心力衰竭患者血清钠对血浆肾素、醛固酮和心钠素的影响

The effects of serum sodium on the levels of plasma renin, aldosterone and atrial natriuretic peptide in patients with congestive heart failure

目的 探讨充血性心力衰竭患者血清钠水平对肾素 血管紧张素 醛固酮系统和心钠素 (ANP)活性的影响。方法 将 12 5例住院心衰患者按血清钠水平分为正常血钠组 (4 7例 )和低钠血症组 (78例 ) ,测定并比较两组患者的血浆肾素 (PRA)、醛固酮 (ALD)和ANP ;低钠血症组患者经补盐和 (或 )限水纠正血钠后 ,采用自身对照的方法 ,观察治疗前后血浆PRA、ALD和ANP的变化。结果 ①低钠血症组患者血浆PRA和ALD水平明显高于正常血钠组患者 (2 .6 7± 0 .2 8与 2 .18± 0 .2 0 ,4 6 1± 2 6 .3与 4 36± 12 .5 ,P <0 .0 1) ,血浆ANP水平前者低于后者 (14 8.0± 14 .5与 174 .0± 15 .1,P <0 .0 1)。② 78例血钠水平被纠正后的低钠血症组患者血浆ANP和ALD水平较补盐前下降 (2 .18± 0 .2 0与 2 .70± 0 .2 6、4 36 .0± 12 .5与 4 6 7.0± 2 5 .9,P <0 .0 1) ,血浆ANP水平较补盐前上升 (172 .0± 16 .2、14 8.0± 14 .5 ,P <0 .0 1)。③心衰患者血清钠水平与血浆PRA和ALD水平呈负相关 (r=- 0 .198,r=- 0 .75 3,P <0 .0 1) ,与ANP水平呈正相关 (r=0 .739,P <0 .0 1)。结论 充血性心衰患者宜适当补盐以维持正常血钠水平 ,这将有利于肾素 血管紧张素 醛固酮系统和ANP之间的平衡。

Objective To investigate the effects of serum sodium on the activation of renin-angiotensin-aldosterone system and atrial natriuretic peptide(ANP) in patients with congestive heart failure. Methods 125 patients with congestive heart failure were divided into two groups according to their serum sodium levels: normal serum sodium group(n=47) and hyponatremia group(n=78). The levels of plasma renin(PRA), aldosterone(ALD) and atrial natriuretic peptide(ANP) in both groups were determined and compared.PRA, ALD and ANP in hyponatremia after the patients were given salt and limited to water for adjusting serum sodium were observed with self-control. Results The levels of plasma PRA and ALD were significantly elevated in hyponatremia patients as compared with normal patients(2.67±0.28 vs 2.18±0.20 & 461±26.3 vs 436±12.5,respectively, both P<0.01), and the levels of plasma ANP in the former were lower than those in the latter(148±14.5 vs 174±15.1,P<0.01). The levels of plasma PRA and ALD in hyponatremia patients were decreased and the levels of plasma ANP elevated when hydonatremia in these patients were corrected(2.18±0.20 vs 2.70±0.26, 436.0±12.5 vs 467.0±25.9 & 172.0±16.2 vs 148.0±14.5 respectively, all P<0.01). Serum sodium was negatively correlated with the levels of plasma ALD and PRA(r=-0.753 & r=-0.198 respectively, both P<0.01), and there was positive correlation between the level of plasma ANP and serum sodium(r=0.739, P<0.01). Conclusion An appropriate supplement of sodium can maintain the balance between the activity of renin-angiotensin-aldosterone system and ANP in patients with congestive heart failure.