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。     

脑钠肽与心房颤动关系的研究进展

脑钠肽是心肌细胞分泌的一种循环激素,目前脑钠肽在心血管领域的诊断和治疗价值已成为人们关注的热点。充血性心力衰竭诊断、治疗、预后,急性冠脉综合征患者的危险分层,都与血脑钠肽水平升高有着密切的关系。血浆脑钠肽浓度与心房颤动的关系也受到越来越多的重视,脑钠肽在心房颤动预测,相关治疗,预后判断中有重要的临床应用价值。近两年来相关研究进展较快,现将有关报道综述如下。     

B型利钠肽与孤立性心房颤动

目的:探讨B型利钠肽(BNP)与孤立性心房颤动(AF)的血栓事件发生、复律及再发之间的关系。方法:103例孤立性AF患者行食道超声(经食道超声心动图)、头颅计算机断层摄影术或磁共振(CT／MRI)检查及血BNP测定。探讨BNP在AF血栓事件及其相关因素中的作用。根据血栓事件将患者分为有血栓事件组(n=15)和无血栓事件组(n=88)。对于有复律指征的患者,根据AF复律及再发情况分为复律不成功患者(复律失败或随访期内再发,n=16)和复律成功患者(复律成功并随访期内维持窦性心律,n=7),分别进行对比研究。结果:服药后无血栓事件组BNP降低幅度优于血栓事件组,有显著性显异(P<0．05)。复律成功患者较复律不成功患者BNP水平低[(60±32)ng／L比(178±70)ng／L,P<0．05]、病程短[(3．0±1．9)个月比(7．6±2．5)个月,P< 0．05]和左心房内径小[(42．3±3．4)mm比(48．6±5．1)mm,P<0．05],均有显著性差异。多因素Logistic回归分析: BNP是预测孤立性AF血栓事件的独立因素(P<0．05);BNP、左心房内径和AF病程是预测AF复律及再发的独立因素(P均<0．05)。结论:BNP可作为预测孤立性AF血栓事件和AF复律与再发的临床指标。     

氨基末端B型利钠肽前体与心房颤动的研究进展

目前氨基末端B型利钠肽前体正广泛应用于临床试验和心血管研究中,近年的研究显示心房颤动与氨基末端B型利钠肽前体水平升高有关。现主要就近年来关于氨基末端B型利钠肽前体作为危险因子和预测因素在心房颤动治疗方面的研究进展进行综述。     

VVI起搏术后心房颤动与心钠素和室房逆传的关系

长期心脏起搏的患者,有部分并发心房颤动,尤其是VVI起搏者。本文主要阐述VVI起搏术后心房颤动与血心钠素和室房逆传的关系,为选择适当的起搏器和起搏方式以及临床干预措施提供理论依据,从而减少起搏术后心房颤动的发生。     

Different Patterns of Angiotensin II and Atrial Natriuretic Peptide Secretion in a Sheep Model of Atrial Fibrillation

INTRODUCTION: It is well established that rapid atrial rates, as in atrial fibrillation (AF), cause atrial electrical and structural remodeling leading to the maintenance of AF. The role of neurohumoral changes in this pathophysiologic vicious circle remains unclear. METHODS AND RESULTS: We followed the concentrations of angiotensin II (AT II) and atrial natriuretic peptide (ANP) in a sheep model of AF. The sheep were atrially paced at 600 beats/min for 15 weeks. Electrophysiologic study was performed at regular intervals, and venous blood samples were taken. There was a slow increase in the vulnerability for AF. The cumulative incidence of sustained AF was 80% after 15 weeks of pacing. This increased vulnerability for AF was accompanied by atrial electrical remodeling and an increase in atrial pressure. AT II increased rapidly and stayed elevated: 17+/-4 pg/mL at baseline, and 40+/-11 and 39+/-7 pg/mL after 1 and 12 weeks of pacing, respectively. ANP rose more progressively: 35+/-7 pg/mL at baseline, and 72+/-17, 95+/-10, and 106+/-23 pg/mL after 1, 3, and 12 weeks, respectively. ANP levels correlated with atrial pressure and inducibility of AF. There was no relation between these parameters and AT II levels. CONCLUSION: AT II and ANP increased significantly in this animal model of AF. Elevation of AT II occurs early and seems to be dependent on rapid atrial rate rather than the presence of AF. ANP increased more progressively. It paralleled the inducibility of AF and atrial stretch. Both neurohumoral pathways may form a potential therapeutic target for treatment of patients with AF.     

Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off- Pump Coronary Artery Bypass Grafting

Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide （NT-proBNP） in the occurrence of atrial fibrillation （AF） after coronary artery bypass grafting （CABG）. Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction （EF） less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients （21.4%）; these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation （ P 〈 0. 01 ）. Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF （ OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ）. Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.     

健心平律丸对阵发性房颤患者BNP、Ald的影响

目的：观察健心平律丸联合小剂量胺碘酮对阵发性房颤患者脑钠肽（BNP）、醛固酮（Ald）的影响。方法采用随机分组对照方法,分为治疗组30例,对照组32例。观察对象2周内未服用抗心律失常药物及影响心率、心电图、血脂的药物。治疗组在对照组治疗基础上,服用健心平律丸6 g,每天3次。对照组服用胺碘酮,从200 mg,每天3次开始,5 d后减为200 mg,每天2次,再5 d后减为200 mg,每天1次维持。治疗开始前及治疗结束后记录主要症状（心悸、胸闷、气短、疲倦乏力、头晕、舌脉象）、证候（心阳不振、气阴两虚、痰瘀阻滞）、体征、心电图、BNP、Ald。结果治疗组与对照组阵发性房颤患者BNP、Ald治疗前无统计学意义（P〉0.05）;治疗组用药3个月后,与治疗前比较,BNP、Ald有统计学意义（P〈0.05）;用药3月后,治疗组与对照组 BNP、Ald 相比较有统计学意义（P〈0.05）。结论健心平律丸联合小剂量胺碘酮能够降低阵发性房颤患者 BNP、Ald 水平,优于常规单用西药组,且无任何毒副反应。     

Increased Plasma Levels of Atrial Natriuretic Peptide (ANP) in Patients with Paroxysmal Supraventricular Tachyarrhythmias

ABSTRACT. Nilsson G, Pettersson A, Hedner J, Hedner T (Department of Internal Medicine, Central Hospital, Halmstad and Department of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden). Increased plasma levels of atrial natriuretic peptide (ANP) in patients with paroxysmal supraventricular tachyarrhythmias. Acta MedScand 1987; 221:15–21. Atrial natriuretic peptide (ANP) is a cardiac hormone originating from atrial cardiocytes. It seems to be involved in the regulatory control of circulating volume and vascular tone. Plasma immunoreactive atrial natriuretic peptide (IrANP) was investigated in 22 patients with paroxysmal supraventricular tachyarrhythmia (16 with atrial fibrillation, 4 with atrial flutter, one with a Wolf-Parkinson-White syndrome (WPW) and one with atrial tachycardia). During the aute attack, IrANP was significantly increased (125.3± 11.4 pmol/1) compared to samples obtained during convalescence (55.9±4.7 pmol/1). Heart rate (HR) was 144±4.3 beats/min during the arrhythmia and 75±2.6 during convalescence. The reduction of IrANP in plasma from the acute attack of tachycardia to follow-up was significantly related to the reduction of HR (p<0.05). Irrespective of type of paroxysmal supraventricular tachyarrhythmia, 50% of the patients experienced polyuria during the attack. This symptom was more frequent in younger patients with a shorter duration of tachycardia. Polyuria patients had a higher HR during the attack of supraventricular tachycardia. Even though polyuria was not alwavs found in the patients with the highest IrANP values, the symptom was associated with significantly higher concentrations of Ir ANP in plasma compared to the non-polyuria group. We conclude that Ir ANP is increased in plasma during acute attacks of paroxysmal supraventricular tachycardia. Furthermore, the polyuria frequently associated with this condition may partly be due to excess release of ANP from cardiac myocytes.     

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.     

