充血性心力衰竭患者血浆肾上腺髓质素与内皮素、血管紧张素Ⅱ关系的初步研究

The Changes of Plasma Adrenomedullin Levels in Patients With Congestive Heart Failure and the Preliminary Study of Correlation Between the Plasma Adrenomedullin and Endothelin and AngiotensinⅡ

目的：研究充血性心力衰竭患者血浆肾上腺髓质素（ＡＭ）含量变化及其与血浆内皮素、血管紧张素Ⅱ的关系。方法：用放射免疫法测定了９５例心力衰竭患者（心力衰竭组）和５０例正常人（正常对照组）的血浆ＡＭ、内皮素和血管紧张素Ⅱ含量，同时用彩色超声心动图测定了５６例心力衰竭患者的左心室射血分数。结果：心力衰竭组患者血浆ＡＭ含量高于正常对照组（５０．６４±２３．１３ｎｇ／Ｌ比１６９２±４．０９ｎｇ／Ｌ，Ｐ＜０．００１）；心力衰竭患者血浆ＡＭ、内皮素、血管紧张素Ⅱ含量升高程度与心力衰竭严重程度相平行；心力衰竭患者血浆ＡＭ与内皮素、血浆ＡＭ与血管紧张素Ⅱ含量均呈显著正相关（ｒ＝０．７２１８，Ｐ＜０．００１；ｒ＝０．６５６６，Ｐ＜０．００１）；血浆ＡＭ含量与左心室射血分数呈显著负相关（ｒ＝－０．６２５８，Ｐ＜０．００１）；血浆ＡＭ与心力衰竭的原发病因无关。结论：ＡＭ参与了心力衰竭的病理生理过程。

Objective:To observe the changes of plasma adrenomedullin(AM) levels in patients with congestive heart failure(CHF)and to study the correlation between plasma AM and endothelin(ET) and angiotensinⅡ(AngⅡ). Methods:Plasma AM,ET and AngⅡ levels were determined by radioimmunoassay in 95 patients with CHF and 50 healthy control subjects.In 95 patients with CHF,the left ventricular ejection fraction(LVEF) of 56 patients was measured by echocardiography. Results:The plasma AM levels were significantly higher in patients with CHF than that in control subjects(50.64±23.13 ng/L vs.16.92±4.09 ng/L, p <0.001).The increase of plasma AM,ET and Ang Ⅱ was parallel with the severity of CHF.There was a significant correlation between plasma levels of AM and ET( r =0 721 8, p <0.001)and Ang Ⅱ( r =0 656 6, p <0.001).LVEF inversely correlated with plasma AM levels in the patients( r =-0.625 8, p <0.001).There was no obvious relation between the plasma AM levels and the primary causes of CHF. Conclusion:These results suggest that AM might play a certain role in the pathophysiology of CHF.The elevated plasma ET and Ang Ⅱ may be responsible for the rise of plasma AM levels in patients with CHF.The plasma AM levels in patients with CHF may serve as an index of the severity of CHF.