心力衰竭患者血浆肾上腺髓质素前体N端20肽的变化

Changes of plasma levels of proadrenomedullin N-terminal 20 peptide in patients with congestive heart failure

目的 观察不同程度的充血性心力衰竭 (CHF)患者药物治疗前后肾上腺髓质素前体N端 2 0肽(PAMP)血浆含量变化 ,以探讨其临床意义。方法 用特异性放射免疫法检测了 45例CHF患者和 7例健康对照者PAMP血浆含量。结果 随心功能恶化 ,PAMP明显降低 ,在心功能Ⅳ级组PAMP水平 [( 2 79± 0 89)pg·mL- 1 ]明显低于Ⅱ级组 [( 6 2 4± 1 71)pg·mL- 1 ]、Ⅲ级组 [( 7 3 8± 1 2 8)pg·mL- 1 ]和对照组 [( 8 5 6± 2 44 )pg·mL- 1 ] ( P<0 0 5 ) ,而Ⅱ、Ⅲ级组间和对照组比较无明显差异 (P >0 0 5 )。经 7d药物有效治疗 ,心衰症状缓解后 ,血浆PAMP浓度在心功能各亚组间并未发生明显改变 ,心功能Ⅳ级组仍维持较低水平。结论 PAMP参与了CHF发生发展的病理过程 ,可作为重度心衰的一项评定指标 。

Objectives To study the changes of plasma levels of proadrenomedullin N terminal peptide(PAMP) in patients with congestive heart faillure(CHF) before and after drug treatment and its significance.Methods Plasma PAMP levels in 45 patients with CHF and 7 heathy control subjects were measured by specific radioimmunoassy.Results The plasma PAMP levels in patients with CHF were significantly decreased with the deterioration of cardiac function.Plasma PAMP levels in 45 patients in NYHA class Ⅳ(2 79±0 89pg/mL) were significantly lower than those in class Ⅱ(6 24±1 71pg/mL)?class Ⅲ(7 38±1 28pg/mL) and control subjects(8 56±2 44pg/mL)(P<0 05).However,there was no significant difference in plasma PAMP levels among those of class Ⅱ?Ⅲ and control subjects.After treatment of 7 days,there was no significant change in plasma PAMP levels in patients with CHF compared with those before treatment.But the plasma PAMP levels in class Ⅳ maintained a lower level.Conclusions PAMP may be involved in the development of heart failure.Plasma levels of PAMP in patients with CHF may serve as an important index of severe heart failure.Short term drug treatment can not reverse the plasma PAMP levels.