Kuznetsova Tatiana, Manunta Paolo, Casamassima Nunnzia, Messaggio Elisabetta, Jin Yu, Thijs Lutgarde, Richart Tom, Fagard Robert H, Bianchi Giuseppe, Staessen Jan A
Studies Coordinating Centre, Department of Cardiovascular Diseases, University of Leuven, Belgium.
J Hypertens. 2009 Sep;27(9):1884-91. doi: 10.1097/HJH.0b013e32832e49a8.
Endogenous ouabain, an endogenous digitalis-like steroid, is synthesized in the adrenal glands and possibly in the hypothalamus. In vitro and in vivo, endogenous ouabain triggers growth and proliferation of cardiomyocytes.
We therefore investigated the association between left ventricular structure and function and plasma endogenous ouabain in a general population.
We randomly recruited 536 individuals from a general population (50.7% women, mean age 53.1 years). Measurements included echocardiographic left ventricular structure and function, blood pressure, plasma endogenous ouabain, and the 24-h urinary excretion of sodium.
The geometric mean plasma endogenous ouabain was 95.5 pmol/l (interquartile range 79.4-120.2 pmol/l). We expressed effect sizes for a 1-SD increase in plasma endogenous ouabain (0.21 on the logarithmic scale), while accounting for important covariables. For a 1-SD increment in plasma endogenous ouabain, SBP, left ventricular posterior wall, the interventricular septum, and relative wall thickness increased by 1.59 mmHg (P = 0.009), 0.138 mm (P = 0.003), 0.152 mm (P = 0.013), and 0.71 x 10 (P = 0.008), respectively. In a sensitivity analysis, involving 431 individuals aged 29-71 years (10-90th percentile interval), a 1-SD increase in plasma endogenous ouabain was associated with opposite trends in ejection fraction (+0.90%, P = 0.005) and left ventricular systolic longitudinal strain (-0.48%, P = 0.011). Moreover, in individuals whose sodium excretion was above median (160 mmol/24 h), the aforementioned associations reached a higher level of statistical significance.
Our population-based study suggested that endogenous ouabain might have a trophic effect on the myocardium, independent of blood pressure and other covariables. The clinical implication of these findings remains to be elucidated.
内源性哇巴因是一种内源性类洋地黄甾体，在肾上腺以及可能在下丘脑合成。在体外和体内，内源性哇巴因均可触发心肌细胞的生长和增殖。
因此，我们在普通人群中研究了左心室结构和功能与血浆内源性哇巴因之间的关联。
我们从普通人群中随机招募了536名个体（女性占50.7%，平均年龄53.1岁）。测量指标包括超声心动图测定的左心室结构和功能、血压、血浆内源性哇巴因以及24小时尿钠排泄量。
血浆内源性哇巴因的几何平均值为95.5 pmol/l（四分位间距为79.4 - 120.2 pmol/l）。我们在考虑重要协变量的情况下，对血浆内源性哇巴因增加1个标准差（对数尺度上为0.21）的效应量进行了表达。血浆内源性哇巴因每增加1个标准差，收缩压、左心室后壁、室间隔和相对壁厚分别增加1.59 mmHg（P = 0.009）、0.138 mm（P = 0.003）、0.152 mm（P = 0.013）和0.71×10（P = 0.008）。在一项涉及431名年龄在29 - 71岁（第10 - 90百分位数区间）个体的敏感性分析中，血浆内源性哇巴因增加1个标准差与射血分数（+0.90%，P = 0.005）和左心室收缩期纵向应变（-0.48%，P = 0.011）的相反趋势相关。此外，在尿钠排泄量高于中位数（160 mmol/24 h）的个体中，上述关联达到了更高的统计学显著性水平。
我们基于人群的研究表明，内源性哇巴因可能对心肌具有营养作用，独立于血压和其他协变量。这些发现的临床意义仍有待阐明。
