Department of Medicine, University of Tennessee Health Science Center, College of Medicine, 956 Court Ave, Memphis, TN 38163, USA.
Veterans Administration Medical Center, Memphis, TN 38163, USA.
Biomed Res Int. 2018 Jul 26;2018:7279036. doi: 10.1155/2018/7279036. eCollection 2018.
In patients with reduced systolic function, the natriuretic peptide system affects heart failure (HF) progression, but the expression of key activating (corin) and degrading enzymes (neprilysin) is not well understood.
This pilot study (n=48) compared plasma levels of corin, neprilysin, ANP, BNP, and cGMP in control patients with normal ejection fractions (mean EF 63 ± 3%) versus patients with systolic dysfunction, with (EF 24 ± 8%) and without (EF 27 ± 7%) decompensated HF (dHF), as defined by Framingham and BNP criteria. Mean ages, use of beta blockers, and ACE-inhibitors-angiotensin receptor blockers were similar between the groups. Corin levels were depressed in systolic dysfunction patients (797 ± 346 pg/ml) versus controls (1188 ± 549, p<0.02), but levels were not affected by dHF (p=0.77). In contrast, levels of neprilysin (p<0.01), cGMP (p<0.001), and ANP (p<0.001) were higher in systolic dysfunction patients than controls and were the highest in patients with dHF.
Levels of neprilysin, ANP, BNP, and cGMP increased in patients with reduced systolic function and were the highest in dHF patients. Conversely, corin levels were low in patients with reduced EF with or without dHF. This pattern suggests possible enzymatic downregulation of natriuretic peptide activity in patients with reduced EF, which may have diagnostic and prognostic implications.
在收缩功能降低的患者中，利钠肽系统会影响心力衰竭（HF）的进展，但关键的激活酶（心钠肽酶原）和降解酶（脑啡肽酶）的表达还不太清楚。
这项初步研究（n=48）比较了心钠肽酶原、脑啡肽酶、ANP、BNP 和 cGMP 的血浆水平，包括射血分数正常的对照组（平均 EF 63±3%）和收缩功能障碍患者，以及射血分数（EF）为 24±8%（伴有失代偿性 HF [dHF]）和 27±7%（不伴有 dHF）的患者。各组之间的平均年龄、β受体阻滞剂和 ACE 抑制剂-血管紧张素受体阻滞剂的使用情况相似。与对照组（1188±549 pg/ml）相比，收缩功能障碍患者的心钠肽酶原水平较低（797±346 pg/ml）（p<0.02），但不受 dHF 的影响（p=0.77）。相比之下，收缩功能障碍患者的脑啡肽酶（p<0.01）、cGMP（p<0.001）和 ANP（p<0.001）水平高于对照组，dHF 患者最高。
收缩功能降低的患者中，脑啡肽酶、ANP、BNP 和 cGMP 的水平升高，dHF 患者最高。相反，EF 降低的患者中，心钠肽酶原水平较低，无论是否伴有 dHF。这种模式表明，EF 降低的患者中利钠肽活性的酶促下调可能具有诊断和预后意义。
