原位心脏移植患者血管活性肠肽血浆浓度缺乏昼夜节律。
Lack of circadian rhythm of plasma concentrations of vasoactive intestinal peptide in patients with orthotopic heart transplants.
作者信息
Cugini P, Lucia P, Scibilia G, Di Palma L, Cioli A R, Cianetti A, Gasbarrone L, Canova R, Marino B
机构信息
Institute of Heart and Large Vessels Surgery, University La Sapienza, Rome, Italy.
出版信息
Br Heart J. 1993 Oct;70(4):363-5. doi: 10.1136/hrt.70.4.363.
OBJECTIVE
To study the circadian pattern of plasma concentrations of vasoactive intestinal peptide (VIP) in patients with orthotopic heart transplants. Circulating VIP is known to have neural and immunological sources.
PATIENTS AND METHODS
13 patients with orthotopic heart transplants were studied 12-53 months (mean 31.8 months) after operation. All were haemodynamically compensated and had no histological evidence of rejection. They were being treated with cyclosporin, azathioprine, and prednisone. Ten healthy individuals were studied as controls. Circulating VIP was assayed six times within a 24h period. Time qualified data were analysed by ANOVA and the cosinor method. Student's t test for unpaired data and Bingham's test for cosinor-derived parameters were used for statistical comparisons.
RESULTS
Plasma concentrations of VIP were lower in the patients with orthotopic heart transplants than in the controls (p < 0.001). ANOVA and the cosinor method respectively showed a statistically significant within-day variability and circadian rhythm in the controls but not in the patients with heart transplants.
DISCUSSION
The low plasma concentrations of VIP in the patients with heart transplants could be the result of the lack of contribution by the cardiac VIPergic fibres, a reduction of VIP release by the pharmacologically suppressed immune system, the inhibitory effects of cyclosporin on neural function and humoral secretions, and the effects of negative feedback on VIP release of high concentrations of atrial natriuretic peptide. The lack of the circadian rhythm suggests a structural disorder, which should be further investigated.
目的
研究原位心脏移植患者血浆中血管活性肠肽（VIP）浓度的昼夜变化规律。已知循环中的VIP有神经和免疫来源。
患者与方法
对13例原位心脏移植患者进行研究，术后12 - 53个月（平均31.8个月）。所有患者血流动力学稳定，无排斥反应的组织学证据。他们正在接受环孢素、硫唑嘌呤和泼尼松治疗。选取10名健康个体作为对照。在24小时内对循环中的VIP进行6次检测。对符合时间条件的数据采用方差分析和余弦法进行分析。采用Student's t检验对非配对数据进行分析，采用Bingham检验对余弦法得出的参数进行统计比较。
结果
原位心脏移植患者血浆中VIP浓度低于对照组（p < 0.001）。方差分析和余弦法分别显示对照组存在显著的日内变异性和昼夜节律，而心脏移植患者则无。
讨论
心脏移植患者血浆中VIP浓度较低可能是由于心脏VIP能纤维缺乏、药物抑制的免疫系统使VIP释放减少、环孢素对神经功能和体液分泌的抑制作用以及高浓度心房利钠肽对VIP释放的负反馈作用。昼夜节律的缺失提示存在结构紊乱，应进一步研究。
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