Goldsmith S R, Francis G S, Levine T B, Cowley A W, Cohn J N
J Am Coll Cardiol. 1983 Dec;2(6):1080-3. doi: 10.1016/s0735-1097(83)80333-7.
Arginine vasopressin, a potent vasoconstrictor and regulator of body water, is frequently increased in the plasma of patients with congestive heart failure. Other neurohumoral control networks, such as the sympathetic nervous system and the renin-angiotensin system, also demonstrate increased activity in congestive heart failure, but fail to respond normally to physiologic stress, such as orthostatic tilt. To assess the response of plasma vasopressin to orthostasis in heart failure, vasopressin was measured before and at 10 and 45 minutes during passive upright tilt in 15 patients with congestive heart failure and their response was compared with that in 9 normal control subjects. Arginine vasopressin was measured by radioimmunoassay. In the normal subjects, plasma arginine vasopressin was 5.3 +/- 2.3 pg/ml at control, was unchanged at 10 minutes, but significantly increased to 7.0 +/- 2.5 pg/ml at 45 minutes (p less than 0.05). In contrast, patients with congestive heart failure showed no significant changes in arginine vasopressin levels from the control levels of 11.6 +/- 5.5 pg/ml. Both plasma norepinephrine and renin activity increased in the normal subjects, but failed to increase from higher baselines in patients with congestive heart failure. Thus, plasma arginine vasopressin, like plasma norepinephrine and renin activity, does not increase in response to upright tilt in patients with congestive heart failure. The explanation is not evident but could involve either abnormalities in reflex control of plasma vasopressin in congestive heart failure or in clearance of the hormone during orthostasis.
精氨酸加压素是一种强效血管收缩剂和身体水分调节剂，在充血性心力衰竭患者的血浆中常常升高。其他神经体液控制网络，如交感神经系统和肾素 - 血管紧张素系统，在充血性心力衰竭时也表现出活性增加，但对诸如直立倾斜等生理应激不能正常反应。为了评估心力衰竭患者血浆加压素对直立位的反应，对15例充血性心力衰竭患者在被动直立倾斜前、倾斜10分钟和45分钟时测量了加压素，并将其反应与9名正常对照受试者的反应进行了比较。精氨酸加压素通过放射免疫测定法测量。在正常受试者中，对照时血浆精氨酸加压素为5.3±2.3 pg/ml，10分钟时未改变，但在45分钟时显著增加至7.0±2.5 pg/ml（p<0.05）。相比之下，充血性心力衰竭患者的精氨酸加压素水平与对照水平11.6±5.5 pg/ml相比无显著变化。正常受试者血浆去甲肾上腺素和肾素活性均增加，但充血性心力衰竭患者未从较高基线水平升高。因此，与血浆去甲肾上腺素和肾素活性一样，充血性心力衰竭患者血浆精氨酸加压素在直立倾斜时不增加。其原因尚不清楚，但可能涉及充血性心力衰竭时血浆加压素反射控制异常或直立位时激素清除异常。