Effect of Atrial Natriuretic Peptide on Electrical Defibrillation Efficacy

ANP and Defibrillation. Introduction : In vitro studies have suggested that human atrial natriuretic peptide (ANP) modulates the electrophysiologic properties of myocardial cells. This study assessed whether ANP could influence defibrillation efficacy.
Methods and Results : In 35 anesthetized dogs, the transcardiac defibrillation threshold (DFT) as well as hemodynamic and electrophysiologic variables were determined before and during treatment with ANP (n = 11), hydralazine (n = 11), or saline (n = 13). ANP (1.5 μg/kg + 0.2 μg/kg per min) increased the plasma concentration of cyclic GMP (a second messenger for ANP) and significantly decreased aortic blood pressure (mean 100 ± 11 mmHg to 83 ± 15 mmHg). ANP also prolonged ventricular repolarization (effective refractory period 157 ± 7 msec to 165 ± 11 msec) and markedly reduced DFT (5.4 ± 1.2 J to 3.8 ± 0.7 J [P < 0.01]) without changing pulmonary artery pressure or sinus cycle length. Neither saline nor hydralazine (1.5 mg/kg) had a significant effect on DFT (saline 4.7 ± 2.1 J to 4.6 ± 2.4 J; hydralazine 4.3 ± 2.0 J to 4.2 ± 1.9 J), although hydralazine caused pronounced hypotension (mean aortic pressure 103 ± 9 mmHg to 74 ± 13 mmHg).
Conclusion : These results suggest that ANP increases defibrillation efficacy, and that this effect is not necessarily shared by other vasodilating agents.     

阵发性心房纤颤转复前后脑钠肽和心功能变化研究

目的探讨阵发性心房纤颤患者转复前后脑钠肽浓度和心功能的变化。方法分析32例阵发性心房纤颤患者转复前后氨基末端脑钠肽前体（N-terminal pro-brain natiruretic peptide,NT-BNP）浓度、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）的变化。结果转复后NT-BNP水平明显降低,与转复前比较差异有显著意义。转复后LVEDV、LVEF增加,与转复前比较差异有显著意义。转复后LVESV无明显变化。结论 LVEF〉50%的阵发性心房纤颤患者心房纤颤发作时心功能下降,成功转复为窦性心律后心脏功能得到改善。     

Different Secretion Patterns of Adrenomedullin,Brain Natriuretic Peptide,and Atrial Natriuretic Peptide During Exercise in Hypertensive and Normotensive Subjects

The purpose of this study was to investigate the effect of exercise on plasma concentrations of adrenomedullin, brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) in patients with essential hypertension (n=15) and in normotensive controls (n=10). Exercise consisted of two fixed workloads, 40 and 80 watts of work load using a supine bicycle ergometer. Plasma levels of all three peptides at rest were significantly higher in hypertensives than in controls. Plasma concentrations of ANP increased with exercise in both groups and had greater     

Electrophysiologic Characteristics of a Dilated Atrium in Patients with Paroxysmal Atrial Fibrillation and Atrial Flutter

This study investigated the difference of atrial electrophysiologic characteristics between a normal and dilated atrium and compared them among patients with paroxysmal atrial fibrillation and flutter. Twenty-seven patients with paroxysmal atrial fibrillation and 28 patients with paroxysmal atrial flutter were divided into four subgroups, according to the presence of a normal atrium or bilateral atrial enlargement. Thirty patients without atrial arrhythmia (20 patients with normal atrium and 10 patients with bilateral atrial enlargement) were included in control group. The atrial refractoriness in patients with a dilated atrium was longer than those with normal atrial size. In patients with paroxysmal atrial fibrillation and patients of control group, the P-wave duration and interatrial conduction velocity with or without atrial enlargement were similar. However, in patients with paroxysmal atrial flutter, P-A_PCS (86 ± 10 ms vs. 73 ± 9 ms, p < 0.05) and P-A_DCS (109 ± 9 ms vs. 95 ± 9 ms, p < 0.05) in patients with a dilated atrium were longer than in patients with a normal atrium. The patients with paroxysmal atrial fibrillation or atrial flutter all demonstrated longer P-wave duration and interatrial conduction time than control group. Among the groups with a normal atrium or a dilated atrium, atrial refractoriness in patients with paroxysmal atrial flutter was shorter than that in control group. Moreover, in the patients with a normal atrium, the potential minimal wavelength in control group (6.6 ± 1.7) was longer than that of paroxysmal atrial fibrillation (5.3 ± 1.1), or atrial flutter (5.0 ± 1.2). These findings suggest that atrial electrophysiologic characteristics of a dilated atrium were different from those of normal atrium, and these changes were different between paroxysmal atrial fibrillation and flutter. Multiple factors are considered to be related to the genesis of atrial tachyarrhythmias.     

