Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany.
J Perinat Med. 2011 Sep;39(5):529-37. doi: 10.1515/jpm.2011.065.
To determine if changes in natriuretic peptide levels [propeptide of atrial natriuretic peptide (proANP) and N-terminal propeptide of brain natriuretic peptide (NT-proBNP)] can be demonstrated in fetuses with serious growth restriction and Doppler ultrasonographic findings of hemodynamic compromise.
Natriuretic peptides of the umbilical vein (proANP and NT-proBNP), arterial and venous blood gases, as well as lactate levels of the umbilical vein were determined in 38 appropriate for gestational age (AGA) fetuses, and 24 intrauterine growth-restricted (IUGR) fetuses with absent (zero-flow) and 17 IUGR fetuses with reversed end-diastolic flow (reverse-flow) of the umbilical artery.
A continuous increase in natriuretic peptides in the presence of progressive deterioration was shown. ANP concentrations were significantly lower in the AGA group (mean 818 fmol/mL; range 508-991 fmol/mL) than the zero-flow group (mean 19,680 fmol/mL; range 13,680-25,080 fmol/mL) and the reverse-flow group (mean 33,880 fmol/mL; range 24,365-41,786 fmol/mL). Significant differences were further demonstrated in BNP concentrations of the AGA group (mean 32 fmol/L; range 25-38 fmol/L), zero-flow group (mean 1191 fmol/L; range 908-1655 fmol/L), and reverse-flow group (mean 3063 fmol/L; range 1281-4968 fmol/L). Additionally, significant differences in lactate concentrations were observed for the three groups: AGA, 2.6 mmol/L (range 2-3 mmol/L); zero-flow group, 4.1 mmol/L (range 3.3-5 mmol/L); and reverse-flow group, 7.7 mmol/L (range 5.9-13.7 mmol/L). Increased ANP levels correlated with the arterial base excess and lactate concentrations, as well as with the flow velocities in the ductus venosus during atrial contraction (a-wave), and both ductus venosus indices (S-a)/D and (S-a)/V(mean). No correlations were established for BNP.
As components of a compensatory mechanism, natriuretic peptides exert an influence on the cardiovascular function of the fetus.
确定严重生长受限胎儿及存在血流动力学障碍多普勒超声表现的胎儿能否检测到利钠肽水平（心钠肽前体（proANP）和脑钠肽 N 端前体（NT-proBNP））的变化。
对 38 例适于胎龄（AGA）胎儿和 24 例宫内生长受限（IUGR）胎儿（其中脐动脉无血流（零流）17 例，脐动脉反向舒张末期血流（反向流）17 例）的脐静脉（proANP 和 NT-proBNP）、动静脉血气及脐静脉血乳酸水平进行了测定。
研究表明，随着病情的恶化，利钠肽水平持续升高。AGA 组（818 皮摩尔/毫升；508-991 皮摩尔/毫升）的 ANP 浓度显著低于零流组（19680 皮摩尔/毫升；13680-25080 皮摩尔/毫升）和反向流组（33880 皮摩尔/毫升；24365-41786 皮摩尔/毫升）。AGA 组（32 皮摩尔/升；25-38 皮摩尔/升）、零流组（1191 皮摩尔/升；908-1655 皮摩尔/升）和反向流组（3063 皮摩尔/升；1281-4968 皮摩尔/升）的 BNP 浓度也有显著差异。三组的乳酸浓度也有显著差异：AGA 组为 2.6mmol/L（2-3mmol/L）；零流组为 4.1mmol/L（3.3-5mmol/L）；反向流组为 7.7mmol/L（5.9-13.7mmol/L）。ANP 水平升高与动脉碱剩余和乳酸浓度以及心房收缩时的静脉导管血流速度（a 波）和静脉导管指数（S-a）/D 和（S-a）/Vmean 相关。未发现 BNP 与上述指标相关。
作为一种代偿机制的组成部分，利钠肽对胎儿心血管功能产生影响。
