充血性心力衰竭时血浆心钠素含量的变化和意义

CHANGES OF PLASMA ATRIAL NATRIURETIC POLYPEPTIDE LEVELS AND IT'S SIGNIFICANCE IN PATIENTS WITH CONGESTIVE HEART FAILURE

目的 :进一步探讨充血性心力衰竭 (CHF)时血浆心钠素 (PANP)含量的变化和意义。方法 :测定 43例正常人及 97例CHF患者的PANP含量并测定CHF患者的左心室舒张末期内径 (LVEDD)和左心室射血分数(LVEF) ,对LVEF正常的CHF患者测定左心室舒张功能参数 (A/E ,DCT)。结果 :a .CHF患者PANP含量显著高于正常人 ,且与心力衰竭严重程度呈正相关。b .心功能Ⅱ级和Ⅲ级的高心病组PANP含量较冠心病、风心病和扩张型心肌病组低。c .治疗后心功能明显改善的患者中 ,大部分患者PANP含量下降 ,有少部分高心病和高心病合并冠心病的患者PANP含量升高。d .CHF患者PANP含量与LVEDD呈正相关 ,与LVEF呈负相关 ;收缩性心力衰竭 (SHF)患者PANP含量与LVEDD ,LVEF相关性较弱。e .LVEF正常的CHF患者PANP含量明显高于正常人 ,与A/E ,DCT呈弱正相关。结论 :PANP含量可做为反映心衰严重程度和评价心衰疗效的一个指标。PANP不足可能是高血压病发展的因素之一。PANP含量对于反映收缩功能状态有较大意义 ,但对于SHF患者升高的PANP只能在一定程度上反映心衰的严重程度。PANP含量可做为诊断舒张功能不全的参考。

Objective:To further investigate the changes of plasma atrial natriuretic polypeptide(PANP) levels and their significance in patients with congestive heart failure (CHF).Methods:The PANP levels in 43 normal subjects and in 97 patients with CHF were determined.Left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction(LVEF) were also measured in patients with CHF.Doppler parameters(A/E,DCT) which represent the left ventricular diastolic function were measured in CHF patients with normal LVEF.Results:a.The PANP levels were significantly higher in patients with CHF than in normal subjects and were positively correlated with severity of heart failure.b.When cardiac function were in class Ⅱ or Ⅲ ,PANP levels were lower in patients with hypertensive heart disease than in those with coronary,rheumatic heart disease and dilated cardiomyopathy.c.PANP levels lowered in majority of the patients with the improvement of cardiac function after treatment,and elevated in a part of patients with hypertensive heart disease and hypertensive heart disease with coronary heart disease.d.PANP levels were positively correlated with LVEDD and negatively correlated wiht LVEF;PANP levels were weakly correlated with LVEDD and LVEF in patients with systolic heart failure (SHF).e.PANP levels were significantly higher in CHF patients with normal LVEF than in normal subjects and were weakly correlated with A/E, DCT.Conclusion:It suggested that PANP levels might be regarded as an index for the severity of CHF and estimating the effects of treatment. PANP insufficiency might be one of factors for developing of hypertension.PANP levels have greater meanings in reflecting left ventricular systolic function,but in patients with SHF, it might reflect the severity of heart failure in some degree.PANP levels might be as a reference for the diagnosis of insufficiency in cardiac diastolic function.