急性坏死性胰腺炎外科处理策略变化及结果

１９８５￣１９９６年间，改变了急性坏死性胰腺炎的外科处理策略（１９８５￣１９９１年主要为早期胰床引流，１９９２￣１９９６年为晚期坏死胰腺组织清除和规则性胰切除），其手术死亡率从４４％降为０（ｐ〈０．０００２），两组病人的胰腺炎严重程度无统计学差异。但１９９２￣１９９６年组胰周脓肿仍是主要并发症。结论：坏死性胰腺炎的外科处理应以坏死组织清除为主，适当的规则性胰腺切除并不增加病死率。     

AP-811, a novel ANP-C receptor selective agonist

AP-811 is a derivative of the Phe8-Ile15 region of atrial natriuretic peptide (ANP) and is one of the smallest linear ligands for ANP receptors. The binding and agonist activities of AP-811 have been compared with those of other ANP analogs for the ANP-A and ANP-C receptors. AP–811 binds with a high binding affinity to and is a strong agonist for the ANP-C receptor, indicating that the binding and agonist sites for this receptor are the same or near each other in the ANP sequence. In contrast, AP-811 showed no agonistic effect for the ANP-A receptor, although it could bind to this receptor. Comparing the biological activities of AP-811 with those of other ANP analogs, we propose that the binding and agonist sites for the ANP-A receptor may consist of separate regions of ANP. In conclusion, AP-811 is the smallest C-receptor-selective agonist.     

INTRACEREBROVENTRICULAR ANP(1–28) HAS NO OBVIOUS EFFECTS ON RENAL BLOOD FLOW AND FUNCTION IN CONSCIOUS SHEEP

1. The study examines whether intracerebroventricular (ICV) infusion of atrial natriuretic peptide (human ANP, 1–28) influences renal electrolyte and water excretion, vasopressin release, renal and femoral blood flows in conscious ewes. The blood flow was measured by chronically implanted ultrasonic flow probes. 2. ICV infusion of ANP(1–28) at 25 pmol/min for 60 min did not affect renal Na and K excretion or plasma vasopressin levels. In two out of six animals a mild water diuresis developed at about 50 min post-infusion. 3. The plasma osmolality, Na, K and protein concentrations did not change during the experiments. 4. The renal and femoral arterial blood flows were not influenced by 30 min ICV infusions of ANP(1–28) at 25 and 85 pmol/min. 5. It is concluded that human ANP(1–28) has no, or negligible, effects on renal function, femoral and renal blood flow when given ICV in amounts obviously elevating cerebrospinal fluid levels far above normal.     

氨氯地平对左室舒张功能衰竭患者的内皮素、内洋地黄及心钠素的影响

目的：比较研究左室和右室舒张功能衰竭患者的内皮素（ＥＴ）、内洋地黄素（ＥＤＦ）、心钠素（ＡＮＰ）的变化。方法：测定２０例左室舒张功能衰竭患者使用氨氯地平前后血ＥＴ、ＥＤＦ、ＡＮＰ的水平。结果：ＥＤＦ：左室舒张功能衰竭组高于正常对照组（Ｐ＜０．０２）,收缩功能衰竭低于正常对照组（Ｐ＜０．００１）。ＥＴ：两组均明显升高,收缩功能紊乱增加更明显（Ｐ＜０．００５）。ＡＮＰ：两组均明显增加,组间无统计学差异。舒张功能衰竭组用氨氯地平６周后：ＥＴ、ＥＤＦ、ＡＮＰ均下降,与临床改善一致。结论：上述三种血管调节肽释放调节异常与左室舒张功能衰竭发生发展有关,动态观察它们的变化有助疗效判断。     

