米力农对顽固性充血性心衰患者内皮素、心钠素及心功能的影响

目的 评价米力农对顽固性充血性心衰患者内皮素、心钠素及心功能的影响。方法 20例顽固性充血性心衰患者,静脉给予米力农7－10d,应用超声心动图评价心功能,用放免分析方法测内皮素和心钠素。结果 顽固性充血性心衰患者血浆内皮素、心钠素较正常人明显升高（P＜0．01）,心功能参数较正常人降低（P＜0．01）;米力农治疗后,心功能明显改善;内皮素、心钠素较治疗前明显下降。结论 米力农对顽固性充血性心衰疗效较好,内皮素及心钠素可以作为评价心功能好坏的指标。     

Comparison of body fluid distribution between chronic haemodialysis and peritoneal dialysis patients as assessed by biophysical and biochemical methods.

BACKGROUND: The control of extracellular volume is a key parameter for reducing hypertension and the incidence of cardiovascular mortality in dialysis patients. In recent years bioimpedance measurement (BIA) has been proven as a non-invasive and accurate method for measuring intracellular and extracellular fluid spaces in man. In addition, plasma atrial natriuretic peptide (ANP) and cyclic guanosine monophosphatase (cGMP) concentrations have been shown to reflect central venous filling. Using these methods, we compared body fluid status between stable patients on haemodialysis and peritoneal dialysis. METHODS: Thirty-nine chronic haemodialysis patients, 43 chronic peritoneal dialysis patients and 22 healthy controls were included in the study. Multifrequency BIA was performed using the Xitron BIS4000B device (frequencies from 5 to 500 kHz were scanned and fitted) in patients before and after haemodialysis. Peritoneal dialysis patients were measured after drainage of the dialysate. Plasma ANP and cGMP levels were measured in plasma using a (125)I solid phase RIA. Serum albumin concentrations and serum osmolality were measured in all patients. The body fluid data were analysed in relation with the clinical findings. RESULTS: Total body water (TBW) was 0.471+/-0.066 l/kg before haemodialysis and 0.466+/-0.054 l/kg after haemodialysis. Peritoneal dialysis patients had a TBW (0.498+/-0.063 l/kg) that was greater than the before and after dialysis values of haemodialysis patients. The extracellular body fluid (V(ecf)) was increased pre-haemodialysis. It was even greater in peritoneal dialysis patients compared with patients both pre- and post-haemodialysis (pre 0.276+/-0.037 l/kg; post 0.254+/-0.034 l/kg; peritoneal dialysis 0.293+/-0.042 l/kg, P<0.05). However, plasma ANP concentrations (representing intravascular filling) in peritoneal dialysis patients were comparable with post-haemodialysis values (284+/-191 pg/ml vs 286+/-144 pg/ml). The correlation coefficient between sysRR and V(ecf) was r=0.257 in haemodialysis (P=0.057) and r=0.258 in peritoneal dialysis (P<0.05). A significant negative correlation was found between serum albumin and V(ecf)/TBW in peritoneal dialysis patients (r= -0.624). CONCLUSION: Body fluid analysis by BIA demonstrated that TBW and V(ecf) were increased in peritoneal dialysis patients, and were comparable or even greater than values found before haemodialysis. However, plasma ANP levels indicated that intravascular filling was not increased in peritoneal dialysis. The ratio of V(ecf) to TBW was correlated to systolic pressure and negatively to serum albumin in peritoneal dialysis patients.     

豚鼠耳蜗心钠素（ANP）免疫反应的分布

采用免疫组织化学（ＡＢＣ）方法研究豚鼠耳蜗心钠素免疫反应（ＡＮＰ－ＩＲ）的分布特征，研究结果表明：耳蜗血管纹、螺旋韧带、螺旋缘、Ｃｏｒｔｉ氏器及螺旋神经节组织均发现有ＡＮＰ－ＩＲ产物，结合图象分析技术对不同部位的ＡＮＰ－ＩＲ阳性产物光密度值进行测定。研究结果提示：心钠素可能作为一种血管活性物质参与内耳淋巴液的生成及耳蜗血流量的调节，并在耳蜗神经系统的信息传递过程中起递质或调质作用。     

肝硬化腹水患者血浆心钠素浓度变化的探讨

本文以放射免疫分析法测定72例肝硬化患者血浆心钠素浓度。结果为肝硬化患者血浆心钠素浓度高于正常对照组,腹水组高于无腹水组。其血浆心钠素浓度随腹水量的不同而有显著差异,即腹水量越多,心钠素浓度越高,随着腹水的消退,心钠素浓度逐渐下降。     

