高血压病、心力衰竭患者血浆肾上腺髓质素前体N端20肽测定的临床意义

Clinical Study of Proadrenomedullin N-Terminal 20 Peptide in Essential Hypertension and Heart Failure

目的 肾上腺髓质素是 1993年发现的一种血管活性多肽 ,肾上腺髓质素前体N端 2 0肽是由其前体产生四个活性片段之一 ,本文观察高血压病和心功能不全患者血浆肾上腺髓质素前体N端 2 0肽水平的变化 ,探讨其病理生理作用。方法 用放免方法测定血浆肾上腺髓质素前体N端 2 0肽、内皮素、血管紧张素Ⅱ含量 ,高压液相测定血浆去甲肾上腺素和肾上腺素水平。结果 对照组肾上腺髓质素前体N端 2 0肽为(18 4 2± 2 33)ng L ,高血压病组为对照组的 1 6 2倍 (P <0 0 1) ,心力衰竭组为对照组的 1 5 3倍 (P <0 0 5 ) ;两组病人血浆肾上腺髓质素前体N端 2 0肽水平与内皮素、血管紧张素Ⅱ、去甲肾上腺素、肾上腺素呈显著正相关 (P <0 0 5 )。结论 心力衰竭和高血压病病人血浆肾上腺髓质素前体N端 2 0肽水平明显高于健康对照组。升高的肾上腺髓质素前体N端 2 0肽可能参与了心力衰竭和高血压病的病理过程 ,肾上腺髓质素前体N端 2 0肽水平的升高对机体具有一定的保护作用。

Objective The adrenomedullin is a vasodilative peptide found in 1993. Now it is proved that the proadrenomedullin can be divided 4 peptides by the endoenzyme. The proadrenomedullin N terminal 20 peptide (PAMP) is one of fourth. The PAMP has many function on cardiovascular physiology. But so far we have not found much the relationship PAMP with cardiovascular diseases. In this study we investigated its plasma levels in the patients with essential hypertension (EH) and heart failure (HF) and discussed its pathophysiological effect.Methods The plasma level of PAMP?endothilin (ET)?angiotension Ⅱ(AngⅡ) were measured with RIA and norepinephrine (NE)?epinephrine (E) were measured with HPLC. Results The plasma level of PAMP in control group was (18.42±2.33) ng/L, EH group was 1.62 times higher than control group and HF group was 1.53 times, its were significantly different compared with the control group respectively ( P <0 05). The plasma levels of PAMP in patients group were positive correlationship with ET?Ang Ⅱ?NE?E( P <0.05). Conclusion The plasma levels of PAMP in patients were higher than control group and these may involved with the pathophysiological process of EH?HF. The elevation of plasma level of PAMP may play the protective role for the patients.\;