Persistent Atrial Flutter in Patients Treated for Atrial Fibrillation with Amiodarone and Propafenone:

INTRODUCTION: Antiarrhythmic drugs have been reported to promote the conversion of atrial fibrillation to atrial flutter in patients with paroxysmal atrial fibrillation. However, information about the electrophysiologic mechanism and response to radiofrequency ablation of these drug-induced atrial flutters is limited. Furthermore, the determinants of the development of persistent atrial flutter in patients treated for atrial fibrillation with antiarrhythmic drugs are still unknown. METHODS AND RESULTS: Among the 136 patients treated for atrial fibrillation with amiodarone (n = 96) or propafenone (n = 40), 15 (11%, mean age 65.5 +/- 12.3 years) were identified to have subsequent development of persistent atrial flutter based on surface ECG characteristics during antiarrhythmic drug treatment. The mean interval between the beginning of drug treatment and the onset of atrial flutter was 5.0 +/- 5.5 months. Intracardiac mapping and entrainment studies revealed that 11 patients had counterclockwise typical atrial flutter, and 4 had clockwise typical atrial flutter. All 15 patients underwent successful ablation with creation of complete bidirectional isthmus conduction block. After a mean follow-up of 12.3 +/- 4.2 months, 14 (93%) of 15 patients who underwent successful ablation and continued taking antiarrhythmic drugs have remained in sinus rhythm. Univariate analysis of clinical variables demonstrated that only atrial enlargement was significantly related to the occurrence of persistent atrial flutter. CONCLUSION: In patients with atrial fibrillation, persistent typical atrial flutter might occur during antiarrhythmic drug treatment, and atrial enlargement was a risk factor for the development of such an arrhythmia. Radiofrequency ablation and continuation of pharmacologic therapy offered a safe and effective means of achieving and maintaining sinus rhythm.     

血浆、腹水中心钠素、加压素的测定及意义

本文采用放射免疫分析法测定25例肝硬化腹水患者血浆、腹水中心钠素和加压素的水平，发现血浆，腹水中心钠素水平相当，均明显高于正常血浆水平；血浆加压素升高不明显，而腹水中加压素浓度显著高于血浆。结果提示心钠素和加压素的分泌释放异常，在肝硬化钠，水潴留及腹水形成中有一定的作用。腹水中高浓度的心钠素和加压素通过腹水回输可能起到一定的治疗作用。     

糖尿病并发冠心病血浆内皮素及心钠肽含量变化及其临床价值

目的测定2型糖尿病（T2DM）并发冠心病（CHD）病人血浆血管内皮素（ET）、心钠素（ANP）含量，探讨其在本病发生与发展中的作用和对临床诊断的价值。方法选择64例糖尿病（DM）病人，其中并发CHD组32例，未并发CHD组32例，以放射免疫分析（Rn）法检测血浆ET、ANP水平，进行分析，并与30名健康体检者作比较。结果DM并发CHD组血浆ET、ANP含量显著高于未并发CHD的DM组及正常健康人组（P〈0．01）；DM无并发CHD组血浆ET、ANP含量显著高于正常对照组（P〈0．05）。影响因素除与本身有无并发CHD外，尚与病程、年龄有关。结论DM并发CHD病人血浆KF、ANP变化可能参与了本病的发病过程。可作为判断病情程度及疗效评价的指标。