血浆心钠肽、脑钠肽、N末端脑钠肽及内皮素-1在体外膜肺氧合过程中的变化

Extracorporeal membrane oxygenation affects the concentrations of ANP,BNP,NT-pro BNP and ET-1 in plasma of dogs

目的:通过动态监测体外膜肺氧合(ECMO)过程中血浆心钠肽(ANP)、脑钠肽(BNP)、N末端脑钠肽(NT-pro BNP)及内皮素-1(ET-1)浓度的变化,寻找监测ECMO过程中心肌功能变化的有效指标。方法:选择健康雄性杂种犬6只,于股动静脉行VA ECMO,在ECMO开始前30 min和开始后1、2、3、6、24、36 h取血浆,应用ELISA检测血浆ANP、BNP、NT-pro BNP和ET-1的动态变化。结果:与ECMO开始前比较,转流开始后3 h血浆BNP浓度显著升高,差异有统计学意义(P<0.05),24 h到达最高值16.12 pg/mL,之后呈下降的趋势,在第36 h时下降至13.53 pg/mL;转流开始后24 h血浆NT-pro BNP浓度显著升高(P<0.05),并达到最高值541.83 pg/L,36 h时NT-pro BNP浓度又显著下降至460.05 pg/L;转流开始后1 h ANP浓度显著升高(P<0.05),并达到最高值26.33 pg/mL,之后恢复到转流前水平,24 h时再次升高达到23.75 pg/mL,但与转流开始前相比,差异无统计学意义(P>0.05),之后逐渐下降;转流开始后1 h与转流前30 min相比,血浆ET-1浓度显著下降至65.07 pg/mL(P<0.05),之后又恢复到ECMO开始前水平。结论:血浆BNP、NT-pro BNP、ANP和ET-1浓度可作为监测ECMO对心肌功能影响的有效指标。

Objective： To explore useful indicators to monitor the change of myocardial function during ECMO by examining the dynamic changes of the concentrations of atrial natriuretic peptide （ANP）, brain natriuretie peptide （BNP）, N terminal pro-brain natriuretic peptide （NT-pro BNP） and endothelin-1 （ET-1） in the plasma of dogs. Methods： Six healthy mongrel male dogs were selected, treated by V-A ECMO at the femoral artery and femoral vein. The plasma samples were collected at the 30 minutes before the ECMO began and at 14 hour, 2nd hour, 34 horn, 6th hour, 24th hour and 36th hour after it. ANP, BNP, NT-pro BNP and ET-1 in the plasma were measured by ELISA to determine the dynamic changes of those. Results： Compared with the plasma level before ECMO, the concentration of BNP increased significantly at 4th, 5th, 6th, 24th hours after ECMO began （P〈0.05）, reaching the highest level 16.12 pg/mL at 24th time point, then decreasing to the level before ECMO began; the concentration of NT-pro BNP increased significantly at 24th time point after ECMO began （P〈0.05） and reached to the highest level 541.83 pg/L ,then decreased again to 460.05 pg/L; the concentration of ANP increased significantly at 1a hour after ECMO began （P〈0.05）, reaching the highest point of 26.33 pg/mL, while at 24th hour increased again to 23.75 pg/mL. But no statistical difference was found （P〉0.05）. The concentration of ET-1 decreased significantly at 1st hour after ECMO began （P〈0.05）, dropping to 65.07 pg/mL, then recovered to the level before ECMO began. Conclusion： The concentrations of BNP, NT-pro BNP, ANP and ET-1 in the plasma can be used to monitor the dynamic change of myocardial function during ECMO.