Yasue H, Yoshimura M, Sumida H, Kikuta K, Kugiyama K, Jougasaki M, Ogawa H, Okumura K, Mukoyama M, Nakao K
Division of Cardiology, Kumamoto University School of Medicine, Japan.
Circulation. 1994 Jul;90(1):195-203. doi: 10.1161/01.cir.90.1.195.
B-type or brain natriuretic peptide (BNP) is a novel natriuretic peptide secreted from the heart that forms a peptide family with A-type or atrial natriuretic peptide (ANP), and its plasma level has been shown to be increased in patients with congestive heart failure. This study was designed to examine the sources and mechanisms of the secretion of BNP in comparison with those of ANP in control subjects and in patients with heart failure.
We measured the plasma levels of BNP as well as ANP in 16 patients with dilated cardiomyopathy (11 men and 5 women; mean age, 59 years) and 18 control subjects (9 men and 9 women; mean age, 54 years) by sampling blood from the femoral vein, the aortic root, the anterior interventricular vein (AIV), and the coronary sinus using the newly developed immunoradiometric assay systems. In the control subjects, there was no significant difference in the plasma ANP level between the aortic root and the AIV (24.0 +/- 5.2 pg/mL versus 32.2 +/- 17.0 pg/mL), but there was a highly significant step-up of the level between the AIV and the coronary sinus (32.2 +/- 17.0 pg/mL versus 371.4 +/- 111.1 pg/mL, P < .001). In contrast, there was a significant step-up of the plasma BNP level between the aortic root and the AIV (8.6 +/- 6.4 pg/mL versus 19.0 +/- 11.5 pg/mL, P < .01) but not between the AIV and the coronary sinus (19.0 +/- 11.5 pg/mL versus 28.8 +/- 14.0 pg/mL). On the other hand, in patients with dilated cardiomyopathy, there was a significant step-up in the plasma ANP level between the aortic root and the AIV (280.6 +/- 183.7 pg/mL versus 612.3 +/- 431.6 pg/mL, P < .01) and between the AIV and the coronary sinus (612.3 +/- 431.6 pg/mL versus 1229.0 +/- 772.7 pg/mL, P < .01). There was a significant step-up in the plasma BNP level between the aortic root and the AIV (268.4 +/- 293.2 pg/mL versus 511.6 +/- 458.1 pg/mL, P < .01) but not between the AIV and the coronary sinus (511.6 +/- 458.1 pg/mL versus 529.7 +/- 455.3 pg/mL) in patients with dilated cardiomyopathy. The arteriovenous difference at the AIV of the plasma level of BNP had a significant positive correlation with left ventricular end-systolic volume index (r = 0.859, P < .001) and a significant negative correlation with left ventricular ejection fraction (r = -.735, P < .001).
We conclude that (1) BNP is secreted mainly from the left ventricle in normal adult humans as well as in patients with left ventricular dysfunction, whereas ANP is secreted from atria in normal adult humans and also from the left ventricle in patients with left ventricular dysfunction; (2) secretion of BNP as well as ANP from the left ventricle increases in proportion to the severity of the left ventricular dysfunction, suggesting that the secretions of ANP and BNP from the left ventricle are regulated mainly by wall tension of the left ventricle; and (3) the peripheral plasma levels of ANP and BNP reflect the secretion rate of these hormones from the left ventricle and may be used as a marker of the degree of left ventricular dysfunction in patients with left ventricular dysfunction.
B型或脑钠肽（BNP）是一种从心脏分泌的新型利钠肽，它与A型或心房利钠肽（ANP）构成一个肽家族，并且充血性心力衰竭患者的血浆水平已被证明会升高。本研究旨在比较对照组和心力衰竭患者中BNP与ANP的分泌来源和机制。
我们使用新开发的免疫放射分析系统，从股静脉、主动脉根部、前室间静脉（AIV）和冠状窦采集血液，测量了16例扩张型心肌病患者（11例男性和5例女性；平均年龄59岁）和18例对照者（9例男性和9例女性；平均年龄54岁）的血浆BNP以及ANP水平。在对照者中，主动脉根部和AIV之间的血浆ANP水平无显著差异（24.0±5.2 pg/mL对32.2±17.0 pg/mL），但AIV和冠状窦之间的水平有高度显著升高（32.2±17.0 pg/mL对371.4±111.1 pg/mL，P<.001）。相比之下，主动脉根部和AIV之间的血浆BNP水平有显著升高（8.6±6.4 pg/mL对19.0±11.5 pg/mL，P<.01），但AIV和冠状窦之间无显著升高（19.0±11.5 pg/mL对28.8±14.0 pg/mL）。另一方面，在扩张型心肌病患者中，主动脉根部和AIV之间的血浆ANP水平有显著升高（280.6±183.7 pg/mL对612.3±431.6 pg/mL，P<.01），AIV和冠状窦之间也有显著升高（612.3±431.6 pg/mL对1229.0±772.7 pg/mL，P<.01）。扩张型心肌病患者中，主动脉根部和AIV之间的血浆BNP水平有显著升高（268.4±293.2 pg/mL对511.6±458.1 pg/mL，P<.01），但AIV和冠状窦之间无显著升高（511.6±458.1 pg/mL对529.7±455.3 pg/mL）。AIV处血浆BNP水平的动静脉差值与左心室收缩末期容积指数呈显著正相关（r = 0.859，P<.001），与左心室射血分数呈显著负相关（r = -.735，P<.001）。
我们得出结论：（1）正常成年人以及左心室功能障碍患者中，BNP主要从左心室分泌，而正常成年人中ANP从心房分泌，左心室功能障碍患者中ANP也从左心室分泌；（2）左心室中BNP和ANP的分泌与左心室功能障碍的严重程度成比例增加，这表明左心室中ANP和BNP的分泌主要受左心室壁张力调节；（3）外周血浆中ANP和BNP水平反映了这些激素从左心室的分泌速率，可作为左心室功能障碍患者左心室功能障碍程度的标志物。
