高。BNP水平:心功能Ⅰ～Ⅱ级与心功能Ⅲ的[(480.53±70.18)ng/ml:(1601.22±108.27)ng/ml]、Ⅳ级的[(480.53±70.18)ng/ml:(2101.15±81.01)ng/ml]比较,差异有显著性(P均0.01)。抗心力衰竭治疗2周后,各级心功能患者BNP水平,LVEF及LVEDd值均较治疗前有明显改善(P0.05～0.01)。结论:BNP水平对心力衰竭的诊断及危险分层有较肯定的预测价值。     

老年心力衰竭患者心功能与血浆B型钠尿肽和尿酸的相关性研究

目的探讨老年心力衰竭(CHF)患者心功能与血浆B型钠尿肽(BNP)和血尿酸的相关性。方法选择132例老年CHF患者作为CHF组,并按心功能分级(NYHA)Ⅰ级26例、Ⅱ级38例、Ⅲ级40例、Ⅳ级28例。同期选择健康体检者50例作为对照组。分别测定血浆BNP及血尿酸水平,比较不同心功能级别入选患者的血浆BNP水平和血尿酸水平。结果 CHF组患者血浆BNP和血尿酸水平明显高于对照组,差异有统计学意义[(784.19±206.00)ng/L vs(41.25±15.34)ng/L,(405.24±90.16)μmol/L vs(286.43±78.68)μmol/L,P<0.01];不同心功能分级患者血浆BNP和血尿酸水平两两比较,差异有统计学意义(P<0.05,P<0.01);CHF时,BNP与心功能分级、血尿酸、左心室舒张末内径(LVEDD)呈正相关(r=0.76、0.33、0.22,P<0.05);与LVEF呈负相关(r=-0.34,P<0.05);尿酸与心功能分级、LVEDD呈正相关(r=0.41、0.23,P<0.05);与LVEF呈负相关(r=-0.24,P<0.05)。结论血浆BNP和血尿酸水平与心功能分级可能具有相关性。     

The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure

BACKGROUND: Plasma C-terminal atrial natriuretic peptide (C-ANP), N-terminal ANP (N-ANP), and brain natriuretic peptide (BNP) have diagnostic utility in detecting left ventricular dysfunction. Their relative value in monitoring symptom status during the chronic treatment of congestive heart failure (CHF) remains undefined. METHODS AND RESULTS: Ninety-eight subjects with CHF were evaluated. Baseline natriuretic peptides were measured by radioimmunoassay, left ventricular ejection fraction (LVEF) was estimated with echocardiography, and New York Heart Association (NYHA) class was determined independently by attending heart failure specialists. Forty-one subjects were restudied during a 6- to 12-month follow-up period after optimizing therapy. At baseline, all natriuretic peptides and LVEF correlated positively with NYHA class (P <.005). Plasma BNP, however, correlated best with NYHA class. At follow-up, only changes of BNP correlated to changes of NYHA class (P =.04). BNP decreased (-45% +/- 12%, N = 14, P =.002) in subjects whose NYHA class improved whereas BNP remained unchanged (-1% +/- 10%, N = 25, P =.95) in those whose NYHA class was stable. CONCLUSIONS: This investigation demonstrates the superiority of plasma BNP as compared to ANP and LVEF in objectively assessing NYHA class during the chronic treatment of CHF. Given that clinical assessment of CHF is subjective, plasma BNP is a useful objective biomarker in monitoring human CHF in the outpatient setting.     

Cyclic GMP production by ANP, BNP, and NO during worsening and improvement of chronic heart failure

Cyclic GMP (cGMP) serves as an intracellular second messenger of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and nitric oxide (NO) and its peripheral blood concentration is an index of its biological activity. It has been reported that the plasma concentration of cGMP is correlated with the concentrations of ANP and BNP and is related to the prognosis of chronic heart failure patients, but the relation with NO has not been studied. Therefore, we investigated the roles of ANP, BNP, and NO in relation to cGMP in the blood during worsening and improvement of chronic heart failure. The subjects were 25 patients who were hospitalized in our hospital for acute worsening of chronic heart failure. Plasma concentrations of NO, norepinephrine (NE), ANP, BNP, and cGMP were measured on acute worsening (admission) and improvement (discharge) of heart failure. The cGMP concentration on worsening showed a positive correlation with the NO concentration (r = (0.57, P < 0.01), but no correlations with ANP or BNP were observed. The cGMP concentration on improvement showed no correlation with the NO concentration, but a positive correlation with ANP (r = 0.69, P < 0.001) and BNP (r = 0.67, P < 0.001). No correlation was observed between the NO and NE concentrations. We also studied serious cases of NYHA IV and mild cases of NYHA II to III. The cGMP concentration in the serious group showed a positive correlation with the NO concentration but no correlations with ANP or BNP concentrations on worsening. However, in the mild group, the cGMP concentration during worsening showed positive correlations with both the NO and BNP concentrations. On improvement, the cGMP concentration showed no correlation with the NO concentration but positive correlations with both the ANP and BNP concentrations in both the severe and mild groups. The results suggest the possibility that cGMP is produced mainly by NO during worsening, and by ANP and BNP rather than NO during improvement of chronic heart failure.     

