充血性心力衰竭患者血管活性物质变化的临床意义

The changes and clinical significance of plasma levels of vasoactive substances in patients with congestive heart failure

目的 研究充血性心力衰竭 (CHF)患者血浆尾加压素Ⅱ (Urotensin -Ⅱ ,UⅡ )变化与其他血管活性物质的变化 ,阐明血管活性物质的可能作用及临床意义。方法 2 0 0 1- 0 8～ 2 0 0 2 - 0 5第一军医大学 (现南方医科大学 )珠江医院心内科对 5 2例充血性心力衰竭患者采用放射免疫方法分别检测血浆UⅡ、肾上腺髓质前体N端 2 0肽 (PAMP)以及心房肽 (ANP)血浆含量 ,同时选 2 0名体检者作为对照组。所有入选者均进行心功能检查。结果 CHF组治疗前血浆UⅡ含量明显低于对照组 [(1 4 8± 1 0 5 )与 (4 2 8± 1 2 1)pg·mL-1,P <0 0 5 ],治疗后与治疗前比较明显升高 [(2 11± 1 4 8)与 (1 4 8± 1 0 5 )pg·mL-1,P <0 0 5 ],血浆UⅡ含量降低与CHF的程度平行。治疗前血浆PAMP、ANP含量CHF组较对照组升高 [(30 6 1± 5 80 )与 (2 1 0 1± 6 5 9)pg·mL-1,P <0 0 5 ]及 [(319 88± 30 2 1)与(41 82± 6 0 9)pg·mL-1,P <0 0 5 ];治疗后血浆PAMP、ANP含量分别比治疗前下降 [(2 5 5 7± 5 0 6 )与 (30 6 1±5 80 )pg·mL-1,P <0 0 5 ]及 [(2 2 8 5 2± 2 2 0 1)与 (319 88± 30 2 1)pg·mL-1,P <0 0 5 ],但均未恢复到对照组及治疗前水平。结论 心力衰竭过程中 ,血浆UⅡ、PAMP。

Objective To observe the changes of plasma urotensinⅡ(UⅡ)、PAMP(proadrenomedullin N-terminal peptide)and ANP(atrial natriuretic peptide)levels in patients with congestive heart failure (CHF) and to illustrate clinical significance of these changes.Methods 52 patients with CHF and 20 age and gender-matched control subjects were studied.Plasma UⅡ.PAMP and ANP levels of 52 patients with CHF and 20 control subjects were measured by radioimmunoassay.Heart function of all study subjects were mensurated by ultrasound cardiography.Results The plasma UⅡ levels were significantly lower in patients with CHF than that in control subjects [(1.48±1.05) vs (4.28±1.21) pg·mL -1,P<0.05].Plasma level of UⅡ increased to 2.11±1.48 pg·mL -1after patients with CHF treated.Plasma PAMP and ANP levels were significantly higher[(30.61±5.80)vs(21.01±6.59)pg·mL -1,P<0.05]and [(319.88±30.21)vs(41.82±6.09)pg·mL -1,P<0.05].Plasma level of PAMP and ANP was lower after treatment than before[(25.57±5.06)vs(30.61±5.80)pg·mL -1,P<0.05]and[(228.52±22.01)vs(319.88±30.21 )pg·mL -1,P<0.05] .Conclusion In the worsening process of heart function,plasma level of UⅡ showed a gradually decreasing change,but plasma level of ANP and PAMP were gradually increased.UⅡ might play a certain role in the pathophysiology of CHF.The plasma UⅡ levels in patients with CHF may serve as an index of the severity of CHF.