Goldsmith S R
Hennepin County Medical Center, Cardiology Division, Minneapolis, Minnesota 55415.
J Am Coll Cardiol. 1992 May;19(6):1180-4. doi: 10.1016/0735-1097(92)90321-d.
Nonspecific baroreflex loading maneuvers such as head-down tilt readily suppress stimulated arginine vasopressin levels in normal humans. To test the hypothesis that the increased arginine vasopressin levels in patients with congestive heart failure would not respond normally to baroreflex loading, 12 patients with congestive heart failure had arginine vasopressin levels and osmolality determined in the supine position and after 15 min of 30 degrees head-down tilt. Arginine vasopressin was increased to 6.5 +/- 2.0 pg/ml at control measurement and did not decrease. Eight patients underwent further study after osmotic stimulation with mannitol. Mannitol increased osmolality from 287 +/- 9.2 to 294 +/- 7.8 mOsm/kg (p less than 0.001) and from 288 +/- 9 to 299 +/- 8.2 mOsm/kg (p less than 0.01) on two occasions. No significant suppression of arginine vasopressin was seen during head-down tilt after mannitol infusion compared with values in a time control period. These results are consistent with an abnormality in baroreflex suppression of arginine vasopressin secretion in chronic congestive heart failure and suggest that such a defect may contribute to long-term high levels of arginine vasopressin in this condition.
非特异性压力感受器反射负荷操作，如头低位倾斜，很容易抑制正常人受刺激后的精氨酸血管加压素水平。为了验证充血性心力衰竭患者精氨酸血管加压素水平升高对压力感受器反射负荷反应异常这一假说，对12例充血性心力衰竭患者测定了仰卧位及头低位倾斜30度15分钟后的精氨酸血管加压素水平和渗透压。对照测量时精氨酸血管加压素升至6.5±2.0 pg/ml，且未降低。8例患者在甘露醇渗透刺激后接受进一步研究。甘露醇两次使渗透压从287±9.2升高至294±7.8 mOsm/kg（p<0.001），从288±9升高至299±8.2 mOsm/kg（p<0.01）。与时间对照期的值相比，甘露醇输注后头低位倾斜期间精氨酸血管加压素未见明显抑制。这些结果与慢性充血性心力衰竭时压力感受器反射抑制精氨酸血管加压素分泌异常一致，并提示这种缺陷可能导致该疾病状态下精氨酸血管加压素长期处于高水平。
