慢性肾功能衰竭病人血浆ANP水平与心脏大小及血液透析的关系

THE RELATIONSHIP BETWEEN CHANGES IN PLASMA ATRIAL NATRIURETICPEPTIDE AND CARDIAC SIZE,AND HEMODIALYSIS IN PATIENTS WITHCHRONIC RENAL FAILURE

探测３２例慢性肾功能衰竭病人的心脏内径，测定血液透析前后血浆ＡＮＰ、ＡＮＧ－Ⅱ，观察心脏改变及血液透析对血浆ＡＮＰ水平的影响。结果左心房内径增宽者血浆ＡＮＰ显著升高（Ｐ＜０．０１），左心室内径增宽者血浆ＡＮＰ水平无明显升高（Ｐ＞０．０５），而且左心房内径与血浆ＡＮＰ水平呈显著直线正相关（ｒ＝０．５０３２，Ｐ＜０．０１）。提示：慢性肾衰病人左心房扩大比左心室扩大更能刺激ＡＮＰ的释放。血液透析后病人ＡＮＰ、ＡＮＧ－Ⅱ水平都进一步升高（Ｐ＜０．０１），而血Ｎａ＋浓度及血压无变化（Ｐ＞０．０５）。表明ＡＮＰ的升高与血Ｎａ＋无关。可能是：（１）由血压介导的对ＡＮＧ－Ⅲ升高的一种对抗性反应；（２）心房容量受体对慢性高容量负荷的适应，使其缺乏对急性容量减少的反馈。

Thirty-two patients with chronic renal failure (CRF )on hemodialysis were studied.The in-ternal diameter of left atrium and ventricle were determined by colour doppler ultrasonic diagnostic instru-ment. The plasma atrial natriuretic peptide (ANP ),angiotensin-Ⅱ(ANG-Ⅱ ) were measured by RIA be-fore and after hemodialysis. It was found that there was good correlation between plasma ANP and the in-ternal diameter of left atrium(r=0.5032.P<0.011 , but not in left ventricle(r=0.2263,P>0.05) , indi-cating that the expansion of the left atrium has a stronger stimulation to release ANP than the left ventri-cle. After hemodialysis, plasma ANP and ANG-Ⅱwere further increased significantly(P< 0. 01 ), butboth serum sodium concentration and blood pressure remained unchanged (P<0. 05), demonstrating thatthe elevation of plasma ANP was not related to sodium concentration. It's suggested that the increase of ANP may be an antagonistic response to the increase in ANG-II,which is mediated by blood pressure;the atrial volume receptors may be adapted to chronic volume expan-sion in CRF patients,thus there may be no feedback to volume decrease in short time during hemodialysis.