Raine A E, Erne P, Bürgisser E, Müller F B, Bolli P, Burkart F, Bühler F R
N Engl J Med. 1986 Aug 28;315(9):533-7. doi: 10.1056/NEJM198608283150901.
To define the relation between atrial pressures and the release of atrial natriuretic peptide, we measured plasma concentrations of the peptide in 26 patients with cardiac disease--11 with normal atrial pressures and 15 with elevated atrial pressures (11 of these 15 had elevated pressures in both atria). Mean peptide levels (+/- SEM) in the peripheral venous blood were increased in the 11 patients with cardiac disease and normal atrial pressures, as compared with 60 healthy controls (48 +/- 14 vs. 17 +/- 2 pmol per liter). In the patients with elevated atrial pressures, peptide concentrations were increased twofold in peripheral venous, right atrial, pulmonary arterial, and systemic arterial plasma, as compared with the concentrations in the patients with normal atrial pressures. A step-up in peptide concentration was seen between the venous and right atrial plasma (P less than 0.002) and between the pulmonary and systemic arterial plasma (P less than 0.01), suggesting release of the peptide from the atria. A linear relation was found between right atrial pressure and right atrial peptide concentration (r = 0.835, P less than 0.001) and between pulmonary wedge pressure and the systemic arterial peptide concentration (r = 0.866, P less than 0.001). Right atrial pressure and the peptide concentration both increased with exercise testing in the nine patients evaluated. We conclude that the release of atrial natriuretic peptide is at least partly regulated by right and left atrial pressures. Distinguishing the relative contributions of the two atria and defining the role of peptide release in the pathogenesis of heart failure will require further investigation.
为了确定心房压力与心房利钠肽释放之间的关系，我们测定了26例心脏病患者血浆中该肽的浓度，其中11例心房压力正常，15例心房压力升高（这15例中有11例双侧心房压力升高）。与60名健康对照者相比，11例心房压力正常的心脏病患者外周静脉血中的平均肽水平（±标准误）升高（分别为48±14和17±2 pmol/L）。心房压力升高的患者外周静脉、右心房、肺动脉和体动脉血浆中的肽浓度与心房压力正常的患者相比增加了两倍。在静脉血与右心房血浆之间（P<0.002）以及肺动脉与体动脉血浆之间（P<0.01）观察到肽浓度升高，提示该肽从心房释放。发现右心房压力与右心房肽浓度之间呈线性关系（r=0.835，P<0.001），肺楔压与体动脉肽浓度之间也呈线性关系（r=0.866，P<0.001）。在接受评估的9例患者中，运动试验时右心房压力和肽浓度均升高。我们得出结论，心房利钠肽的释放至少部分受左右心房压力调节。区分两个心房的相对作用以及确定肽释放在心力衰竭发病机制中的作用需要进一步研究。
