急性脑血管病致多器官功能障碍综合征心钠素、肾素-血管紧张素-醛固酮系统机制的临床研究

目的:探讨心钠素(ANP)、肾素-血管紧张素-醛固酮系统(RAAS)在急性脑血管病(ACVD)致多器官功能障碍综合征(MODS)中的病理作用机制。方法:采用放射免疫分析法动态测定53例ACVD并或不并MODS患者及20例正常对照者血浆ANP、肾素活性(PRA)、血管紧张素-Ⅱ(AT-Ⅱ)、醛固酮(ALD)含量。结果:ACVD后血浆ANP含量较对照组显著下降,且并发MODS者下降程度大于单纯ACVD者(P<0.05);血浆PRA及AT-Ⅱ、ALD含量较对照组升高,并发MODS者升高程度大于单纯ACVD者且差异有显著性(P<0.05)。血浆ANP、PRA、AT-Ⅱ及ALD的动态变化规律随MODS的发生与否而不同。结论:血浆ANP、PRA、AT-Ⅱ及ALD的浓度可反映ACVD后下丘脑-垂体的损伤及程度,可作为判断ACVD病情及预后的客观指标。ANP、RAAS参与ACVD致MODS的发生发展过程,检测血浆ANP、AT-Ⅱ及ALD的含量可早期发现并预防MODS的发生。

A clinical study on mechanism of ANP and RAAS in acute cerebrovascular disease with multiple organs dysfunction syndrome

Objective: To study the function of atrial natriuretic polypeptide (ANP)renin angiotensin aldosterone system (RAAS) in the mechanism of acute cerebrovascular disease (ACVD) with multiple organs dysfunction syndrome (MODS) Methods: Observing dynamicly plasma ANP, PRA, angiotensin-Ⅱ (AT-Ⅱ) and aldosterone (ALD) content in 53 ACVD patients with or without MODS and 20 normal contracts with radiative immune analysis. Results: Plasma ANP content decreased significantly in ACVD. The decrease degree from high to low was that of ACVD with MODS, cerebral hemorrhage and cerebral infarction. Plasma PRA, AT-Ⅱ, ALD level increased significantly after ACVD, the plasma concentrations in ACVD patients with MODS were higher than in ACVD alone (P<0. 05). The dynamic change regularities in ACVD and ACVD with MODS were different. Conclusion: The abnormal alteration of plasma ANP, PRA, AT-Ⅱ and ALD levels in ACVD patients indicated the damage of hypothalamus and pituitary. It could be regarded as laboratory indexes for judging ACVD condition and prognosis. ANP and RAAS participated the occurrence and development of MODS caused by ACVD, to determine plasma ANP, AT-Ⅱ and ALD content could find earlier and prevent the occurrence of MODS.