Tokura T, Kinoshita H, Fujimoto S, Hisanaga S, Kitamura K, Eto T
First Department of Internal Medicine, Miyazaki Medical College, Miyazaki, Japan.
Nephrol Dial Transplant. 2001 Apr;16(4):783-6. doi: 10.1093/ndt/16.4.783.
Adrenomedullin (AM) is a potent vasodilator and natriuretic peptide with hypotensive effects. Immunoreactive AM in human plasma consists of the biologically active mature form, AM (1-52)-CONH2 (mAM) and the intermediate form, AM-gly-COOH (iAM). However, the different effects of mAM and iAM in patients on haemodialysis (HD) have remained unclear.
Thirty-nine patients on HD and 10 controls were included in this study. We determined plasma levels of mAM and iAM using an immunoradiometric assay that recognizes total AM (tAM) and another that is specific for only mAM.
The plasma concentrations of mAM and iAM in patients before HD were significantly higher than those in the controls (n=10) (4.76+/-0.28 vs 1.28+/-0.22 fmol/ml, P<0.001, 25.99+/-1.47 vs 8.52+/- 0.91 fmol/ml, P<0.001 respectively). The plasma levels of mAM and iAM before HD significantly and negatively correlated with systolic blood pressure (SBP) (r=-0.46, P<0.01, and r=-0.32, P<0.05 respectively) and diastolic blood pressure (DBP) (r=-0.32, P<0.05, and r=-0.35, P<0.05 respectively). After HD, plasma mAM and iAM levels as well as SBP and DBP were significantly lower than before HD. Plasma levels of mAM and iAM correlated significantly (r=0.73, P<0.001).
These data suggest that mAM and/or iAM are involved in blood pressure regulation in patients undergoing HD, and further work is needed to understand the precise role of adrenomedullin in this regulation.
肾上腺髓质素（AM）是一种具有强大血管舒张和利钠作用的肽类物质，有降压效果。人血浆中的免疫反应性AM由生物活性成熟形式AM（1 - 52）- CONH2（mAM）和中间形式AM - gly - COOH（iAM）组成。然而，mAM和iAM在血液透析（HD）患者中的不同作用仍不清楚。
本研究纳入了39例HD患者和10例对照者。我们使用能识别总AM（tAM）的免疫放射分析方法以及仅对mAM特异的另一种方法来测定血浆中mAM和iAM的水平。
HD患者透析前血浆中mAM和iAM的浓度显著高于对照组（n = 10）（分别为4.76±0.28对1.28±0.22 fmol/ml，P < 0.001；25.99±1.47对8.52±0.91 fmol/ml，P < 0.001）。HD患者透析前血浆中mAM和iAM的水平与收缩压（SBP）显著负相关（r = - 0.46，P < 0.01；r = - 0.32，P < 0.05），与舒张压（DBP）也显著负相关（r = - 0.32，P < 0.05；r = - 0.35，P < 0.05）。HD后，血浆mAM和iAM水平以及SBP和DBP均显著低于HD前。血浆mAM和iAM水平显著相关（r = 0.73，P < 0.001）。
这些数据表明mAM和/或iAM参与HD患者的血压调节，需要进一步研究以了解肾上腺髓质素在该调节中的精确作用。