Developmental programing of thirst and sodium appetite

Thirst and sodium appetite are the sensations responsible for the motivated behaviors of water and salt intake, respectively, and both are essential responses for the maintenance of hydromineral homeostasis in animals. These sensations and their related behaviors develop very early in the postnatal period in animals. Many studies have demonstrated several pre- and postnatal stimuli that are responsible for the developmental programing of thirst and sodium appetite and, consequently, the pattern of water and salt intake in adulthood in need-free or need-induced conditions. The literature systematically reports the involvement of dietary changes, hydromineral and cardiovascular challenges, renin–angiotensin system and steroid hormone disturbances, and lifestyle in these developmental factors. Therefore, this review will address how pre- and postnatal challenges can program lifelong thirst and sodium appetite in animals and humans, as well as which neuroendocrine substrates are involved. In addition, the possible epigenetic molecular mechanisms responsible for the developmental programing of drinking behavior, the clinical implications of hydromineral disturbances during pre- and postnatal periods, and the developmental origins of adult hydromineral behavior will be discussed.     

Effects of variation of atrioventricular interval on left ventricular diastolic filling dynamics and atrial natriuretic peptide levels in patients with DDD pacing for complete heart block.

AIMS: This study was designed to evaluate the effect of variation of atrioventricular (AV) interval (AVI) on left ventricular (LV) diastolic function and ANP and c-GMP levels during DDD pacing in patients with complete AV block and normal systolic function. METHODS: The study population comprised 22 patients (mean age 65.2+/-14.3, 12 males) with complete AV block. All patients underwent complete Doppler echocardiography before implantation of a DDD-pacemaker. Twenty-four hours later, patients were paced for a period of 30 min, at three different AVIs (100 ms, 150 ms and 200 ms), at rest. During each pacing period, Doppler-derived LV diastolic indices were re-evaluated and ANP and c-GMP levels were reassessed. RESULTS: Overall comparison showed a significant progressive augmentation, from 200 ms to 100 ms AVI, in transmitral E/A wave ratio (from 0.53+/-0.13 to 0.90+/-0.25, P = 0.0005) and in LV filling time (from 0.33+/-0.05 to 0.40+/-0.06s, P = 0.0005), followed by a significant progressive reduction in ANP and c-GMP levels. An AVI of 100 ms or 150 ms was associated with improved diastolic indices and lower natriuretic peptides levels, compared with the longer AVI. CONCLUSION: Programmed AVI during DDD pacing affects LV diastolic performance and plasma ANP and c-GMP levels. The assessment of these parameters constitutes a useful modality for AVI optimization.     

Effect of Chronic Ethanol Consumption on the Atrial Natriuretic System of Spontaneously Hypertensive Rats

There is a lot of discussion on the effects of ethanol (ETOH) on blood pressure (BP). It has been suggested that chronic moderate ETOH consumption prevents the development of age-dependent hypertension in humans and spontaneously hypertensive rats (SHR). However, the mechanism mediating this effect is unknown. In the present studies, we hypothesized the implication of atrial natriuretic peptide (ANP), a BP-lowering hormone, on the antihypertensive effect of moderate ETOH consumption. A 20% v/v solution of alcohol was given as drinking fluid to SHR and normotensive Wistar-Kyoto (WKY) rats for up to 32 weeks. This treatment prevented, at least in part, the age-dependent increase of BP in SHR and WKY rats. The lower BP was associated with significantly lower levels of circulating atrial natriuretic peptide in both groups. After chronic ETOH administration, total ANP content and concentration were higher in the left and right atria of SHR and WKY rats than in water-treated controls. Despite the ETOH-induced increase in atrial ANP content, there was no significant change in atrial ANP mRNA, suggesting decreased atrial release. Chronic ETOH treatment significantly reduced ANP mRNA in the ventricles of SHR but not of WKY rats. Correspondingly, ventricular ANP content and concentration were lowered by ETOH in SHR only. Chronic ETOH administration induced a significant increase of plasma arginine vasopressin and a significant decrease of plasma aldosterone in SHR but not in WKY rats. Thus, chronic ETOH treatment prevented the age-dependent elevation of BP in both SHR and WKY rats, and altered the activity of heart ANP as well as of the aldosterone and plasma arginine vasopressin systems.     

