Leunissen K M, Menheere P P, Cheriex E C, van den Berg B W, Noordzij T C, van Hooff J P
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Nephrol Dial Transplant. 1989;4(5):382-6. doi: 10.1093/oxfordjournals.ndt.a091894.
The relationship between inferior vena cava diameter (VCD), collapse-index (CI) determined by echography, and alpha-human atrial natriuretic peptide (alpha-h-ANP) concentrations were studied in 19 chronic haemodialysis patients. A significant correlation was found between VCD and alpha-h-ANP before dialysis (r = 0.78; P less than 0.0001). No such correlation was found between CI, left atrial diameter and left ventricular end-diastolic diameter, and alpha-h-ANP values. In nine patients who according to vena cava indices were hypervolaemic before dialysis (group I), alpha-h-ANP concentrations were significantly greater than in ten normo- or hypovolaemic patients (group II): 392.8 +/- 134.1 pg/ml and 168.0 +/- 62.5 pg/ml respectively. Although the same amount of fluid was ultrafiltrated in both groups, alpha-h-ANP decreased significantly in group I only, whereas in group II the decrease was not significant: 392.8 +/- 134.1 to 185.2 +/- 81.7 (P less than 0.001); 168.0 +/- 62.5 to 130.0 +/- 59 respectively. After achieving normovolaemia alpha-h-ANP concentrations in patients with a mitral valve insufficiency grade I was doubled compared to normovolaemic patients without mitral valve insufficiency, suggesting that alpha-h-ANP release will also occur from the left atrium. In the latter group alpha-h-ANP values were approximately doubled compared to healthy controls. The highly significant correlation between VCD before dialysis and changes in alpha-h-ANP during dialysis with fluid removal underlines the value of vena cava diameter in estimating volume status.
在19例慢性血液透析患者中研究了下腔静脉直径（VCD）、超声心动图测定的塌陷指数（CI）与α-人心房利钠肽（α-h-ANP）浓度之间的关系。透析前VCD与α-h-ANP之间存在显著相关性（r = 0.78；P < 0.0001）。CI、左心房直径和左心室舒张末期直径与α-h-ANP值之间未发现此类相关性。在9例根据腔静脉指标在透析前血容量过多的患者（I组）中，α-h-ANP浓度显著高于10例血容量正常或血容量不足的患者（II组）：分别为392.8±134.1 pg/ml和168.0±62.5 pg/ml。尽管两组超滤的液体量相同，但仅I组的α-h-ANP显著下降，而II组的下降不显著：分别从392.8±134.1降至185.2±81.7（P < 0.001）；从168.0±62.5降至130.0±59。在达到血容量正常后，I级二尖瓣关闭不全患者的α-h-ANP浓度是无二尖瓣关闭不全的血容量正常患者的两倍，这表明α-h-ANP也将从左心房释放。在后一组中，α-h-ANP值比健康对照者大约增加一倍。透析前VCD与透析期间液体清除时α-h-ANP变化之间的高度显著相关性强调了腔静脉直径在评估容量状态方面的价值。
