Pomini G, Rugna A, Lupia M, Opocher G, Gribaldo R
Divisione Medica 1, Università di Padova.
G Ital Cardiol. 1992 Jul;22(7):807-12.
Patients with severe congestive heart failure often have high plasma Atrial Natriuretic Factor (ANF) and neurohormonal activation. Ace inhibitors give clinical and hemodynamic benefits and lower plasma angiotensin and norepinephrine levels. The interactions between ANF and the Ace inhibitors are mainly modulated via the renin angiotensin system.
Plasma ANF, renin activity, urinary aldosterone and catecholamine levels were evaluated in 10 patients with congestive heart failure (at baseline, after 15 days of adequate treatment with digoxin and diuretics, and after 45 days of enalapril) in order to assess the changes of ANF and vasoconstrictor neurohormones with chronic Ace inhibitor therapy.
ANF increased significantly in the congestive heart failure group compared to a normal subject control group (P < 0.001). After digoxin and diuretic therapy NHYA class improved significantly, but no significant hormonal changes were found. On the contrary, the addition of enalapril caused a significant decrease of plasma ANF and urinary aldosterone and catecholamines (P < 0.05).
The relationship between the renin angiotensin system and catecholamines is complex but our findings indicate that: 1) Traditional therapy is effective in improving symptoms, but cannot induce a decrease of vasoconstrictive neurohormones; 2) ACE inhibitor therapy reduces ANF and neurohormonal activation. 3) ANF is a useful marker in evaluating the response to treatment.
重度充血性心力衰竭患者常有血浆心房利钠因子（ANF）升高及神经激素激活。血管紧张素转换酶抑制剂（Ace抑制剂）具有临床和血流动力学益处，并可降低血浆血管紧张素和去甲肾上腺素水平。ANF与Ace抑制剂之间的相互作用主要通过肾素-血管紧张素系统调节。
对10例充血性心力衰竭患者（在基线、用地高辛和利尿剂充分治疗15天后以及依那普利治疗45天后）的血浆ANF、肾素活性、尿醛固酮和儿茶酚胺水平进行评估，以评估慢性Ace抑制剂治疗时ANF和血管收缩神经激素的变化。
与正常受试者对照组相比，充血性心力衰竭组的ANF显著升高（P<0.001）。地高辛和利尿剂治疗后，纽约心脏协会（NHYA）心功能分级显著改善，但未发现激素有明显变化。相反，加用依那普利后，血浆ANF、尿醛固酮和儿茶酚胺显著降低（P<0.05）。
肾素-血管紧张素系统与儿茶酚胺之间的关系复杂，但我们的研究结果表明：1）传统治疗对改善症状有效，但不能使血管收缩神经激素降低；2）ACE抑制剂治疗可降低ANF和神经激素激活；3）ANF是评估治疗反应的有用标志物。
