Rosenfeld J V, Barnett G H, Sila C A, Little J R, Bravo E L, Beck G J
Neurosurgical Intensive Care Unit, Cleveland Clinic Foundation, Ohio.
J Neurosurg. 1989 Jul;71(1):32-7. doi: 10.3171/jns.1989.71.1.0032.
Atrial natriuretic factor (ANF) is a diuretic natriuretic peptide hormone produced by both the heart and brain which has been postulated to play a role in the hemodynamic and sodium instability that frequently follows subarachnoid hemorrhage (SAH). Levels of ANF were measured in 12 patients with nontraumatic SAH and nine control patients with unruptured cerebral aneurysms. At surgery, the mean plasma ANF level (+/- standard deviation) of the SAH group was significantly higher than that of the control group (158.1 +/- 83.8 vs. 57.8 +/- 45.3 pg/ml, respectively; p = 0.01). There was no significant difference in serum sodium concentration, blood pressure, or central venous pressure between these groups. Nine patients with SAH due to aneurysm rupture had plasma ANF levels similar to those in three patients with SAH due to other causes. Four patients with moderate to severe SAH had significantly higher mean cerebrospinal fluid (CSF) ANF values (17.7 +/- 12.8 pg/ml) than five patients with minimal SAH (0.6 +/- 0.9 pg/ml) or the control group of nine patients (3.7 +/- 1.3 pg/ml) (p less than 0.05). Five patients with moderate to severe SAH had significantly higher plasma ANF values (202.6 +/- 72.2 pg/ml) than five with minimal SAH (86.8 +/- 29.2 pg/ml) or the control group (57.8 +/- 45.3 pg/ml) (p less than 0.05). Plasma ANF values were substantially higher than CSF ANF content in the SAH group (p less than 0.01) and in the control group (p = 0.05). From these data it is concluded that: 1) plasma ANF is elevated significantly after SAH; 2) this rise appears unrelated to the cause of hemorrhage, serum sodium concentration, blood pressure, or central venous pressure, but is related to the extent of the hemorrhage; 3) ANF concentrations in the CSF are significantly lower than in plasma, and are elevated after moderate to severe SAH; and 4) the source of CSF ANF is probably the plasma, and the source of plasma ANF is likely the heart.
心房利钠因子（ANF）是一种由心脏和大脑产生的利尿排钠肽激素，据推测它在蛛网膜下腔出血（SAH）后常见的血流动力学和钠稳态失衡中发挥作用。对12例非创伤性SAH患者和9例未破裂脑动脉瘤对照患者的ANF水平进行了测量。手术时，SAH组的平均血浆ANF水平（±标准差）显著高于对照组（分别为158.1±83.8与57.8±45.3 pg/ml；p = 0.01）。这些组之间的血清钠浓度、血压或中心静脉压无显著差异。9例因动脉瘤破裂导致SAH的患者血浆ANF水平与3例因其他原因导致SAH的患者相似。4例中度至重度SAH患者的平均脑脊液（CSF）ANF值（17.7±12.8 pg/ml）显著高于5例轻度SAH患者（0.6±0.9 pg/ml）或9例对照组患者（3.7±1.3 pg/ml）（p＜0.05）。5例中度至重度SAH患者的血浆ANF值（202.6±72.2 pg/ml）显著高于5例轻度SAH患者（86.8±29.2 pg/ml）或对照组（57.8±45.3 pg/ml）（p＜0.05）。SAH组和对照组中血浆ANF值均显著高于CSF ANF含量（SAH组p＜0.01，对照组p = 0.05）。从这些数据得出以下结论：1）SAH后血浆ANF显著升高；2）这种升高似乎与出血原因、血清钠浓度、血压或中心静脉压无关，但与出血程度有关；3）CSF中ANF浓度显著低于血浆，且在中度至重度SAH后升高；4）CSF ANF的来源可能是血浆，血浆ANF的来源可能是心脏。
