Hung J S, Fu M, Cherng W J, Inoue K, Tsai R C, Ishibashi M, Yamaji T
Department of Medicine, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Am Heart J. 1989 Feb;117(2):381-5. doi: 10.1016/0002-8703(89)90783-7.
To determine whether an acute fall in atrial pressure decreases the secretion of atrial natriuretic peptide in man, changes in the plasma levels of this peptide were studied after catheter balloon valvuloplasty of the mitral valve. Ten patients with severe mitral stenosis were included in the study. The valvuloplasty resulted in an immediate reduction in left atrial pressure and an increase in the mitral valve area. Decreases in right atrial pressure were inconsistent and less significant. Plasma atrial natriuretic peptide levels, which were elevated before the valvuloplasty, decreased significantly in all 10 patients at 15 minutes after the valvuloplasty and reached lower plateaus at 30, 45, and 60 minutes after the procedure. In the seven patients studied for a longer period, both plasma atrial natriuretic peptide levels and the left atrial pressure remained reduced 24 hours after the valvuloplasty. Plasma atrial natriuretic peptide levels before and 30 to 60 minutes after the valvuloplasty were positively correlated to simultaneously determined left and right atrial pressures. These results indicate that atrial stretch caused by increased atrial pressure is an important stimulus for atrial natriuretic peptide release in man. "De-stretching" of the myocytes of the atria results in rapid inhibition of atrial natriuretic peptide secretion.
为了确定心房压力的急性下降是否会减少人体心房利钠肽的分泌，在二尖瓣导管球囊瓣膜成形术后研究了该肽血浆水平的变化。本研究纳入了10例重度二尖瓣狭窄患者。瓣膜成形术导致左心房压力立即降低，二尖瓣面积增加。右心房压力的降低并不一致且不太显著。瓣膜成形术前升高的血浆心房利钠肽水平，在瓣膜成形术后15分钟时，所有10例患者均显著下降，并在术后30、45和60分钟达到较低平台期。在研究时间更长的7例患者中，瓣膜成形术后24小时，血浆心房利钠肽水平和左心房压力均持续降低。瓣膜成形术前以及术后30至60分钟的血浆心房利钠肽水平与同时测定的左、右心房压力呈正相关。这些结果表明，心房压力升高引起的心房牵张是人体心房利钠肽释放的重要刺激因素。心房肌细胞的“去牵张”导致心房利钠肽分泌迅速受到抑制。
