超声心动图评价高血压左室肥厚的逆转

在高血压病人中,约有１／３会出现左心室肥厚（ＬＶＨ）,ＬＶＨ使心血管病发生率增加,死亡率增高,是独立于高血压的一个危险因素〔１—３〕。逆转ＬＶＨ也是降压治疗的重要目标。本研究用二维超声心动图定量左室心肌重量,评价钙离子拮抗剂在左室肥厚逆转中的价值以及...     

原发性高血压患者的超声心动图左室构型

本文应用二维及Ｍ型超声心动图方法对２７２例原发性高血压患者的左室构型进行了研究。左室正常构型占５１％；向心性重构占１８％，其相对壁厚度增加，而左室质量指数仍在正常范围内，似与平时舒张压增高有关；离心性肥厚占２１％，呈室壁增厚和心腔扩大，与长期血压增高致心肌收缩功能降低有关；而典型的向心性肥厚病程显著长于离心性肥厚，故离心性肥厚不一定是由向心性肥厚发展而来，二者可能为各自独立的高心病表现。     

慢性肺心病患者血浆内皮素与心钠素的变化

对２０例男性慢性肺心病患者和２０例正常人（对照组）血浆内皮素（ＥＴ）和心钠素（ＡＮＰ）进行检测。结果显示：肺心病组血浆ＥＴ值明显低于对照组，ＡＮＰ值略低于对照组，差异无显著性，肺心病急性发作期ＥＴ值虽低于缓解期，但差异无显著性，ＡＮＰ值明显高于缓解期，未发现ＥＴ和ＡＮＰ之间有相关性。     

高血压病患者血浆心钠素与左房血流动力学变化的关系研究

应用超声心动图技术和放射性免疫测定法对１００例高血压病患者左房血流动力学变化与血浆心钠素水平的关系进行分析研究。结果示：高血压左室肥厚组和非左室肥厚组血浆心钠素水平显著高于正常对照组（Ｐ＜０．００１）；且左室肥厚组与非左室肥厚组之间亦有显著性差异。血浆心钠素水平与左房功能指标ＬＡＶ、ＬＡＴ、ＬＡＰ、ＬＡＦ及ＭＡＰ呈高度线性相关；与ＬＡＤ、ＬＶＭＩ、ＬＶＥＦ、ＰＦＲ、Ａ峰、ＬＶＤ、Ａ／Ｅ呈中度相关（相关系数依次为：０．８１、０．８０、０．７８、０．７６、０．７０、０．６８，－０．６１、０．６０、０．６７、０．５０及０．４８，Ｐ＜０．０１～０．００１），但与Ｅ峰不相关（ｒ＝０．１６，Ｐ＞０．０５）。随着高血压病程及分期的增加，血浆心钠素水平有增加趋势。结论认为定量测定血浆心钠素将有助于评价高血压病患者左房血流动力学及左室功能的异常变化程度。     

心力衰竭患者血浆心钠素水平与左心功能关系的临床研究

目的:探讨血浆心钠素(ANP)水平与心力衰竭患者临床心功能变化之间的关系.方法:采用特异性放免法测定心衰患者血浆ANP水平,同时采用NYHA心功能分级和超声心动图检查评定患者左心功能.结果:随心功能恶化,血浆ANP水平呈上升趋势.各级心功间差异均有显著性意义(P＜0.05).经抗心衰药物综合治疗后,ANP水平降低(P＜0.01).ANP水平与左心室射血分数(LVEF)、左心室短轴缩短率(ΔD%)呈负相关;与左室收缩末内径(LVSd)、左室舒张末内径(LVDd)呈正相关.结论:心钠素在心力衰竭的进展中,其血中浓度与心衰程度密切相关,可用于监测心衰程度.     

糖尿病患者合并高血压与胰岛素抵抗及血浆心钠素和内皮素变化的关系

为探讨胰岛素抵抗、血浆心钠素、内皮素与糖尿病合并高血压的关系，测定48例血压正常及50例合并高血压的糖尿病患者和对照组50例空腹血糖、空腹血浆胰岛素、心钠素、内皮素水平。发现合并高血压的糖尿病患者存在胰岛素抵抗，血浆内皮素、心钠素水平较血压正常者升高。结果说明胰岛素抵抗、血浆内皮素升高。心钠素作用不足在糖尿病合并高血压的发生发展中起重要作用。     

超声心动图观察血压昼夜变异与高血压左室肥厚的关系

目的：观察血压昼夜节律变异与高血压左室肥厚的关系。方法：用动态血压监测24小时平均收缩压和舒张压，白昼平均收缩压和舒张压，夜间平均收缩压和舒张压，血压负荷值，用彩色多普勒超声心动图以Devereux校正公式计算左室重量和左室重量指数，判断有无左室肥厚，结果：非构型高血压与左室肥厚的关系密切，结论：夜间血压持续高和节律消失使心血管系统更长时间处于过重负荷下，易导致和加重左室肥厚的发生和发展。     

