高血压病患者血浆心钠素水平变化及其临床意义

CHANGE OF PLASMA ATRIAL NATRIURETIC PEPTIDE ANDITS CLINICAL SIGNIFICANCE IN EH PATIENTS

目的：为探讨高血压病（ＥＨ）患者血浆心钠素（ＡＮＰ）浓度变化与左室舒张功能（ＬＶＤＦ）和左室肥厚（ＬＶＨ）的关系。方法：采用脉冲多谱勒超声心动图和放射免疫分析方法，分组对８４例ＥＨ患者和３６例正常人的心脏结构、ＬＶＤＦ和ＡＮＰ水平进行了检测。结果：Ｄｏｐｐｌｅｒ显示：与正常对照组相比，单纯ＥＨ患者的Ｅ峰、Ｅ／Ａ比值降低，Ａ峰增高（Ｐ＜００５）；伴左房扩大（ＬＡＥ）或／和ＬＶＨ时改变更明显（Ｐ＜００５～０．０１）。血浆ＡＮＰ与血压及ＬＶＨ有关，血压越高，左室重量指数（ＬＶＭＩ）越大，ＡＮＰ浓度亦越高。ＥＨ伴ＬＡＥ和／或ＬＶＨ时，血浆ＡＮＰ浓度更增高。相关分析表明，血浆ＡＮＰ与平均动脉压（ＭＡＰ）、左房内径（ＬＡＤ）及ＬＶＭＩ均呈正相关（ｒ＝０．５７８６，ｒ＝０．４９４３，ｒ＝０．４８０６，Ｐ＜００１），ＡＮＰ与Ｅ／Ａ比值有良好的负相关性（ｒ＝－４８７３，Ｐ＜００１）。结论：提示高血压的发生、发展，ＬＶＨ的形成及左心室舒张功能受损（ＬＶＤＤ）与血浆ＡＮＰ可能有一定关系。测定ＡＮＰ水平。

Objective:To study the relationship between changes of plasma atrial natriuretic peptide(ANP)level and left ventricular diastolic function(LVDF),left ventricular hypertrophy(LVH) in patients with essential hypertension(EH).Methods:Pulsed Doppler echocardiograph was performed to detect heart structure,LVDF,and immunoradiometric assay was used to measure the plasma peptide level in 84 EH patients,classified into three groups according to diastolic blood pressure.Results:Compared with the 36 agematched normal subjects,the peak E,and E/A ratio were markedly reduced,the peak A was significantly increased in mildmoderate EH patients.The plasma ANP level in EH patients was higher than that in normal subjects(P<005)。It was found that increase of plasma ANP was closely related with the severity of hypertension.These changes were more obvious in patients with left atrial enlargment(LAE) or/and LVH than that of patients without LAE or/and LVH(P<005～0.01)。The analysis of linear correlation showed that the level of plasma ANP positively correlated with mean artery pressure(MAP),LAD and LVMI(r=0.5786,r=0.4943,r=0.48