Lourenço Patrícia, Araújo José Paulo, Azevedo Ana, Ferreira António, Bettencourt Paulo
Serviço de Medicina Interna, Hospital S. João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, 4202-451 Porto, Portugal.
Eur J Heart Fail. 2009 Feb;11(2):185-90. doi: 10.1093/eurjhf/hfn037.
Attenuation of the effects of natriuretic peptides has been demonstrated in animal models but studies in humans are scarce, particularly concerning renal attenuation. We investigated the attenuation of B-type natriuretic peptide (BNP) in chronic advanced heart failure (HF).
We included 62 outpatients with HF and severe left ventricular systolic dysfunction. Cases had at least one hospital admission or emergency department visit for acute HF in the previous year and were in NYHA class III/IV despite optimized therapy. The individual age- and sex-matched controls were symptomatically controlled (NYHA I and II). We collected 24 h urine and a blood sample from all patients. Plasma BNP and plasma (pcGMP) and urine cyclic guanosine monophosphate (ucGMP) were measured. Patients were followed for 3 months for hospital admission or all-cause death. ucGMP to plasma BNP (ucGMP/BNP) ratio was attenuated in cases vs. controls [median (IQR): 8354 (4293-16,456) vs. 12,693 (6896-22,851)]. There were no differences in pcGMP to BNP (pcGMP/BNP) ratio or urine cGMP excretion. Patients with worse outcome had lower pcGMP/BNP [260 (86-344) vs. 381 (244-728) in patients without adverse outcome events] and lower ucGMP/BNP [4146 (2207-9363) vs. 10,922 (7495-19,971)].
Renal NP's second messenger production is attenuated in advanced HF. Patients with worse outcome have lower ucGMP/BNP and pcGMP/BNP ratios.
利钠肽作用的减弱在动物模型中已得到证实，但人类研究较少，尤其是关于肾脏减弱方面。我们研究了慢性晚期心力衰竭（HF）中B型利钠肽（BNP）的减弱情况。
我们纳入了62例患有HF且左心室收缩功能严重障碍的门诊患者。这些病例在过去一年中至少因急性HF入院或到急诊科就诊一次，尽管接受了优化治疗，但仍处于纽约心脏协会（NYHA）III/IV级。年龄和性别匹配的个体对照症状得到控制（NYHA I和II级）。我们收集了所有患者的24小时尿液和血液样本。测量了血浆BNP、血浆（pcGMP）和尿环磷酸鸟苷（ucGMP）。对患者进行了3个月的随访，观察其是否入院或全因死亡。与对照组相比，病例组中ucGMP与血浆BNP的比值（ucGMP/BNP）减弱[中位数（四分位间距）：8354（4293 - 16456）对12693（6896 - 22851）]。pcGMP与BNP的比值（pcGMP/BNP）或尿cGMP排泄量无差异。预后较差的患者pcGMP/BNP较低[无不良结局事件的患者中为260（86 - 344）对381（244 - 728）]，ucGMP/BNP也较低[4146（2207 - 9363）对10922（7495 - 19971）]。
晚期HF中肾脏NP的第二信使生成减弱。预后较差的患者ucGMP/BNP和pcGMP/BNP比值较低。
