充血性心力衰竭患者心房利钠肽和脑利钠肽的不同分泌模式。

Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure.

作者信息

Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M, Nakao K, Imura H

机构信息

Division of Cardiology, Kumamoto University School of Medicine, Japan.

出版信息

Circulation. 1993 Feb;87(2):464-9. doi: 10.1161/01.cir.87.2.464.

DOI:10.1161/01.cir.87.2.464

PMID:8425293

Abstract

BACKGROUND

The plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are increased in relation to the severity of congestive heart failure (CHF). This study was designed to examine whether the secretion patterns of ANP and BNP vary with underlying cardiac disorders of CHF with different degrees of overload in atria and ventricles.

METHODS AND RESULTS

We measured plasma levels of ANP and BNP in the aorta in 20 patients with mitral stenosis (MS) in whom atria are mainly overloaded, 30 patients with dilated cardiomyopathy (DCM) in whom both atria and ventricles are overloaded, and 20 control subjects during cardiac catheterization. Pulmonary capillary wedge pressure (PCWP) was significantly higher in the MS and DCM groups (16.7 +/- 4.7 mm Hg and 15.1 +/- 7.7 mm Hg, respectively) than in the control group (7.2 +/- 1.1 mm Hg, p < 0.01), whereas there was no significant difference between the MS and DCM groups. Left ventricular end-diastolic pressure (LVEDP) was significantly higher in the DCM group than in the MS group (16.4 +/- 7.8 mm Hg versus 7.6 +/- 2.0 mm Hg, p < 0.01), and the level was comparable between the MS and control groups (7.6 +/- 2.0 mm Hg versus 6.8 +/- 1.2 mm Hg, p = NS). The plasma ANP level was significantly higher in the MS and DCM groups (356 +/- 169 pg/ml and 331 +/- 323 pg/ml, respectively) than in the control group (98 +/- 41 pg/ml, p < 0.01), whereas there was no significant difference between the MS and DCM groups. The plasma BNP level was significantly higher in the DCM group than in the MS group (333 +/- 405 pg/ml versus 147 +/- 54 pg/ml, p < 0.01), and the level was significantly higher in the MS group than in the control group (147 +/- 54 pg/ml versus < 10 pg/ml, p < 0.01). The plasma levels of ANP and BNP had a highly positive correlation with PCWP in the DCM group (p < 0.01). On the other hand, in the MS group, the plasma ANP level had a highly significant correlation with PCWP (p < 0.01) but the plasma BNP level did not.

CONCLUSIONS

We conclude that plasma levels of BNP mainly reflect the degree of ventricular overload and that the secretion patterns of ANP and BNP vary with underlying cardiac disorders of CHF with different degrees of overload in atria and ventricles.

摘要

背景

心房利钠肽（ANP）和脑利钠肽（BNP）的血浆水平与充血性心力衰竭（CHF）的严重程度相关。本研究旨在探讨ANP和BNP的分泌模式是否因CHF潜在的心脏疾病不同，心房和心室的负荷程度不同而有所差异。

方法与结果

我们在心脏导管插入术期间，测量了20例主要为心房负荷过重的二尖瓣狭窄（MS）患者、30例心房和心室均负荷过重的扩张型心肌病（DCM）患者以及20例对照者主动脉中的ANP和BNP血浆水平。MS组和DCM组的肺毛细血管楔压（PCWP）显著高于对照组（分别为16.7±4.7mmHg和15.1±7.7mmHg）（对照组为7.2±1.1mmHg，p<0.01），而MS组和DCM组之间无显著差异。DCM组的左心室舒张末期压力（LVEDP）显著高于MS组（16.4±7.8mmHg对7.6±2.0mmHg，p<0.01），MS组与对照组的该水平相当（7.6±2.0mmHg对6.8±1.2mmHg，p=无显著性差异）。MS组和DCM组的血浆ANP水平显著高于对照组（分别为356±169pg/ml和331±323pg/ml）（对照组为98±41pg/ml，p<0.01），而MS组和DCM组之间无显著差异。DCM组的血浆BNP水平显著高于MS组（333±405pg/ml对147±54pg/ml，p<0.01），MS组的该水平显著高于对照组（147±54pg/ml对<10pg/ml，p<0.01）。DCM组中ANP和BNP的血浆水平与PCWP高度正相关（p<0.01）。另一方面，在MS组中，血浆ANP水平与PCWP高度显著相关（p<0.01），但血浆BNP水平则不然。