The natriuretic peptides in heart failure: Diagnostic and therapeutic potentials
The natriuretic peptides in heart failure: Diagnostic and therapeutic potentials
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DOI：
10.1111/paa.1999.111.5.406
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发表时间：
1999-09-01
期刊：
影响因子：
--
通讯作者：
Burnett, JC
中科院分区：
文献类型：
--
作者：
Chen, HH;Burnett, JC
利钠肽是一组结构相似但遗传上不同的肽，在心血管、肾脏和内分泌稳态中具有不同的作用。心房利钠肽（ANP）和脑利钠肽（BNP）是心肌细胞来源，C型利钠肽（CNP）是内皮细胞来源。ANP和BNP与利钠肽-A受体（NPR-A）结合，NPR-A通过3 '，5'-环鸟苷一磷酸（cGMP）介导尿钠排泄、血管舒张、肾素抑制、抗有丝分裂和促生长特性。CNP缺乏利钠作用，但通过鸟苷酸环化酶连接的利钠肽-B受体（NPR-B）具有血管舒张和生长抑制作用;所有三种肽均被利钠肽-C受体（NPR-C）清除，并被胞外酶中性内肽酶24.11（NEP）降解，这两种酶均在肾脏、肺和血管壁中广泛表达。充血性心力衰竭（CHF）是一种病理状态，其中利钠肽的激活超过了所有其他状态。本文就利钠肽在CHF中的重要作用、利钠肽在无症状性左心室功能不全（LVD）中的作用、利钠肽低反应性在严重心力衰竭中的作用机制、利钠肽在CHF中的诊断和预后意义、利钠肽在心力衰竭中的作用机制、利钠肽在以及利钠肽在这种多器官综合征中的治疗潜力。
The natriuretic peptides are a group of structurally similar but genetically distinct peptides that have diverse actions in cardiovascular, renal, and endocrine homeostasis. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are of myocardial cell origin and C-type natriuretic peptide (CNP) is of endothelial origin. ANP and BNP bind to the natriuretic peptide-A receptor (NPR-A), which, via 3',5'-cyclic guanosine monophosphate (cGMP), mediates natriuresis, vasodilatation, renin inhibition, antimitogenesis, and lusitropic properties. CNP lacks natriuretic actions but possesses vasodilating and growth-inhibiting actions via the guanylyl cyclase-linked natriuretic peptide-B receptor (NPR-B); All three peptides are cleared by the natriuretic peptide-C receptor (NPR-C) and are degraded by the ectoenzyme neutral endopeptidase 24.11 (NEP), both of which are widely expressed in the kidneys, lungs, and the vascular wall. Congestive heart failure (CHF) represents a pathological state in which the activation of the natriuretic peptides exceeds those of all other states. In this brief review, we will at-tempt to provide an update on important issues regarding natriuretic peptides in CHF, with a focus on their functional importance as a beneficial humoral response in asymptomatic left ventricular dysfunction (LVD), the mechanisms of natriuretic peptide hyporesponsiveness in severe heart failure, the diagnostic and prognostic significance of the natriuretic peptides in CHF, and the therapeutic potential of the natriuretic peptides in this multiorgan syndrome.