慢性心力衰竭患者心钠素水平及与心功能关系的观察

The study of atrial natriuretic polypeptide level and the relationship between atrial natriuretic polypeptide and heart function in chronic heart failure patients

目的探讨心钠素(ANP)在慢性心力衰竭发生与发展过程中的意义及与心功能的关系。方法选择35例慢性心力衰竭患者和32例正常对照,采用放射免疫法测定其血浆ANP水平,应用彩色多普勒超声心动图测定左心室收缩末期内径(LVSd)、左心室舒张末期内径(LNDd)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)及心动周期中二尖瓣舒张晚期心室充盈峰速度(A)与二尖瓣舒张早期心室充盈峰速度(E)的比值(A／E),观察ANP水平与心功能之间的关系。结果心力衰竭患者血浆ANP水平比健康对照组明显升高(P<0．001),且随着心功能程度的不断加重,ANP水平逐渐升高．依次为心功能Ⅱ级<心功能Ⅲ级<心功能Ⅳ级(P<0．05-0．001)。ANP水平与LVEF、LVFS呈负相关,r值分别为0．76(P<0．01)、-0．72(P<0．01);与LVSd、LVDd及A／E呈正相关,r值分别为0．65(P<0．01)、0．79(P<0．01)、0．72(P<0．01)。结论慢性心力衰竭进展中,ANP水平与心力衰竭的严重程度密切相关,能够反映不同的心功能状态,为慢性心力衰竭的诊断与治疗提供参考依据。

Objective To discuss the significance of atrial natriuretic polypeptide（ANP） in the progress of chronic heart failure （CHF） and the relationship between ANP and heart function. Methods The plasma levels of ANP were tested by radioimmunoassay and the parameters of cardiac function were obtained by echocardiography in 35 CHF patients and 32 normal patients. The cardiac function parameters included left ventricle end-systolic volumeml （LVSd）, left ventricle end diastolic volumeml （LVDd）, left ventricle ejection fraction （LVEF）, left ventricle fractional shortening （LVFS） and mitral valve peak flow velocity A/E ratio. The correlation between ANP and the parameters was analyzed. Results The plasma level of ANP in heart failure group elevated obviously comparing to the control group （P 〈 0.001 ）. In different NYHA Classification, the plasma levels of ANP varied increasingly along with the heart function degree （ Ⅱ 〈 Ⅲ 〈 Ⅳ ,P 〈 0.05 - 0.001 ）. The ANP levels were negatively correlated with LVEF（r = - 0.76, P 〈 0.01 ） and LVSF（r = - 0.72, P 〈 0.01 ）; positively correlated with LVSd （r = 0.65, P 〈 0.01 ）, LVDd （r = 0.79, P 〈 0.01 ） and A/E （r = 0.72,P 〈 0.01 ） respectively. Conclusions In the progressing of chronic heart failure, ANP has a close correlation with the cardiac function and echocardiogram parameters. It can reflect different heart function and help to diagnosis and treat clinical chronic heart failure.