在肺动脉高压中，血浆脑钠肽水平与右心室功能障碍的程度成正比增加。

Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension.

作者信息

Nagaya N, Nishikimi T, Okano Y, Uematsu M, Satoh T, Kyotani S, Kuribayashi S, Hamada S, Kakishita M, Nakanishi N, Takamiya M, Kunieda T, Matsuo H, Kangawa K

机构信息

Department of Internal Medicine, and Research Institute, National Cardiovascular Center, Suita, Osaka, Japan.

出版信息

J Am Coll Cardiol. 1998 Jan;31(1):202-8. doi: 10.1016/s0735-1097(97)00452-x.

DOI:10.1016/s0735-1097(97)00452-x

PMID:9426041

Abstract

OBJECTIVES

This study sought to investigate the influence of right ventricular (RV) hemodynamic variables and function on the secretion of brain natriuretic peptide (BNP) in patients with isolated RV overload.

BACKGROUND

Plasma BNP is known to increase in proportion to the degree of left ventricular (LV) overload. However, whether BNP secretion is also regulated in the presence of RV overload remains unknown.

METHODS

Plasma BNP and atrial natriuretic peptide (ANP) levels in the pulmonary artery were measured in 44 patients with RV overload: 18 with RV volume overload (RVVO) due to atrial septal defect and 26 with RV pressure overload (RVPO) due to primary or thromboembolic pulmonary hypertension. Right heart catheterization was performed in all patients. RV and LV ejection fraction, myocardial mass and volume of the four chambers were determined by using electron beam computed tomography.

RESULTS

Although both plasma BNP and ANP levels were significantly elevated in patients with RV overload compared with values in control subjects, plasma BNP and the BNP/ANP ratio were significantly higher in patients with RVPO than with RVVO (BNP 294 +/- 72 vs. 48 +/- 14 pg/ml; BNP/ANP 1.6 +/- 0.2 vs. 0.8 +/- 0.2, both p < 0.05). Plasma BNP correlated positively with mean pulmonary artery pressure (r = 0.73), total pulmonary resistance (r = 0.79), mean right atrial pressure (r = 0.79), RV end-diastolic pressure (r = 0.76) and RV myocardial mass (r = 0.71); it correlated negatively with cardiac output (r = -0.33) and RV ejection fraction (r = -0.71). Plasma BNP significantly decreased from 315 +/- 120 to 144 +/- 54 pg/ml with long-term vasodilator therapy (total pulmonary resistance decreased from 23 +/- 4 to 15 +/- 3 Wood U).

CONCLUSIONS

Plasma BNP increases in proportion to the extent of RV dysfunction in pulmonary hypertension.

摘要

目的

本研究旨在探讨单纯右心室（RV）负荷过重患者右心室血流动力学变量及功能对脑钠肽（BNP）分泌的影响。

背景

已知血浆BNP水平随左心室（LV）负荷过重程度成比例升高。然而，在右心室负荷过重情况下BNP分泌是否也受调节尚不清楚。

方法

对44例右心室负荷过重患者测定肺动脉血浆BNP和心房利钠肽（ANP）水平：18例因房间隔缺损导致右心室容量负荷过重（RVVO），26例因原发性或血栓栓塞性肺动脉高压导致右心室压力负荷过重（RVPO）。所有患者均行右心导管检查。采用电子束计算机断层扫描测定右心室和左心室射血分数、心肌质量及四个心腔的容积。

结果

与对照组相比，右心室负荷过重患者血浆BNP和ANP水平均显著升高，但RVPO患者血浆BNP及BNP/ANP比值显著高于RVVO患者（BNP：294±72 vs. 48±14 pg/ml；BNP/ANP：1.6±0.2 vs. 0.8±0.2，均p<0.05）。血浆BNP与平均肺动脉压（r=0.73）、总肺阻力（r=0.79）、平均右心房压（r=0.79）、右心室舒张末期压力（r=0.76）及右心室心肌质量（r=0.71）呈正相关；与心输出量（r=-0.33）及右心室射血分数（r=-0.71）呈负相关。长期血管扩张剂治疗后血浆BNP从315±120 pg/ml显著降至144±54 pg/ml（总肺阻力从23±4降至15±3 Wood单位）。