Early expression of natriuretic peptides and SERCA in mild heart failure: association with severity of the disease

BACKGROUND: We investigated changes in genetic expression of atrial and brain natriuretic peptides (ANP and BNP) and sarcoplasmic reticulum Ca(2+)-ATPase (SERCA) in patients with stable mild to moderate chronic heart failure (CHF), since data on this topic were primarily obtained in end-stage CHF. METHODS: We studied tissue from 25 patients with idiopathic dilated cardiomyopathy (IDC) in New York Heart Association (NYHA) class II (n=12) and III-IV (n=13). Myocardial tissue from normal hearts (n=10) served as controls. Messenger RNA (mRNA) expression of ANP, BNP, and SERCA was isolated, and correlated with severity of CHF, left ventricular function (LVEF), peak oxygen uptake (peak VO(2)), and wedge pressure. RESULTS: A significant trend for gradual changes in mRNA expression according to increasing NYHA class was found for ANP, BNP (P<0.0001) and SERCA (P=0.04), with a marked increase in patients with more advanced CHF (ANP and BNP: P<0.01 vs. controls; SERCA: NS) and less pronounced changes in patients with mild CHF. mRNA of ANP and BNP correlated strongly with LVEF (-0.621 and -0.621, respectively, both P<0.01) and peak VO(2) (-0.625 and -0.555, respectively, both P<0.01) and, to a lesser extent, with wedge pressure (0.440 and 0.488, respectively, both P<0.05). SERCA correlated most strongly with wedge pressure (-0.623, P<0.01), and weak, non-significant correlations with LVEF and peak VO(2) were found. CONCLUSIONS: Genetic expression of ANP, BNP, and SERCA is progressively altered in proportion to the severity of CHF, although this is more marked for ANP and to a lesser extent BNP, than for SERCA. These changes support the concept that already early in CHF, genetic expression is affected, which has implications for the understanding of the pathophysiology of CHF.     

慢性心力衰竭患者外周血白介素-27与树突状细胞亚群变化的研究

目的 探讨白介素-27(IL-27)、树突状细胞(dendritic cells,DCs)在慢性心力衰竭患者外周血中的表达变化。方法 选取2012年6月至2013年12月入住南方医科大学珠江医院心血管内科的慢性心力衰竭患者96例,根据纽约心功能分级,分为纽约心功能(NYHA)Ⅳ级组、NYHA Ⅲ级组、NYHA Ⅱ级组以及NYHA Ⅰ级组,心脏超声检测心功能变化,流式细胞术检测外周血DCs亚群比例和计数,ELISA法检测外周血IL-27、BNP的表达。结果 NYHA Ⅰ级组、NYHA Ⅱ级组、NYHA Ⅲ级组、NYHA Ⅳ级组,IL-27浓度呈依次递减(P<0.05),BNP浓度依次递增;NYHA Ⅳ级组和NYHA Ⅲ级组的mDC比例和mDC计数明显低于NYHA Ⅰ级组和NYHA Ⅱ级组(P<0.05)。结论 IL-27和树突状细胞(dendritic cells,DCs)参与了慢性心力衰竭的发生发展。     

Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure

OBJECTIVES: We have previously demonstrated that patients with symptomatic congestive heart failure (CHF), but not with asymptomatic left ventricular dysfunction (LVD), have augmented plasma atrial natriuretic peptide (ANP) response to exercise. Plasma brain natriuretic peptide (BNP) response to exercise is less extensively studied. The aim of this study was to determine whether responses of plasma BNP during exercise normalized for exercise workload are altered in patients with LVD and CHF. SUBJECTS AND METHODS: Twenty-nine patients with LVD, 32 patients with CHF (NYHA classes II-III) and 27 age-matched control subjects were studied. Ventilatory, plasma ANP and BNP responses were assessed during symptom-limited cardiopulmonary exercise testing. Plasma natriuretic peptide levels were measured at rest and immediately after peak exercise. The increment in plasma BNP was divided by the increment in oxygen uptake (VO2) from rest to peak exercise, and this ratio [BNP exercise ratio: (peak BNP - rest BNP)/(peak VO2 - rest VO2)] was compared amongst the three groups. RESULTS: Peak VO2 (Control, LVD and CHF: 28.2 +/- 1.7, 21.1 +/- 1.8, 16.2 +/- 0.6 ml, min(-1) kg(-1), respectively), anaerobic threshold and peak workload became smaller as heart failure worsened. Resting and peak plasma ANP levels were significantly higher only in CHF, whilst resting and peak plasma BNP levels displayed a significant and continuous increase from normal subjects to LVD and CHF. The ANP exercise ratio (1.25 +/- 0.36, 2.61 +/- 0.57, 7.72 +/- 1.65, ANOVA P = 0.0002) was significantly higher only in patients with CHF, whilst the BNP exercise ratio (0.35 +/- 0.10, 2.60 +/- 0.69, 4.98 +/- 0.97, ANOVA P = 0.0001) was significantly higher in patients with LVD and became progressively higher in patients with CHF. CONCLUSIONS: These data showed that the BNP exercise ratio, an exercise plasma BNP response normalized with exercise workload, was augmented in patients with LVD, and became progressively higher in CHF, suggesting that an augmented exercise BNP ratio exists early in the course of developing CHF.     

高龄老年人舒张性心功能不全与血浆脑钠肽水平关系探讨

目的：观察高龄老年人舒张性心功能哀竭（DHF）与血浆B型脑钠肽（BNP）水平关系。方法：选择临床充血性心功能衰竭（CHF）症状而左室射血分数（LVEF）≥50％的80例高龄老年病人,按NYHA心功能分级,分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级。40例正常人作为对照组,分别测定和比较人院时和症状好转后血浆BNP值。结果：心功能不全组明显高于对照组,心衰症状好转后BNP值显著下降。结论：高龄老年人DHF患者血浆BNP显著升高,且随心衰症状好转BNP浓度相应下降。