充血性心力衰竭时肾脏对血管加压素的超敏反应。

Renal hypersensitivity to vasopressin in congestive heart failure.

作者信息

Wong B P, Wong N L

机构信息

Department of Medicine, University of British Columbia, University Hospital, Koerner Pavilion, Vancouver, B.C., Canada.

出版信息

Cardiology. 1998 Jul;90(1):20-7. doi: 10.1159/000006811.

DOI:10.1159/000006811

PMID:9693166

Abstract

Plasma vasopressin (AVP) levels are often elevated in congestive heart failure (CHF). To determine the significance of AVP in CHF, we performed clearance studies on the UM-X7.1 strain of cardiomyopathic (CM) hamsters with moderate heart failure and age-matched healthy controls. Exogenous AVP or a selective V2 agonist (0.3 ng.kg-1. min-1) reduced the fractional excretion of sodium (FENa) and water (FEH2O) by 40-46% in the control group. Although the CM hamsters exhibited a blunted physiological response to the V2 agonist, their urinary cAMP levels were fivefold that of normal and reflect an altered regulation of V2 receptor signalling during CHF. Additional studies also showed that infusion of a V2 antagonist (0.3 ng.kg-1. min-1) produced natriuresis and diuresis in CM hamsters (FENa: 7.9 +/- 1.1 vs. 4.8 +/- 0.6%, p < 0.05; FEH2O: 2.2 +/- 3 vs. 1.5 +/- 0. 2%, p < 0.05) but did not decrease fluid reabsorption in the normal hamsters. In conclusion, the attenuated renal response to exogenous AVP in CM hamsters may be attributed to an enhanced endogenous AVP response during CHF.

摘要

充血性心力衰竭（CHF）患者的血浆血管加压素（AVP）水平通常会升高。为了确定AVP在CHF中的意义，我们对中度心力衰竭的UM-X7.1心肌病（CM）仓鼠品系和年龄匹配的健康对照进行了清除率研究。在对照组中，外源性AVP或选择性V2激动剂（0.3 ng·kg-1·min-1）使钠分数排泄率（FENa）和水分数排泄率（FEH2O）降低了40 - 46%。尽管CM仓鼠对V2激动剂的生理反应减弱，但其尿cAMP水平是正常仓鼠的五倍，这反映了CHF期间V2受体信号调节的改变。进一步的研究还表明，输注V2拮抗剂（0.3 ng·kg-1·min-1）可使CM仓鼠产生利钠和利尿作用（FENa：7.9 +/- 1.1 vs. 4.8 +/- 0.6%，p < 0.05；FEH2O：2.2 +/- 3 vs. 1.5 +/- 0.2%，p < 0.05），但对正常仓鼠的液体重吸收没有影响。总之，CM仓鼠对外源性AVP的肾反应减弱可能归因于CHF期间内源性AVP反应增强。