Rubin D A, Uretsky B F, Zerbe T R, Estrada-Quintero T, Murali S
Department of Cardiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, PA 15213.
Am Heart J. 1994 Oct;128(4):769-73. doi: 10.1016/0002-8703(94)90275-5.
To determine whether elevated plasma atrial natriuretic peptide (ANP) levels observed after cardiac transplant are related to ventricular ANP expression and/or the severity of rejection, 59 ambulatory patients with cardiac transplant underwent hemodynamic evaluation, endomyocardial biopsy, and plasma ANP sampling. Forty-two of the 59 patients had right ventricular (RV) biopsy specimens immunohistochemically stained for the presence of ANP. Plasma ANP levels were elevated (p < 0.0001) in transplant patients (172 +/- 12 pg/ml) compared to normal subjects (36 +/- 4 pg/ml). Sixty-four percent of transplant patients showed stainable RV ANP on endomyocardial biopsy. There was no significant difference in plasma ANP levels between patients with or without RV ANP. The degree of RV staining did not correlate with plasma ANP levels, degree of rejection, mean atrial or systemic pressures, or specific immunosuppressive regimen. Plasma ANP levels were higher in patients with moderate or severe rejection (237 +/- 17 pg/ml) compared to patients with mild or no rejection (163 +/- 12 pg/ml; p 0.03), but there was significant overlap of values. These data suggest that ventricular ANP secretion may account for some of the increase in plasma ANP levels in cardiac transplant patients. However, increased plasma ANP levels in some transplant patients who have no RV ANP and the lack of correlation between the amount of stainable RV ANP and plasma ANP levels suggest that other mechanisms are also likely responsible for plasma ANP elevations in this setting.
为了确定心脏移植后观察到的血浆心房利钠肽（ANP）水平升高是否与心室ANP表达和/或排斥反应的严重程度相关，59例心脏移植门诊患者接受了血流动力学评估、心内膜心肌活检和血浆ANP采样。59例患者中有42例的右心室（RV）活检标本进行了ANP免疫组织化学染色。与正常受试者（36±4 pg/ml）相比，移植患者（172±12 pg/ml）的血浆ANP水平升高（p<0.0001）。64%的移植患者在心内膜心肌活检中显示可染色的RV ANP。有无RV ANP的患者血浆ANP水平无显著差异。RV染色程度与血浆ANP水平、排斥反应程度、平均心房或全身压力或特定免疫抑制方案均无相关性。与轻度或无排斥反应的患者（163±12 pg/ml；p=0.03）相比，中度或重度排斥反应的患者血浆ANP水平更高（237±17 pg/ml），但数值有显著重叠。这些数据表明，心室ANP分泌可能是心脏移植患者血浆ANP水平升高的部分原因。然而，一些没有RV ANP的移植患者血浆ANP水平升高，以及可染色的RV ANP量与血浆ANP水平之间缺乏相关性，表明其他机制也可能导致这种情况下的血浆ANP升高。
