左心房直径是二尖瓣狭窄患者心房利钠肽分泌不足的一个简单指标：术后补充合成人α-心房利钠肽的疗效

Left atrial diameter is a simple indicator of a deficiency in atrial natriuretic peptide secretion in patients with mitral stenosis: efficacy of postoperative supplementation with synthetic human alpha-atrial natriuretic peptide.

作者信息

Hayashi Yoshitaka, Ohtani Masakatsu, Sawa Yoshiki, Hiraishi Taizo, Kobayashi Yasuhiko, Matsuda Hikaru

机构信息

Division of Cardiovascular Surgery, Osaka Minami National Hospital, Kawachinagano City, Osaka, Japan.

出版信息

J Cardiovasc Pharmacol. 2004 Dec;44(6):709-17. doi: 10.1097/00005344-200412000-00014.

DOI:10.1097/00005344-200412000-00014

PMID:15550792

Abstract

OBJECTIVE

With regard to a deficiency in atrial natriuretic peptide (ANP) secretion, the relationship between plasma ANP and left atrial diameter measured by echocardiography was examined and the efficacy of postoperative supplementation was evaluated.

METHODS

(1) Ninety-six patients with mitral valve disease from 1997 to 2002 (M:F = 65:31, mean-age 65.3 +/- 8.9 years) were studied for relationship analyses. (2) Twenty-six patients with mitral stenosis and left atrial diameter > or = 60 mm undergoing mitral valve replacement (M:F = 17:9, mean-age 67.4 +/- 7.5 years) were randomly allocated to one of two groups; ANP-treated group (n = 13, 0.05 microg/kg/min of synthetic human alpha-ANP was postoperatively administered) and Control group (n = 13).

RESULTS

(1) There were significant positive correlations between left atrial diameter and plasma renin-activity (r = 0.690, P < 0.01) and between left atrial diameter and plasma aldosterone (r = 0.757, P < 0.01). The maximum value of plasma ANP was 249.5 pg/mL accompanied with 56.2 mm of left atrial diameter in 29 patients suffering from mitral stenosis. There was a significant negative correlation between left atrial diameter and ANP in patients with left atrial diameter > 56.2 mm (r = - 0.725, P < 0.0001), whereas there was a significant positive correlation in patients with left atrial diameter < or = 56.2 mm (r = 0.529, P = 0.0066). (2) At 24 hours after operation, the ANP-treated group showed significantly lower plasma renin-activity (9.2 +/- 3.3 versus 36.2 +/- 7.4 ng/mL/h) and aldosterone (113.6 +/- 36.9 versus 473.8 +/- 95.8 pg/mL) than the Control group.

CONCLUSIONS

Left atrial diameter can be a simple and useful indicator of a deficiency in endogenous ANP secretion in patients with mitral stenosis, and postoperative ANP supplementation contributes to suppressing further activation of renin-angiotensin system during the immediate postoperative period.

摘要

目的

针对心房利钠肽（ANP）分泌不足的情况，研究血浆ANP与经超声心动图测量的左心房直径之间的关系，并评估术后补充ANP的疗效。

方法

（1）对1997年至2002年的96例二尖瓣疾病患者（男:女 = 65:31，平均年龄65.3±8.9岁）进行关系分析研究。（2）将26例二尖瓣狭窄且左心房直径≥60 mm并接受二尖瓣置换术的患者（男:女 = 17:9，平均年龄67.4±7.5岁）随机分为两组；ANP治疗组（n = 13，术后给予0.05 μg/kg/min的合成人α-ANP）和对照组（n = 13）。

结果

（1）左心房直径与血浆肾素活性之间存在显著正相关（r = 0.690，P < 0.01），左心房直径与血浆醛固酮之间也存在显著正相关（r = 0.757，P < 0.01）。29例二尖瓣狭窄患者血浆ANP的最大值为249.5 pg/mL，此时左心房直径为56.2 mm。左心房直径>56.2 mm的患者中，左心房直径与ANP之间存在显著负相关（r = - 0.725，P < 0.0001），而左心房直径≤56.2 mm的患者中存在显著正相关（r = 0.529，P = 0.0066）。（2）术后24小时，ANP治疗组的血浆肾素活性（9.2±3.3对36.2±7.4 ng/mL/h）和醛固酮（113.6±36.9对473.8±95.8 pg/mL）显著低于对照组。