心钠素两种不同受体mRNA在阿霉素诱导的肾病综合征大鼠肾脏的表达

目的：在阿霉素诱导的肾病综合征大鼠动物模型探讨肾病水肿发病机理。方法：观察阿霉素诱导的肾病综合征大鼠模型扩容利尿反应及心钠素（ＡＮＰ）两种受体的表达。结果：肾病大鼠对扩容利尿的反应较正常对照组明显下降（Ｐ＜０．０１）。虽然两组大鼠在扩容时血浆心钠素上升幅度相似，但其尿中ＡＮＰ第二信使ｃＧＭＰ的排泄（ＵｃＧＭＰＶ）在肾病组比正常对照组明显下降（５．８５±２．６～３１．４±７．５ｖｓ６．０２±３．０～９８．４５±１６．８ｐｍｏｌ／ｍｉｎ，Ｐ＜０．０１）。Ｎｏｒｔｈｅｒｎ杂交显示，两组大鼠肾脏ＡＮＰ－Ａ受体ｍＲＮＡ表达相似，但肾病组大鼠肾脏ＡＮＰ－Ｃ受体ｍＲＮＡ表达较正常对照组明显升高（Ａ×ａｒｅａ１ｖｓ０．３２，Ｐ＜０．０１）。结论：肾病综合征水钠潴留可能与其肾脏ＡＮＰ－Ｃ受体高表达有关。     

人脑组织和脑脊液中含有脑钠素

本文应用放射免疫测定方法首次证明了人脑组织和脑脊液中存在着脑钠素。经过高压液相层析分析,脑组织和脑脊液中的脑钠素均有二种不同的分子形式。在脑组织中,以分子量较大者为主;而在CSF中,分子量较小的单体形式略占优势。脑内脑钠素的作用尚不十分清楚,本文观察到它能增加局部脑血流量,提示其可能参与中枢神经系统利钠、利尿及血管活动的调节。     

The influence of chronic treatment with verapamil on plasma atrial natriuretic peptide levels in young and elderly hypertensive patients

Summary In a double-blind, placebo-controlled crossover study, the plasma atrial natriuretic peptide (ANP) levels of nine young and ten elderly hypertensive patients were compared after placebo and after treatment with 120 mg verapamil given three times daily over 4 weeks. During placebo, plasma ANP levels proved to be higher in elderly patients than in young subjects. Chronic treatment with verapamil induced a rise in ANP levels in both young and elderly patients with hypertension.     

心房纤维颤动时血浆心纳素浓度变化及其临床意义

本研究应用放免测定法观察３２例心房纤维颤动患者血浆心钠素动态变化。结果表明，房颤组血浆心钠素为８５５．２±１３４．４ｐｇ／ｍｌ，健康对照组为４５４．４±７２．４ｐｇ／ｍ１，两组相比差异有高度显著性（Ｐ＜０．０１）．其中阵发性房颤发作期为９１４．７±１７９．６ｐｇ／ｍｌ，非发作期仅为５１２．８±１４１．６ｐｇ／ｍｌ，两者相比Ｐ＜０．０１．阵发性房颤非发作期与对照组相比以及阵发性房颤发作期与持续性房颤相比，差异均无显著性。     

脑钠素对心钠素分泌的影响

脑钠素(brain natriuretic peptide,BNP)是由26个氨基酸组成的多肽,其结构和功能与心钠素(atrial natriuretic peptide,ANP)极为相似,且两者在体内作用于同一受体,因而BNP与ANP的分泌可能互相影响,对此我们做了初步研究。结果表明,给大鼠静脉滴注BNP(40μg/kg)可使心房中ANP含量和血中ANP浓度明显增加,同时血中神经肽Y(Neuropeptide Y)浓度也明显升高。而体内外灌流实验表明,BNP不能直接刺激心房分泌ANP。我们认为,BNP引起血中ANP浓度的增加是由于BNP与ANP竞争同一受体引起的。BNP占据了ANP受体而使得与ANP结合的受体减少,其结果导致心房合成和分泌ANP增加。BNP引起的NPY浓度升高是机体对BNP引起的血压降低的代偿性反应。     

α-Human-ANP response to preanesthetic volume expansion and subsequent renal transplantation in diabetic and nondiabetic uremic patients

-Human atrial natriuretic peptide (ANP) concentrations were measured in 11 diabetic patients with uremia and in 16 nondiabetic uremic controls undergoing renal transplantation after preanesthetic volume expansion with 1000 ml saline solution within 10 min. Two diabetic and seven nondiabetic patients received grafts from living donors and the rest from cadaveric donors. Volume expansion induced a significant increase in the cardiac filling pressures (P(0.001), which were kept at that level especially at declamping, which was preceded by mannitol infusion. The baseline mixed venous ANP levels were significantly higher in the diabetic (252±6 pg/ml) than in the nondiabetic group (103±14 pg/ml; P(0.05). In the nondiabetic group, ANP increased to 177±40 pg/ml as a response to volume loading (P(0.05); it was not clearly changed in the diabetic group. Arterial ANP increased from 267±55 to 343±75 pg/ml in the diabetic group (P(0.05) and from 102±17 to 147±31 pg/ml in the nondiabetic group (P(0.05). During transplantation, mixed venous ANP decreased to 125±55 pg/ml in the diabetic and to 80±10 pg/ml in the nondiabetic group (P(0.001). About 30% of circulating ANP was taken up by the transplant irrespective of postoperative graft function. Two patients in each group showed delayed diuresis requiring postoperative dialysis therapy (22% of all cadaveric transplantations). ANP levels at declamping had no correlation to the outcome of kidney function.