肺源性心脏病患者急性发作期和缓解期血浆CNP、ADM的变化及意义

Changes and significants of plasma CNP and ADM levels in acute exacerbation and clinical remission stages of patients with chronic pulmonary heart disease

目的探讨C型利钠肽(CNP)及肾上腺髓质素(ADM)在慢性肺源性心脏病急性发作期和缓解期的水平及其临床意义。方法以放射免疫法检测观察组100例慢性肺源性心脏病急性加重期和缓解期及正常对照组60例健康体检者血浆CNP、ADM水平的变化,同时测定血氧分压和二氧化碳分压。结果 (1)观察组患者急性加重期和临床缓解期血浆CNP[(60.21±15.48)ng/L,(48.95±29.40)ng/L],ADM[(45.66±28.64)pg/ml,(28.95±14.35)pg/ml]水平均显著高于正常对照组[(20.16±5.56)ng/L,(19.98±5.43)pg/ml],差异有统计学意义(P<0.01);(2)观察组急性加重期血浆CNP、ADM水平显著高于临床缓解期(P<0.01);(3)观察组患者CNP、ADM与血氧分压呈负相关(r=-0.622,-0.702,P<0.05),与血二氧化碳分压无明显相关性(r=0.205,0.233,P>0.05);(4)血浆CNP与ADM呈正相关(r=0.279,P<0.05)。结论血浆CNP、ADM水平变化可以反映慢性肺源性心脏病患者的临床病情变化。

Objective To investigate clinical significance of plasma c-type natriuretic peptide（CNP）and adrenomedullin（ADM）levels in acute exacerbation and clinical remission stages of patients with chronic pulmonary heart disease. Methods Plasma levels of CNP and ADM were measured by radioimmoassay in acute exacerbation and clinical remission stages of 100 patients with chronic pulmonary heart disease, oxygen partial pressure and carbon dioxide partial pressure were also measured at the same time. Plasma levels of CNP and ADM were measured in 60 healthy persons as normal control. Results （1） The plusma levels of CNP[（60.21±15.48）ng/L,（48.95±29.4）ng/L]and ADM（45.66±28.64,28.95±14.35）pg/ml of acute exacerbation and remission stage patients in observe group are all higher than those of normal control group（20.16±5.56,19.98±5.43）pg/ml,and the differents are significant（both P〈0.01）;（2）Plasma levels of CNP and ADM in acute exacerbation were significantly higher than that in clinical remission stages（P〈0.01）;（3）Plasma levels of CNP and ADM in patients with pulmonary heart disease were negatively correlated with oxygen partial pressure but has no particular correlation with carbon dioxide partial pressure（r=-0.622,-0.702,all P〈0.05;r=0.205, 0.233,all P〉0.05）;（4）Plasma level of CNP was positively correlated with that of ADM（r=0.279,P〈0.05）. Conclusions Plasma levels of CNP and ADM may contribute to the assessment of clinical condition in patient with pulmonary heart disease.