Bussières-Chafe L M, Pflugfelder P W, Henderson A R, MacKinnon D, Taylor A W, Kostuk W J
Faculty of Kinesiology, University Hospital, University of Western, Ontario, London.
Can J Cardiol. 1994 Mar;10(2):245-50.
To determine the influence of body posture and central hemodynamics on the plasma levels of immunoreactive atrial natriuretic peptide (irANP) during exercise in cardiac transplant patients.
Central hemodynamics, mixed expired gas and ventilatory measurements, and venous blood sampling (for irANP determination) were obtained in cardiac transplant patients at rest and during supine (n = 12) or upright (n = 12) graded cycle exercise. Cardiopulmonary and irANP responses to exercise were compared between the upright and supine postures.
At rest (supine), irANP concentrations were similar in both groups (172 +/- 87 pg/mL supine and 182 +/- 72 pg/mL upright) and did not correlate with resting supine central hemodynamics. During exercise, central filling pressures increased in both groups but patients exercising in the supine position had a greater increase. Peak exercise right atrial pressure was 12 +/- 4 mmHg supine versus 7 +/- 5 mmHg upright (P < 0.005). Peak exercise pulmonary capillary wedge pressure was 22 +/- 6 mmHg supine versus 14 +/- 5 mmHg upright (P < 0.005). At peak exercise, irANP levels were greater in the supine than upright position (419 +/- 166 pg/mL supine versus 277 +/- 40 pg/mL upright, P < 0.05). The change in irANP from rest to peak exercise correlated (P < 0.05) with changes in pulmonary capillary wedge pressure (r = 0.67), systolic pulmonary artery pressure (r = 0.78) and right atrial pressure (r = 0.53). There was, however, no correlation between change in irANP and peak oxygen consumption, change in heart rate or change in mean arterial blood pressure.
In cardiac transplant recipients, exercise is a stimulus for ANP secretion, and augmentation in plasma irANP levels during exercise is modulated by changes in central hemodynamics.
确定心脏移植患者运动期间身体姿势和中心血流动力学对免疫反应性心房利钠肽（irANP）血浆水平的影响。
在心脏移植患者静息时以及仰卧位（n = 12）或直立位（n = 12）进行分级自行车运动期间，获取中心血流动力学、混合呼出气和通气测量值以及静脉血样本（用于测定irANP）。比较直立位和仰卧位运动时的心肺和irANP反应。
静息时（仰卧位），两组的irANP浓度相似（仰卧位为172±87 pg/mL，直立位为182±72 pg/mL），且与静息仰卧位中心血流动力学无关。运动期间两组的中心充盈压均升高，但仰卧位运动的患者升高幅度更大。运动高峰时右心房压力仰卧位为12±4 mmHg，直立位为7±5 mmHg（P < 0.005）。运动高峰时肺毛细血管楔压仰卧位为22±6 mmHg，直立位为14±5 mmHg（P < 0.005）。运动高峰时，仰卧位的irANP水平高于直立位（仰卧位为419±166 pg/mL，直立位为277±40 pg/mL，P < 0.05）。irANP从静息到运动高峰的变化与肺毛细血管楔压变化（r = 0.67）、收缩期肺动脉压变化（r = 0.78）和右心房压力变化（r = 0.53）相关（P < 0.05）。然而，irANP变化与峰值耗氧量、心率变化或平均动脉血压变化之间无相关性。
在心脏移植受者中，运动是ANP分泌的刺激因素，运动期间血浆irANP水平的升高受中心血流动力学变化的调节。
