Kinugawa T, Ogino K, Kitamura H, Saitoh M, Omodani H, Osaki S, Hisatome I, Miyakoda H
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Am J Med Sci. 1996 Sep;312(3):110-7. doi: 10.1097/00000441-199609000-00003.
The aim of this study was to determine the responses of plasma catecholamines, renin-angiotensin-aldosterone (RAA) activity, and plasma atrial natriuretic peptide (ANP) to exercise in patients with congestive heart failure (CHF). Cardiac and neurohormonal responses were assessed during submaximal treadmill exercise testing in 23 patients with CHF (New York Heart Association classes I-III) and 13 control subjects (without CHF). Plasma norepinephrine, epinephrine, renin activity (PRA), angiotensin II (ATII), aldosterone, and ANP were measured at rest and immediately after exercise. Exercise duration was shorter in patients with CHF (control, 10.4 +/- 0.9 minute; CHF, 6.2 +/- 0.7 minute; P < 0.01). Heart rate and blood pressure responses were similar except for the smaller peak heart rate (control, 145 +/- 5 beats per minute; CHF, 129 +/- 4 beats per minute; P < 0.05) and higher systolic blood pressure at recovery stage (control, 122 +/- 4 mm Hg; CHF, 142 +/- 4 mm Hg; P < 0.01) in patients with CHF. At rest, plasma norepinephrine levels were insignificantly higher in patients with CHF (control, 110 +/- 10 pg/mL; CHF, 170 +/- 26 pg/mL; P = 0.09), and ANP levels (control, 40 +/- 5 pg/mL; CHF, 94 +/- 17 pg/mL; P < 0.05) and PRA levels (control, 0.77 +/- 0.11 ng/mL/hr; CHF, 4.33 +/- 1.25 ng/mL/hr; P < 0.05) were significantly higher. There were no differences in peak norepinephrine, epinephrine, or ANP between the two groups. Angiotensin II and aldosterone levels were similar between the two groups, although, in patients with CHF, there was a trend toward higher levels of ATII while at rest (control, 12.4 +/- 1.4 pg/mL; CHF, 20.3 +/- 3.3 pg/mL; P = 0.08) and at peak (control, 20.5 +/- 1.8 pg/mL; CHF, 41.0 +/- 9.4 pg/mL; P = 0.10). Peak values of PRA, ATII, and aldosterone positively correlated with respective resting values of PRA (r = 0.88 ng/mL/hr, P < 0.01), ATII (r = 0.63 pg/mL, P < 0.01), and aldosterone (r = 0.99, P < 0.01). Peak norepinephrine and peak ANP also positively correlated with respective resting values of norepinephrine (r = 0.58 pg/mL, P < 0.05) and ANP (r = 0.94, P < 0.01). Analysis of these results showed that patients with CHF had significantly higher levels of PRA and ANP at rest, and a trend toward augmentation in RAA system activity during exercise with less exercise workload. Basal level of neurohormones seemed to be an important determinant for the degree of exercise-induced neurohormonal activation in patients with CHF.
本研究旨在确定充血性心力衰竭（CHF）患者血浆儿茶酚胺、肾素 - 血管紧张素 - 醛固酮（RAA）活性及血浆心钠素（ANP）对运动的反应。对23例CHF患者（纽约心脏协会心功能分级I - III级）和13名对照受试者（无CHF）进行次极量平板运动试验，评估心脏和神经激素反应。在静息状态及运动结束后即刻测定血浆去甲肾上腺素、肾上腺素、肾素活性（PRA）、血管紧张素II（ATII）、醛固酮和ANP。CHF患者的运动持续时间较短（对照组，10.4±0.9分钟；CHF组，6.2±0.7分钟；P<0.01）。除CHF患者运动峰值心率较小（对照组，145±5次/分钟；CHF组，129±4次/分钟；P<0.05）及恢复期收缩压较高（对照组，122±4mmHg；CHF组，142±4mmHg；P<0.01）外，两组的心率和血压反应相似。静息时，CHF患者血浆去甲肾上腺素水平略高（对照组，110±10pg/mL；CHF组，170±26pg/mL；P = 0.09），ANP水平（对照组，40±5pg/mL；CHF组，94±17pg/mL；P<0.05）和PRA水平（对照组，0.77±0.11ng/mL·hr；CHF组，4.33±1.25ng/mL·hr；P<0.05）显著更高。两组间去甲肾上腺素、肾上腺素或ANP的峰值无差异。两组间血管紧张素II和醛固酮水平相似，不过CHF患者在静息时（对照组，12.4±1.4pg/mL；CHF组，20.3±3.3pg/mL；P = 0.08）及峰值时（对照组，20.5±1.8pg/mL；CHF组，41.0±9.4pg/mL；P = 0.10）有ATII水平升高的趋势。PRA、ATII和醛固酮的峰值与各自的静息值呈正相关（PRA，r = 0.88ng/mL·hr，P<0.01；ATII，r = 0.63pg/mL，P<0.01；醛固酮，r = 0.99，P<0.01）。去甲肾上腺素峰值和ANP峰值也与各自的静息值呈正相关（去甲肾上腺素，r = 0.58pg/mL，P<0.05；ANP，r = 0.94，P<0.01）。对这些结果的分析表明，CHF患者静息时PRA和ANP水平显著更高，且运动期间RAA系统活性有增强趋势，但运动负荷较小。神经激素的基础水平似乎是CHF患者运动诱导的神经激素激活程度的重要决定因素。