多普勒超声心动图评价高血压病左室舒张功能

高血压病患者长期血压升高,往往累及心脏,使心脏功能发生改变。作者最近应用脉冲多普勒探查二尖瓣舒张期血流,以评价左室舒张功能。现报道如下。资料与方法高血压病36例(男24例,女12例),平均年龄56±9(36～68)岁,病程15.80(1～40年),均为本院住院或门诊病人。患者经询问病史,测量血压、心电图、胸部 X 线摄片、眼     

运动训练对高血压病患者心房利钠肽的影响

通过２０例每次１小时的有氧训练，检测实验前后高血压病患者的血压和血浆心房利钠肽水平。结果显示，经训练后两项指标均显著下降，而对照组两者均无显著变化。该实验进一步证实了运动训练对高血压病患者的降压效应，并探讨了这一治疗效应和患者血浆心房利钠肽水平变化的关系。     

老年高血压患者不同心室构型与氮末端B型脑钠肽前体的相关性

目的分析老年高血压患者不同心脏构型之间的氮末端B型脑钠肽前体(NT-proBNP)水平差异。方法检查老年高血压患者326例,正常人265名NT-proBNP水平,通过超声测量,按Ganau分类法,将高血压组左心室质量指数升高的患者分为向心性肥厚型、离心性肥厚型两种构型。结果高血压病组NT-proBNP水平高于对照组。按心脏重构分组后,向心性肥厚组NT-proBNP水平升高最多,离心性肥厚组次之,而正常构型组和向心性重构组与对照组没有显著性差异。结论老年高血压患者在未出现心功能失代偿时NT-proBNP已出现明显升高,且不同构型之间NT-proBNP水平不同,提示NT-proBNP可能参与左心室的重构甚至是心功能的恶化。     

No Correlation Between Atrial Natriuretic Peptide Concentrations and Echocardiographic Measurements of Left Atrial Size or Left Ventricular Size and Function in Patients with Persistent Atrial Fibrillation

Atrial fibrillation (AF) may be associated with activation of atrial natriuretic peptide (ANP). The exact trigger for the release of ANP is still being debated. Atrial volume, pressure, and wall stretch are considered to be the main determinants of ANP activation. The aim of the study was to evaluate plasma ANP concentrations in patients with persistent AF and to analyze the echocardiographic determinants of ANP concentration in this group. The study population included 67 patients, 59 ± 7 years of age, with a median AF duration of 5.5 months (range 0.1–12). The relationship between plasma ANP concentrations and echocardiographic left atrial (LA) diameter and volume, and left ventricular (LV) diameter and ejection fraction (EF) was analyzed by logistic regression analysis. The median baseline plasma ANP concentration was 63 pg/mL (range 21–126) in the study group versus 34 pg/mL (range 16–73) in a control group. The mean left antero-posterior atrial dimension, LA volume, LV enddiastolic diameter, and LVEF were 48 mm, 104 mL, 52 mm, and 54%, respectively. A significant linear positive correlation was found between plasma ANP concentration and maximal LA volume (r = 0.62, P < 0.01). A negative correlation was found between LVEF and plasma ANP concentration (r =−0.42, P = 0.01). However, by multivariate regression analysis, no echocardiographic parameter was an independent predictor of plasma ANP concentration. Plasma ANP concentrations were independent of echocardiographic measurements of LA size or LV size and function in patients with persistent AF.     

新生儿呼吸衰竭时血浆心房利钠多肽水平的变化

目的 :探讨血浆心房利钠多肽 (ANP)在新生儿呼吸衰竭中的作用及临床意义。方法 :应用放射免疫法分别测定 48例 (新生儿窒息 32例 ,新生儿肺炎 16例 )呼吸衰竭的足月新生儿病后 3d内、10～ 14d的血浆ANP水平 ,并与不伴有呼吸衰竭的 18例 (新生儿窒息 10例 ,新生儿肺炎 8例 )对照     

左室收缩功能正常的心房颤动患者血清NT-pro-BNP水平的变化及影响因素探讨

目的:观察左室收缩功能正常的心房颤动(房颤)患者氨基末端-脑钠肽前体(NT-pro-BNP)的变化并探讨其影响因素。方法:对116例左室射血分数正常(LVEF>50％)患者测定血清NT-pro-BNP水平,行经胸超声心动图检查,并调查人口学特征、心血管病主要危险因素情况、合并症、用药情况、血生化学检查。除外既往心功能不全、肝肾功能不全、甲状腺疾病或肿瘤病史患者。结果:持续性房颤血清NT-pro-BNP水平的中位值显著升高(1018．0ng／L比137．9 ng／L,P<0．001),多因素分析发现房颤类型(P<0．0001)、年龄(P=0．0004)、LAD(P<0．0001)是影响NT-pro-BNP的因素,而性别、体重指数、LVEF,房颤的病程和伴随疾病与NT-pro-BNP水平无关。结论:房颤类型,患者年龄和左房内径是房颤患者NT-proBNP升高的独立预测因素。     

