Possibility of downregulation of atrial natriuretic peptide receptor coupled to guanylate cyclase in peripheral vascular beds of patients with chronic severe heart failure.
Possibility of downregulation of atrial natriuretic peptide receptor coupled to guanylate cyclase in peripheral vascular beds of patients with chronic severe heart failure.
复制标题
慢性严重心力衰竭患者外周血管床中与鸟苷酸环化酶偶联的心房钠尿肽受体下调的可能性。
作者：
T. Tsutamoto;T. Kanamori;N. Morigami;Y. Sugimoto;O. Yamaoka;M. Kinoshita
背景
高水平的内源性心钠素（ANP）被认为是通过减少前负荷和后负荷来补偿心力衰竭患者的状况。然而，最近的报道表明，高血浆心钠素水平是心力衰竭患者的预后预测因子。因此，内源性ANP在心力衰竭患者中的作用尚未明确。
方法和结果
测定97例慢性充血性心力衰竭（CHF）患者股动脉和股静脉血浆心钠素（ANP）和环鸟苷酸（cGMP）水平。从股动脉到股静脉，血浆ANP水平显著降低，而血浆cGMP水平显著升高。在轻度CHF患者中（n = 52），血浆cGMP水平与ANP水平相关，计算的ANP提取水平也与计算的外周循环cGMP产生水平相关（r = 0.70，p < 0.001）。相反，这些相关性在重度CHF患者中未发现（n = 45）。在这些患者中，尽管血浆ANP水平高，但血浆cGMP水平似乎达到平台，并且外周循环中cGMP产生与ANP提取的摩尔比显著低于轻度CHF患者（36.7 +/- 9.5对183 +/- 17，p < 0.001）。在急性重度CHF患者（n = 9）和轻度CHF患者中，给予外源性ANP的患者，血浆cGMP水平与血浆ANP水平成比例增加，但不饱和。
结论
这些结果表明，与鸟苷酸环化酶偶联的ANP受体下调可能发生在慢性严重CHF患者的外周血管床。
BACKGROUND
High levels of endogenous atrial natriuretic peptide (ANP) are thought to compensate the condition of patients with heart failure by reducing preload and afterload. However, recent reports have indicated that a high plasma ANP level is a prognostic predictor in patients with heart failure. Therefore, the role of endogenous ANP has not been clearly established in patients with heart failure.
METHODS AND RESULTS
The plasma ANP and cGMP levels were determined in the femoral artery and the femoral vein of 97 patients with chronic congestive heart failure (CHF). The plasma ANP level decreased significantly, whereas the plasma cGMP levels increased significantly from the femoral artery to the femoral vein. Among patients with mild CHF (n = 52), the plasma cGMP level correlated with the ANP level, and the calculated ANP extraction level also correlated with the calculated cGMP production in the peripheral circulation (r = 0.70, p < 0.001). In contrast, these correlations were not found in patients with severe CHF (n = 45). Among these patients, the plasma cGMP levels seemed to reach a plateau despite high levels of plasma ANP, and the molar ratio of cGMP production to ANP extraction in the peripheral circulation was significantly lower than in patients with mild CHF (36.7 +/- 9.5 versus 183 +/- 17, p < 0.001). In patients with acute severe CHF (n = 9) and those with mild CHF, patients who were administered exogenous ANP, plasma cGMP levels increased in proportion to those of plasma ANP without saturation.
CONCLUSIONS
These results indicate that downregulation of ANP receptors coupled to guanylate cyclase may occur in the peripheral vascular beds of patients with chronic severe CHF.
人体免疫反应性心房钠尿激素血浆水平与血流动力学功能之间的关系。
影响因子：
37.8
作者：
Bates,ER;Shenker,Y;Grekin,RJ
通讯作者：
Grekin,RJ