Lauster F, Heim J M, Drummer C, Fülle H J, Gerzer R, Schiffl H
Medizinische Klinik, Universität München, Germany.
Kidney Int Suppl. 1993 Jun;41:S57-9.
We investigated, whether plasma cyclic guanosine 3':5'-monophosphate (cGMP) may be suited as a marker of hyperhydration in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). In 81 HD patients the levels of atrial natriuretic peptide (ANP) and cGMP were markedly elevated before HD (ANP: 165 +/- 11.1 pg/ml; cGMP 43.5 +/- 2.2 pmol/ml). Significantly lower values (P < 0.01) were found after HD (ANP: 97 +/- 8.4 pmol/ml; cGMP 19.5 +/- 1.5 pmol/ml). Twenty-three patients had cGMP levels above 20 pmol/ml after HD. Therefore "dry body weight" was reduced in these patients. This resulted in a "normalization" of cGMP values to a postdialytic range below 20 pmol/ml in the majority of patients. All seven patients with persistently high cGMP levels despite weight reduction had left sided heart failure. In 33 CAPD patients ANP was slightly lower than after HD (68 +/- 10.4 pg/ml), and the cGMP level (22.4 +/- 2.3 pmol/ml) was between pre- and postdialytic values in HD. In eight CAPD patients with clinical signs of hypervolemia plasma cGMP, but not ANP, was significantly elevated. We conclude that the plasma cGMP level appears to be a reliable marker for fluid overload in patients on renal replacement therapy with normal heart function.
我们研究了血浆环磷酸鸟苷（cGMP）是否适合作为血液透析（HD）和持续性非卧床腹膜透析（CAPD）中高水合状态的标志物。在81例HD患者中，HD前心房利钠肽（ANP）和cGMP水平显著升高（ANP：165±11.1 pg/ml；cGMP 43.5±2.2 pmol/ml）。HD后发现其值显著降低（P<0.01）（ANP：97±8.4 pmol/ml；cGMP 19.5±1.5 pmol/ml）。23例患者HD后cGMP水平高于20 pmol/ml。因此，这些患者的“干体重”降低。这导致大多数患者的cGMP值“正常化”至透析后低于20 pmol/ml的范围。所有7例尽管体重减轻但cGMP水平持续升高的患者均有左心衰竭。在33例CAPD患者中，ANP略低于HD后水平（68±10.4 pg/ml），cGMP水平（22.4±2.3 pmol/ml）介于HD的透析前和透析后值之间。在8例有高血容量临床体征的CAPD患者中，血浆cGMP而非ANP显著升高。我们得出结论，血浆cGMP水平似乎是心脏功能正常的肾脏替代治疗患者液体超负荷的可靠标志物。