运动对青年血浆内皮素及心钠素的影响

以放射免疫学方法检测了28名青年在Bruce运动试验中血浆ET及ANP的变化，以了解试验中心血管反应的生理机制。方法是将28名（男20名，女8名）学生配对分成4组，每组7名（男5名，女2名），年龄19．6±1．1岁。其中1组不运动作为对照组，其余3组分别作不同水平运动。结果ET及ANP随运动强度增加而增加．运动6min时ANP显著升高（P＜0．05）；运动12min时ANP及ET均显著增加（P＜0．01及0．05），休息8min后ANP明显下降。提示；ET及ANP在运动试验中是影响心血管反应的重要因素之一。     

Failure of Plasma Atrial Natriuretic Peptide Levels to Increase During Exercise in Patients with Chronic Atrial Fibrillation

It is generally accepted that plasma atrial natriuretic peptide release occurs secondary to atrial stretch. The influence of coordinated atrial contraction (AC) upon this process is not fully appreciated. The aim of the study was to determine the importance of coordinated AC upon peripheral atrial natriuretic peptide levels (α-hANP) during exercise. Peripheral α-hANP levels were measured at rest and during exercise in 12 patients with complete heart block (CHB) and permanent rate responsive pacemakers. Seven patients had coordinated AC and five had chronic atrial fibrillation (AE). Each patient performed three treadmill exercise tests. Maximal inspired oxygen volume (VO₂ max) was determined during test 1. Tests 2 and 3 were performed to 70% VO₂ max, the pacemaker being programmed to either VVI or VVIR mode. Plasma α-hANP was measured using a two-site immunoradiometric assay. At rest there was a small but significant difference between the two patient groups: AF 60.2 pg/mL versus AC 97.6 pg/mL; P = 0.03. During exercise in the AC patients, there was a significant increase in α-hANP levels, in VVIR mode, to 238.4 pg/mL, and in VVI mode, to 207.9 pg/mL, P = 0.002 and 0.003, respectively. In those patients with chronic AF, there was no significant rise or fall in α-hANP levels in either pacing mode, VVIR 65.2 pg/mL, VVI 46.6 pg/mL. Previous workers have suggested that α-hANP release by nonfunctioning atria is normal. We have shown that the presence of coordinated AC is required for the release of α-hANP during exercise in patients with CHB, and that this appears to be independent of ventricular rate.     

Effects of Systolic Atrial Function on Plasma Renin Activity and Natriuretic Peptide Secretion after High Rate Atrial and Ventricular Pacing in Dogs

Rapid atrial rates cause electrical, structural remodeling, and neuro-humoral changes. This study compares the effects of mechanical remodeling on plasma renin activity (PRA) and atrial natriuretic peptide (ANP) secretion. Eight beagles were subjected to rapid atrial pacing (AP) at 400 beats/min for 16 days. After complete recovery of left ventricular function, they underwent rapid ventricular pacing (VP) at 240 beats/min of equal duration. Left atrial systolic maximal dimension (LAmax) and left atrial appendage (LAA) peak late emptying velocity (LAA-E) were assessed by echocardiography. Blood samples were taken from the right atrium and from the peripheral vein. LAmax after AP and VP enlarged significantly (2.16 ± 0.21 cm vs 2.41 ± 0.23 cm, P = 0.002). Compared with baseline, LAA-E velocities were significantly reduced (0.65 ± 0.12 m/s vs 0.26 ± 0.16 m/s, P = 0.001) after AP only. AP caused a significant elevation of PRA in right atrial (9.28 ± 4.23 nmol/L per hour) and peripheral samples compared with baseline values (4.82 ± 2.53 nmol/L per hour, P = 0.04). ANP levels increased after AP (1117.12 ± 252.21 fmol/L) with respect to baseline values (824.37 ± 159.08 fmol/L, P = 0.001). There was no difference in PRA and ANP levels between atrial and peripheral samples. Atrial size and impaired systolic appendage function play an important role in secretion of PRA and ANP. Both neuro-humoral pathways may be therapeutic targets in the treatment of patients with AF.     

心钠素的病理生理及临床研究进展

心钠素通过水盐代谢平衡在调节血压中起重要作用。现就其病理生理机制和临床研究进展予以综述。