不同类型左室功能不全患者血浆心钠素、内皮素变化及相关性研究

Mitral Flow Patterns and Plasma Levels of Atrial Natriuretic Peptide and Endothelin in Left Ventricular Dysfunction Patients

目的 :分析心功能不全患者限制性充盈 (RF)和非限制性充盈 (NRF)时二尖瓣血流频谱 (MFP)、血浆心钠素 (ANP)和内皮素 (ET)的变化特点。方法 :选择 4 8例左室收缩功能不全 (LVEF <0 4 5 )的陈旧性心肌梗塞患者和 2 8名健康对照为研究对象。采用经胸多普勒超声心动图 (TDE)检测左房前后径 (LA)、左室舒末内径 (LVD)、左室射血分值 (LVEF)和MFP ;用12 5I放射免疫均相竞争法检测血浆ANP和ET浓度。结果 :按照二尖瓣舒张早期最大血流速度 (E)与舒张晚期最大血流速度 (A)的比值 (E/A)和E波减速时间 (DT)将病例组分类 :RF组 2 8例 ,NRF组 2 0例。NRF组和RF组LVD均扩大 ,ANP和ET升高 ;RF组与NRF组比较 ,LA(41 6 1± 7 5 6mm)和LVD(6 3 5± 10 2 9mm)显著扩大 (P均 <0 0 1) ,LVEF减低 6 %(P <0 0 5 ) ,心功能分级Ⅲ～Ⅳ (NYHA)患者所占比例较大 (P <0 0 1) ,血浆ANP和ET水平显著升高 (P均 <0 0 0 1)。病例组患者血浆ANP浓度与E/A相关 (r=0 6 9,P均 <0 0 1)。结论 :RF组患者收缩功能障碍和心室重构严重 ,血浆ANP和ET水平显著升高 ;

Objective: To study the hemodynamic alterations of mitral flow patterns(MFP) and plasma levels of atrial natriuretic peptide(ANP)and endothelin(ET) in left ventricular dysfunction patients with restrictive filling(RF) or non-restrictive filling(NRF) patterns Methods: Forty eight patients with remote myocardial infarction and systolic heart failure(left ventricular ejection fraction<0 45) and 28 controls underwent two-dimension transthoracic Doppler echocardiography to measure the left atrial anteroposterior diameter(LAAPD),left ventriole end-diastolic diameter(LVEDD),left ventricle ejection fraction(LVEF) and mitral flow pattern(MEP),and subject's plasma levels of ANP and ET were simultaneously measured by radioimmunossay Results:According to either ratio of mitral protodiastolic maximal to late diastolic maximal flow speed(E/A) or deceleration time (DT) of E(wave) or both,the patients were assigned to two groups:restrictive filling(RF) group,28/48(58 3%)and nonrestrictive filling(NRF) group,20/48(41 7%) The patients in both groups showed their left ventricles to be larger and their plasma concentrations of ANP and ET to be higher Patients in RF group showed larger left atria and ventricles( P <0 001,respectively),higher levels of plasma ANP and ET( P <0 001,respectively),greater proportion of Ⅲ/Ⅳ grade heart failure( P <0 01) and lower LVEF ( P <0 05) than patients in NRF group ANP but not ET correlated positively with E/A( r =0 69, P <0 001) in both group patients Conclusion:The patients in both NRF and RF groups present the elevated plasma concentrations of ANP and ET Compared to NRF group,the patients in RF group show the levels of plasma ANP and ET increasing more, and systolic dysfunction and ventricular remodeling deeper ANP secretion is related to abnormal filling patterns of left ventricle