McKenna K, Smith D, Moore K, Glen A, Tormey W, Thompson C J
Diabetes Centre, Victoria Infirmary, Glasgow and the Department of Diabetes, Beaumont Hospital Dublin, Ireland.
Diabet Med. 2001 Dec;18(12):973-8. doi: 10.1046/j.0742-3071.2001.00569.x.
Atrial natriuretic peptide (ANP) increases urinary albumin excretion in Type 1 diabetes mellitus (DM). Brain natriuretic peptide (BNP) is structurally and functionally related to ANP, but its effect on urine albumin excretion rate (UAER) is unknown.
To compare the albuminuric effects of intravenous infusion of ANP and BNP, and to assess the effect of both peptides on tubular protein excretion.
Eight subjects with Type 1 DM were randomised to a three leg, double blind, and placebo controlled study. On each study day, subjects were euglycaemic clamped and subsequently water loaded (20 mL/kg orally, plus urine losses) to steady state diuresis. When in steady state, creatinine clearance was estimated in three separate 1 hour periods. At the end of the first period, a 1 hour intravenous infusion of either placebo, ANP 0.025 microg/kg/min, or BNP 0.025 microg/kg/min was administered. There followed a 1 hour recovery period. Urine was collected at 15 min intervals for estimation of urine albumin (ACR) and alpha1 microglobulin creatinine ratio (MCR). Results were analysed by anova.
Creatinine clearance was similar on the three study days, and was unaltered by any infusion. ACR was unaltered by placebo (1.3 +/- 0.5-1.2 +/- 0.4 mg/mmol, mean +/- SD, p = 0.81), but increased compared to placebo with infusion of both ANP (1.2 +/- 0.4-9.8 +/- 8.4 mg/mmol, P = 0.0004), and BNP (1.1 +/- 0.4-13.4 +/- 8.6 mg/mmol, P = 0.0001). The MCR was unaltered by placebo infusion (P = 0.89), but increased compared with placebo after infusion of ANP (5.4 +/- 0.9-12.3 +/- 4.2 mg/mmol, P < 0.0001), and BNP (5.4 +/- 0.8-12.1 +/- 2.5 mg/mmol, P < 0.0001).
Intravenous infusion of BNP and ANP both increase the urine excretion of albumin and the tubular protein alpha1 microglobulin, independent of creatinine clearance.
心房利钠肽（ANP）可增加1型糖尿病（DM）患者的尿白蛋白排泄。脑利钠肽（BNP）在结构和功能上与ANP相关，但其对尿白蛋白排泄率（UAER）的影响尚不清楚。
比较静脉输注ANP和BNP对尿白蛋白的影响，并评估两种肽对肾小管蛋白排泄的作用。
8名1型糖尿病患者被随机分为一项三阶段、双盲、安慰剂对照研究。在每个研究日，使受试者血糖正常钳夹，随后口服补液（20 mL/kg，加上尿失量）至稳态利尿。处于稳态时，在三个独立的1小时时间段内估算肌酐清除率。在第一个时间段结束时，静脉输注1小时安慰剂、0.025 μg/kg/min的ANP或0.025 μg/kg/min的BNP。随后是1小时的恢复期。每隔15分钟收集尿液，以估算尿白蛋白（ACR）和α1微球蛋白肌酐比值（MCR）。结果采用方差分析。
三个研究日的肌酐清除率相似，且任何输注均未改变。安慰剂组的ACR未改变（1.3±0.5 - 1.2±0.4 mg/mmol，均值±标准差，p = 0.81），但与安慰剂相比，输注ANP（1.2±0.4 - 9.8±8.4 mg/mmol，P = 0.0004）和BNP（1.1±0.4 - 13.4±8.6 mg/mmol，P = 0.0001）后ACR均升高。安慰剂输注对MCR无影响（P = 0.89），但输注ANP（5.4±0.9 - 12.3±4.2 mg/mmol，P < 0.0001）和BNP（5.4±0.8 - 12.1±2.5 mg/mmol，P < 0.0001）后，与安慰剂相比MCR升高。
静脉输注BNP和ANP均可增加白蛋白尿排泄及肾小管蛋白α1微球蛋白，且与肌酐清除率无关。
