Riegger A J
Medizinischen Universitätsklinik Würzburg.
Arzneimittelforschung. 1988 Mar;38(3A):479-83.
The role of atrial natriuretic peptide in the pathophysiology of heart failure is unknown. The aim of the study were changes of atrial natriuretic peptide, hemodynamic, renal and hormonal parameters during the development of cardiac failure in an animal model of congestive heart failure in the conscious dog due to rapid right ventricular pacing and in rats with chronic left ventricular failure due to a left ventricular infarction. The effects of intravenous administration of atrial natriuretic peptide were studied in patients with severe congestive heart failure, dogs with experimental cardiomyopathy and conscious rats with acute right ventricular failure due to repeated pulmonary emboli. The results suggest an important role of atrial natriuretic peptide in the early phase of heart failure as a counterregulating system concerning vasoconstrictory and volume retaining mechanisms like the renin-angiotensin-aldosterone system, the sympathetic nerve activity and vasopressin. In chronic heart failure the renal effects of atrial natriuretic peptide are attenuated. Pharmacological doses have beneficial effects on ventricular function by reducing pre- and afterload. The reduction in effectiveness of atrial natriuretic peptide in congestive heart failure may be due to a down-regulation of specific receptors, or caused by hemodynamic renal changes preventing the action of the hormone on the kidney in heart failure or may be due to an activation of counterregulating systems overridding the effects of atrial natriuretic peptide.
心房利钠肽在心力衰竭病理生理学中的作用尚不清楚。本研究的目的是观察清醒犬因快速右心室起搏导致充血性心力衰竭的动物模型以及左心室梗死所致慢性左心室衰竭大鼠在心力衰竭发展过程中，心房利钠肽、血流动力学、肾脏及激素参数的变化。研究了静脉注射心房利钠肽对重度充血性心力衰竭患者、实验性心肌病犬以及因反复肺栓塞导致急性右心室衰竭的清醒大鼠的影响。结果表明，心房利钠肽在心力衰竭早期作为一种反调节系统发挥重要作用，涉及肾素 - 血管紧张素 - 醛固酮系统、交感神经活动和血管加压素等血管收缩和容量维持机制。在慢性心力衰竭中，心房利钠肽的肾脏效应减弱。药理剂量通过降低前负荷和后负荷对心室功能产生有益影响。充血性心力衰竭时心房利钠肽有效性降低可能是由于特异性受体下调，或因血流动力学和肾脏变化阻止了该激素在心力衰竭时对肾脏的作用，也可能是由于反调节系统的激活抵消了心房利钠肽的作用。