实验性犬SAH后CVS血浆、CSF中NPY、ANP含量动态变化及巴曲酶的保护作用研究

目的探讨蛛网膜下腔出血（ＳＡＨ）后脑血管痉挛（ＣＶＳ）的发病机理和防治方法。方法采用放免法动态观察了犬ＳＡＨ后血浆、ＣＳＦ中神经肽Ｙ（ＮＰＹ）、心钠素（ＡＮＰ）含量动态变化及巴曲酶的保护作用。结果单纯注血组及巴曲酶治疗组血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ含量较注血前及同期正常对照组明显增高（Ｐ＜０．０１）；单纯注血组在注血后３０ｍｉｎ血浆、ＣＳＦ中ＮＰＹ含量开始升高，ＣＳＦ中ＡＮＰ含量亦在注血后３０ｍｉｎ升高，血浆ＡＮＰ含量则在第２ｄ开始升高，至第７ｄ最高。蛛网膜下腔给药组和静脉注入巴曲酶０．４ＢＵｋｇ－１ｄ－１组血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ含量均明显低于同期单纯注血组（Ｐ＜０．０１）。结论血浆、ＣＳＦ中ＮＰＹ、ＡＮＰ的异常增高是ＳＡＨ后ＣＶＳ的原因之一，巴曲酶可以防止ＮＰＹ和ＡＮＰ的异常增高。     

Involvement of maxi-KCa channel activation in atrial natriuretic peptide-induced vasorelaxation

Large conductance, voltage- and Ca²⁺-sensitive K⁺ (maxi-K_Ca) channels play an important role in the regulation of vascular smooth muscle excitability and contractility. The activity of maxi-K_Ca channels is modified by a variety of intracellular messengers including cGMP, as well as by voltage and Ca²⁺. In the present study, we investigated the functional relevance of maxi-K_Ca channels in atrial natriuretic peptide (ANP)-mediated vasorelaxation in the isolated rat mesenteric artery. ANP produced concentration-dependent relaxation in the de-endothelialized rat mesenteric artery . Iberiotoxin, a specific blocker of maxi-K_Ca channels, greatly attenuated the ANP-induced vasorelaxation. Similarly, a large portion of the vascular relaxation induced by 8-Bromo-cGMP, a membrane permeable analogue of cGMP, was inhibited by iberiotoxin. These results indicate that activation of maxi-K_Ca channels contributes substantially to the vascular relaxation produced by ANP in the rat mesenteric artery. Intracellular cGMP, increased by ANP, and the subsequent activation of cGMP-dependent protein kinase (PKG) may play a central role in the activation of maxi-K_Ca channels in the ANP-produced vascular relaxation. Received: 3 February 1998 / Accepted: 12 March 1998     

川芎嗪对严重烫伤豚鼠早期血浆心钠素含量变化的影响

目的　观察严重烫伤豚鼠早期血浆心钠素的含量变化及川芎嗪对其影响。方法　复制 3 0 %TBSA三度烫伤动物 (豚鼠 )模型 ,随机分成复苏组和川芎嗪治疗组 ,每组均在烫伤后 2 ,4,8,12 ,2 4,48h六个时相点 ,抽腹腔静脉血2 -3ml ,用放射免疫法测定血浆ANP浓度。另设正常对照组。结果　两组血浆ANP均在伤后 2h显著升高 (P <0 .0 1) ,4h后开始下降 ,8-2 4h下降显著 (P <0 .0 5 ) ,48h后又开始回升 ;但治疗组从 4h后含量明显高于复苏组。结论　烫伤豚鼠早期血浆ANP分泌量降低 ,中药川芎嗪可促进ANP的分泌。提示重度烧伤早期应用中药川芎嗪有重要的临床价值。