慢性心力衰竭患者血浆心钠素水平的变化及人工合成心钠素的干预作用

The variation of atrial natriuretic(ANP)and effectiveness of ANP for chronic heart failure patients

目的探讨慢性心力衰竭(CHF)时血浆心钠素(ANP)水平的变化及人工合成心钠素对慢性CHF患者的治疗效果。方法慢性CHF患者80例随机分为心钠素治疗组和常规治疗组各40例。常规治疗组常规使用强心剂、利尿剂、硝酸酯类药物。心钠素治疗组在常规治疗措施基础上给予心钠素220mg静脉滴注,每日1次,治疗2周。结果治疗前CHF组血浆ANP水平为(198.5±68.9)pg/ml,LVEF为(36.8±8.7)%,明显低于对照组的(289.8±0.2)pg/ml和(63.2±10.8)%(P<0.01)。NYHAⅡ级、Ⅲ级、Ⅳ级患者血浆ANP浓度分别为(235.7±73.8)pg/ml、(200.3±67.9)pg/ml和(156.7±69.1)pg/ml,均明显低于对照组(P<0.01)。冠心病CHF、高血压心脏病CHF、瓣膜病CHF和扩张型心肌病CHF患者血浆ANP浓度分别为(200.9±57.2)pg/ml、(195.6±75.3)pg/ml、(190.1±82.6)pg/ml和(193.6±79.8)pg/ml,不同病因组患者的ANP水平差异无统计学意义(P>0.05)。治疗后心钠素治疗组HR、SBP、DBP较治疗前及常规治疗组明显降低(P<0.05),LVEF、ANP、BNP较治疗前及常规治疗组明显升高(P<0.05)。心钠素治疗组总有效率为87.5%,高于常规治疗组的62.5%(P<0.01)。结论慢性CHF患者血浆心钠素水平明显降低,且随心衰程度的加重明显降低。人工合成的心钠素有助于改善心衰患者的临床症状和心功能。

Objective To explore the variation of atrial natriuretic peptide （ANP） and effectiveness of ANP for chronic heart failure patients. Methods 80 chronic heart failure patients were randomly divided to test group and control group.Control group was treated with cardiac,diuretic and nitrate esters. Test group was treated with cardiac, diuretie and nitrate esters and synthetic ANP 2 weeks. Results The contents of plasma ANP were （198.5±68.9）pg/ml while the contents of plasma LVEF were （36.8±8.7）% pretherapy. The two items were singnifiantly lower than those in the eontrol group that ANP were （289.8±0.2）pg/ml and LVEF were （63.2±10.8）%（P〈 0.01 ）. The contents of plasma ANP in the group of NYHA grade- Ⅱ were （235.7±73.8）pg/ml,those in the group of NYHA grade- Ⅲ were （200.3~67.9）pg/ml,and those in the group of NYHA grade-IV were （156.7±69.1）pg/ml. The contents of plasma ANP in the three groups were all singnifiantly lower than those in the control group （P〈 0.01 ）. The contents of plasma ANP in the group of CAD-CHF, hypertensive heart disease-CHF,hypertensive heart disease-CHF and dilated cardiomyopathy-CHF were （200.9±57.2）pg/ml, （ 195.6±75.3 ）pg/ml, （ 190.1±82.6）pg/ml and（ 193.6±79.8）pg/ml respectivelyo There were not difference in the four groups separated according to the different diseases（P〉0.05 ）.HR, SBP, DBP post-treatment were singnifiantly decreased than those pretherapy and those in the eontrol group post-treatment（P〈0.05）. LVEF,ANP,BNP post-treatment were singnifiantly increased than those pretherapy and those in the control group post-treatment（P〈O.05）.The total effective rate in ANP-therapy group is 87.5%,higher than that in the eontrol group was 62.5%（P〈0.01）.Conclusion ANP levels were significantly decreased in chronic heart failure patients, synthetic ANP could improve symptoms and eardiae ftmetion of chronic heart failure patients, and reduce the systolic pressure, heart failure of test group.