经皮穿刺球囊二尖瓣成形术前后血浆心钠素、肾素-血管紧张素-醛固酮水平的变化

Changes of plasma atrial natriuretic factor and renin angiotensin aldosterone system before and after percutaneous balloon mitral valvuloplasty

目的 观察风心病二尖瓣狭窄 (MS)患者经皮穿刺球囊二尖瓣成形术 (PBMV)前后血浆心钠素 (ANF)、肾素 (PRA) -血管紧张素 (AT) -醛固酮 (Ald)系统 (RAAS)以及血液动力学的变化。方法 采用放射免疫分析法 (RIA)测定正常组与MS组PBMV前后血浆ANF和RAAS的水平 ;二尖瓣口面积 (MVA)、平均跨瓣压差 (PGmean)的测定用超声心动图 (UCG) ;平均左房压 (LAP)的测定用心导管法。结果 MS组PBMV术前ANF、PGmean均明显高于正常组 (P <0 .0 0 1) ,MVA低于正常组(P <0 .0 0 1) ,PRA、AT -Ⅱ、Ald与正常组比较无统计学差异 (P >0 .0 5 ) ;PBMV术后ANF、PGmean、LAP均明显降低 (P <0 0 0 1) ,MVA明显扩大 (P <0 .0 0 1) ,PRA、AT -Ⅱ、Ald与术前比较无显著差异 (P >0 .0 5 ) ;ANF水平与PGmean ,LAP成正相关关系 ,(相关系数r分别为 0 .40 ,0 .41,P <0 .0 5 )与MVA呈负相关关系 (r为 - 0 .39,P <0 .0 5 ) ;RAAS水平与ANF水平、血液动力学参数无相关关系。结论 ANF水平变化与血液动力学改善明显相关 ,与RAAS水平无相关关系 ,说明人体内ANF与RAAS的相互联系和相互影响较为复杂 ,可能与心功能不全。

Objective[WT5”BZ] To investigate changes of plasma atrial natriuretic factor(ANF),renin(PRA)angiotensin(AT) aldosterone(Ald)system(RAAS)and hemodynamics before and after percutaneous balloon mitral valvuloplasty(PBMV)in 19 patients with rheumatic mitral stenosis(MS).[WT5”BX]Methods[WT5”BZ] Plasma ANF,PRA AT II Ald were measured in 19 healthy subjects and in 19 MS patients before and after PBMV by radioimmunoassay(RIA). Mitral valve area(MVA)and mean pressure gradient across the mitral valve(PGmean) were measured by ultrasonic cardiography(UCG),and left atrial pressure(LAP)by cardiac catheterization. [WT5”BX]Results[WT5”BZ] Plasma levels of ANF and PGmean were higher and MVA was smaller in MS patients before PBMV than those in healthy people( P <0 001);PRA,AT Ⅱ and Ald were not significantly different compared with the normal( P >0.05).After PBMV,ANF decreased〔from (357.89±187.97) to (214.79±131.91) ng/L, P <0.001〕,PGmean decreased〔from (1.79±1.03) to (0 59±0 27)kPa, P <0 001〕,LAP decreased〔from (2.39±0.85) to (1.52±0.51) kPa, P <0.001〕,MVA increased〔from (0.85±0.20) to (1.64±0.36)cm 2, P <0.001〕,PRA,AT Ⅱ and Ald were not significantly changed.There were significant correlations between PGmean and ANF( r =0.40, P <0.05),LAP and ANF( r =0.41, P <0.05),MVA and ANF( r = 0.39, P <0.05).There was no significant correlation between RAAS and ANF, and RAAS and hemodynamics. [WT5”BX]Conclusion[WT5”BZ] There is a significant correlation between the improvement of hemodynamics and the changes of plasma ANF.There is not a significant correlation between RAAS and ANF.These findings indicate that there is a complex relationship between RAAS and ANF.Cardiac function and hemodynamics might be involved in its regulation.