左心室功能不全和充血性心力衰竭患者血浆脑钠肽对动态运动的反应增强。

Augmented response in plasma brain natriuretic peptide to dynamic exercise in patients with left ventricular dysfunction and congestive heart failure.

作者信息

Kato M, Kinugawa T, Ogino K, Endo A, Osaki S, Igawa O, Hisatome I, Shigemasa C

机构信息

1st Department of Internal Medicine, Tottori University Faculty of Medicine, Yonago, Japan.

出版信息

J Intern Med. 2000 Oct;248(4):309-15. doi: 10.1046/j.1365-2796.2000.00736.x.

DOI:10.1046/j.1365-2796.2000.00736.x

PMID:11086641

Abstract

OBJECTIVES

We have previously demonstrated that patients with symptomatic congestive heart failure (CHF), but not with asymptomatic left ventricular dysfunction (LVD), have augmented plasma atrial natriuretic peptide (ANP) response to exercise. Plasma brain natriuretic peptide (BNP) response to exercise is less extensively studied. The aim of this study was to determine whether responses of plasma BNP during exercise normalized for exercise workload are altered in patients with LVD and CHF.

SUBJECTS AND METHODS

Twenty-nine patients with LVD, 32 patients with CHF (NYHA classes II-III) and 27 age-matched control subjects were studied. Ventilatory, plasma ANP and BNP responses were assessed during symptom-limited cardiopulmonary exercise testing. Plasma natriuretic peptide levels were measured at rest and immediately after peak exercise. The increment in plasma BNP was divided by the increment in oxygen uptake (VO2) from rest to peak exercise, and this ratio [BNP exercise ratio: (peak BNP - rest BNP)/(peak VO2 - rest VO2)] was compared amongst the three groups.

RESULTS

Peak VO2 (Control, LVD and CHF: 28.2 +/- 1.7, 21.1 +/- 1.8, 16.2 +/- 0.6 ml, min(-1) kg(-1), respectively), anaerobic threshold and peak workload became smaller as heart failure worsened. Resting and peak plasma ANP levels were significantly higher only in CHF, whilst resting and peak plasma BNP levels displayed a significant and continuous increase from normal subjects to LVD and CHF. The ANP exercise ratio (1.25 +/- 0.36, 2.61 +/- 0.57, 7.72 +/- 1.65, ANOVA P = 0.0002) was significantly higher only in patients with CHF, whilst the BNP exercise ratio (0.35 +/- 0.10, 2.60 +/- 0.69, 4.98 +/- 0.97, ANOVA P = 0.0001) was significantly higher in patients with LVD and became progressively higher in patients with CHF.

CONCLUSIONS

These data showed that the BNP exercise ratio, an exercise plasma BNP response normalized with exercise workload, was augmented in patients with LVD, and became progressively higher in CHF, suggesting that an augmented exercise BNP ratio exists early in the course of developing CHF.

摘要

目的

我们之前已经证明，有症状的充血性心力衰竭（CHF）患者，而非无症状的左心室功能障碍（LVD）患者，运动时血浆心钠素（ANP）反应增强。关于运动时血浆脑钠肽（BNP）反应的研究较少。本研究的目的是确定左心室功能障碍和充血性心力衰竭患者运动时血浆BNP对运动负荷进行校正后的反应是否发生改变。

受试者与方法

研究了29例左心室功能障碍患者、32例充血性心力衰竭（纽约心脏协会II - III级）患者和27例年龄匹配的对照受试者。在症状限制的心肺运动试验期间评估通气、血浆ANP和BNP反应。在静息时和运动峰值后立即测量血浆利钠肽水平。将血浆BNP的增加值除以静息到运动峰值时摄氧量（VO2）的增加值，比较三组之间的这个比值[BNP运动比值：（运动峰值BNP - 静息BNP）/（运动峰值VO2 - 静息VO2）]。

结果

随着心力衰竭加重，运动峰值VO2（对照组、左心室功能障碍组和充血性心力衰竭组分别为：28.2±1.7、21.1±1.8、16.2±0.6 ml·min⁻¹·kg⁻¹）、无氧阈值和运动峰值负荷变小。仅充血性心力衰竭患者静息和运动峰值时血浆ANP水平显著升高，而静息和运动峰值时血浆BNP水平从正常受试者到左心室功能障碍患者再到充血性心力衰竭患者呈显著且持续升高。仅充血性心力衰竭患者的ANP运动比值（1.25±0.36、2.61±0.57、7.72±1.65，方差分析P = 0.0002）显著更高，而左心室功能障碍患者的BNP运动比值（0.35±0.10、2.60±0.69、4.98±0.97，方差分析P = 0.0001）显著更高，并且在充血性心力衰竭患者中逐渐升高。