Ishikura F, Nagata S, Akaike M, Tamai J, Miyatake K
Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Am J Cardiol. 1991 Jan 1;67(1):74-8. doi: 10.1016/0002-9149(91)90103-r.
To clarify the factors that influenced the secretion of human atrial natriuretic peptide (ANP) during exercise, we studied the relations between the changes in ANP, transmitral pressure gradient, heart rate and blood pressure at exercise in 16 patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, ANP levels increased from 107 +/- 70 to 183 +/- 96 pg/ml during exercise testing (p less than 0.01), concomitant with the increment in mean transmitral pressure gradient, heart rate and systolic blood pressure. After PTMC, ANP levels also increased from 78 +/- 43 to 117 +/- 64 pg/ml, concomitant with the increment of those parameters. However, increments of ANP, mean transmitral pressure gradient and heart rate after PTMC were lower than those before PTMC. Because the most important factor influencing the secretion of ANP was unclear, the differences between these parameters were calculated at submaximal exercise before and after PTMC. There was a significant relation only between the change in ANP and mean transmitral pressure gradient (r = 0.70, p less than 0.01). These results suggest that the most important factor influencing the secretion of ANP during exercise is the change in transmitral pressure gradient in patients with mitral stenosis.
为了阐明运动期间影响人心房利钠肽（ANP）分泌的因素，我们研究了16例二尖瓣狭窄患者在经皮经静脉二尖瓣交界切开术（PTMC）前后运动时ANP变化、跨二尖瓣压力梯度、心率和血压之间的关系。在PTMC前，运动试验期间ANP水平从107±70 pg/ml增加到183±96 pg/ml（p<0.01），同时平均跨二尖瓣压力梯度、心率和收缩压增加。PTMC后，ANP水平也从78±43 pg/ml增加到117±64 pg/ml，同时这些参数也增加。然而，PTMC后ANP、平均跨二尖瓣压力梯度和心率的增加低于PTMC前。由于影响ANP分泌的最重要因素尚不清楚，因此在PTMC前后次极量运动时计算这些参数之间的差异。仅ANP变化与平均跨二尖瓣压力梯度之间存在显著关系（r = 0.70，p<0.01）。这些结果表明，二尖瓣狭窄患者运动期间影响ANP分泌的最重要因素是跨二尖瓣压力梯度的变化。
