充血性心力衰竭患者输注肾上腺髓质素的血流动力学、肾脏及激素效应

Hemodynamic, renal, and hormonal effects of adrenomedullin infusion in patients with congestive heart failure.

作者信息

Nagaya N, Satoh T, Nishikimi T, Uematsu M, Furuichi S, Sakamaki F, Oya H, Kyotani S, Nakanishi N, Goto Y, Masuda Y, Miyatake K, Kangawa K

机构信息

Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan.

出版信息

Circulation. 2000 Feb 8;101(5):498-503. doi: 10.1161/01.cir.101.5.498.

DOI:10.1161/01.cir.101.5.498

PMID:10662746

Abstract

BACKGROUND

Experimental studies have shown that adrenomedullin (AM) causes vasodilatation, diuresis, and a positive inotropic effect. In humans, however, whether infusion of AM has beneficial effects in congestive heart failure (CHF) remains unknown.

METHODS AND RESULTS

Hemodynamic, renal, and hormonal responses to intravenous infusion of human AM (0.05 microg. kg(-1). min(-1)) were examined in 7 patients with CHF and 7 normal healthy subjects (NL). In NL group, AM significantly decreased mean arterial pressure (-16 mm Hg, P<0. 05) and increased heart rate (+12 bpm, P<0.05). In CHF group, AM also decreased mean arterial pressure (-8 mm Hg, P<0.05) and increased heart rate (+5 bpm, P<0.05), but to a much lesser degree (P<0.05 versus NL). AM markedly increased cardiac index (CHF, +49%; NL, +39%, P<0.05) while decreasing pulmonary capillary wedge pressure (CHF, -4 mm Hg; NL, -2 mm Hg, P<0.05). AM significantly decreased mean pulmonary arterial pressure only in CHF (-4 mm Hg, P<0.05). AM increased urine volume (CHF, +48%; NL, +62%, P<0.05) and urinary sodium excretion (CHF, +42%; NL, +75%, P<0.05). Only in CHF, plasma aldosterone significantly decreased during (-28%, P<0.05) and after (-36%, P<0.05) AM infusion. These parameters remained unchanged in 7 patients with CHF and 6 healthy subjects who received placebo.

CONCLUSIONS

Intravenous infusion of AM has beneficial hemodynamic and renal effects in patients with CHF.

摘要

背景

实验研究表明，肾上腺髓质素（AM）可引起血管舒张、利尿及正性肌力作用。然而，在人类中，输注AM对充血性心力衰竭（CHF）是否具有有益作用尚不清楚。

方法与结果

对7例CHF患者和7名正常健康受试者（NL）进行了静脉输注人AM（0.05μg·kg⁻¹·min⁻¹）的血流动力学、肾脏及激素反应研究。在NL组中，AM显著降低平均动脉压（-16 mmHg，P<0.05）并增加心率（+12次/分钟，P<0.05）。在CHF组中，AM也降低平均动脉压（-8 mmHg，P<0.05）并增加心率（+5次/分钟，P<0.05），但程度要小得多（与NL组相比，P<0.05）。AM显著增加心脏指数（CHF组增加49%；NL组增加39%，P<0.05），同时降低肺毛细血管楔压（CHF组降低4 mmHg；NL组降低2 mmHg，P<0.05）。AM仅在CHF组显著降低平均肺动脉压（-4 mmHg，P<0.05）。AM增加尿量（CHF组增加48%；NL组增加62%，P<0.05）和尿钠排泄（CHF组增加42%；NL组增加75%，P<0.05）。仅在CHF组中，输注AM期间（-28%，P<0.05）及之后（-36%，P<0.05）血浆醛固酮显著降低。7例接受安慰剂的CHF患者和6名健康受试者的这些参数保持不变。