肾胺酶与肾交感神经活性在慢性心力衰竭中的作用

Roles of renalase and renal sympathetic nerve activity in patients with chronic heart failure

摘要目的：探讨肾胺酶与局部肾交感活性在慢性心力衰竭中的作用。方法：测定60例慢性心力衰竭患者和42例对照组血浆肾素（PRA）、血管紧张素Ⅰ（AngⅠ）、血管紧张素Ⅱ（AngⅡ）、肾上腺素（E）、去甲肾上腺素（NE）及肾胺酶活性。观察不同纽约心功能分级（NYHA）心衰患者间PRA及肾胺酶等指标间的差异及相关关系。结果：心衰组PRA、E、NE、AngⅠ活性增高，肾胺酶活性降低。与轻微心衰组相比，严重心衰组肾胺酶活性及左室射血分数降低（P分别为〈0．01、0．034），N末端脑钠尿肽前体（NT—proBNP）及PRA增高（均P〈0．01）。线性相关分析显示肾胺酶活性与L0gNT-pmBNP（r=-0．400，P=0．002）。LogNE（r=-0．315，P=0．014）呈负相关。多因素LDgistic回归分析显示，NT-proBNP（OR=6．962，95％CI=1．223～39．638）、PRA（OR=3．736，95％CI=1．031-13．540）及肾胺酶活性（OR=0．253，95％CI=0．069—0．927）是影响NYHA级别高低的独立因素。结论：慢性心衰患者反映肾交感神经活性的指标PRA增加，肾胺酶活性降低，且与心衰严重程度有关。

Objective To assess the roles of renalase and renal sympathetic nerve activity in patients with chronic heart failure （CHF）. Methods Plasma renin activity （PRA）, angiotensin Ⅰ （Ang Ⅰ ）, angiotensin Ⅱ （Ang Ⅱ ）, adrenaline （E）, noradrenaline （NE） and renalase were determined in 60 patients with C HF （CHF group） and in 42 healthy cases （control group）. Data were compared between patients with mild and serious CHF. Results PRA, E, NE and Ang Ⅰ increased and renalase decreased in CHF group than those in control group. Compared with mild CHF, renalase and left ventricular ejection fraction decreased （P 〈 0.01, 0.034）, while N- terminal pro-B-type natriuretic peptide （NT-proBNP） and PRA significantly increased （P 〈 0.01 ）. Linear correlation analysis showed that renalase was inversely correlated with Log NT-proBNP （r = -0.400, P = 0.002） and Log NE （r = -0.314, P = 0.014）. Logistic regression analysis showed that NT-proBNP （OR = 6.963, 95%CI = 1.223 to 39.638）, PRA（OR = 3.736, 95%CI = 1.031 to 13.540） and renalase （OR = 0.253, 95%CI = 0.069 to 0.927） were associated with increased NYHA classes. Conclusions PRA would increase while renalase would decrease in patients with CHF. PRA and renalase were correlated to the severity of CHF.