HORMONAL CHANGES IN PATIENTS WITH SEVERE CHRONIC CONGESTIVE-HEART-FAILURE TREATED BY ULTRAFILTRATION
HORMONAL CHANGES IN PATIENTS WITH SEVERE CHRONIC CONGESTIVE-HEART-FAILURE TREATED BY ULTRAFILTRATION
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DOI：
10.1093/oxfordjournals.ndt.a092133
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发表时间：
1992-01-01
影响因子：
6.1
通讯作者：
SIMONSEN, S
中科院分区：
文献类型：
--
作者：
FORSLUND, T;RIDDERVOLD, F;SIMONSEN, S
对5例连续2天进行超滤治疗的慢性充血性心力衰竭患者血浆心房利钠肽（ANP）、抗利尿激素（ADH）、血浆肾素活性（PRA）及循环血流动力学进行了研究。这些患者属于纽约心脏协会IV级，被认为是心脏移植的候选者。在每次超滤期间，平均去除3.3 +/- 0.5升液体。在超滤过程中，血浆ANP浓度保持不变，开始时为369 +/- 151 pg/ml，结束时为316 +/- 116 pg/ml，而血浆ADH浓度和PRA浓度分别从5.1 +/- 2.1增加到7.5 +/- 3.4 pg/ml (P < 0.02), 5.9 +/- 3.0增加到7.7 +/- 3.2 ng/ml (P < 0.03) （n = 10）。治疗后血浆ADH、PRA在1 h内降至基线值，肺动脉压、肺毛细血管楔压、右心房压明显下降，超滤期间血压、心率保持不变。取出体积为3.3 +/- 0.5升的液体，使胶体渗透压从22.0 +/- 3.0增加到33.7 +/- 3.9 mmHg （P < 0.02）。出乎意料的是，血浆ANP浓度没有下降。由于长期严重的心力衰竭，心房壁可能已经失去了一些弹性特性，导致适应充盈压力降低的能力下降。因此，心房壁拉伸保持不变，解释了ANP水平不变。超滤治疗增加了对利尿剂治疗的反应，4名患者存活了足够长的时间，接受了心脏移植。
Plasma atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), plasma renin activity (PRA), and circulatory haemodynamics were studied in five patients with chronic congestive heart failure undergoing ultrafiltration on two consecutive days. The patients were in the New York Heart Association class IV, and were considered candidates for heart transplantation. A mean of 3.3 +/- 0.5 litres of fluid was removed during each ultrafiltration.Plasma ANP concentration remained unchanged during ultrafiltration: 369 +/- 151 pg/ml at start and 316 +/- 116 pg/ml at the end, while plasma ADH concentration and PRA increased from 5.1 +/- 2.1 to 7.5 +/- 3.4 pg/ml (P < 0.02), and 5.9 +/- 3.0 to 7.7 +/- 3.2 ng/ml (P < 0.03) respectively (n = 10). After treatment, plasma ADH and PRA declined to baseline values within 1 h. Pulmonary artery, pulmonary capillary wedge, and right atrial pressures decreased significantly, while blood pressure and heart rate remained constant during ultrafiltration. A volume of 3.3 +/- 0.5 litres of fluid was removed, and caused an increase in colloid osmotic pressure from 22.0 +/- 3.0 to 33.7 +/- 3.9 mmHg (P < 0.02).It was unexpected that plasma ANP concentration did not decline. Due to long-standing severe heart failure the atrial wall may have lost some of its elastic properties, resulting in less ability to adapt to reduced filling pressures. Accordingly, atrial wall stretch remained unchanged, explaining the constant ANP levels. Ultrafiltration treatment caused an increased responsiveness to diuretic therapy, and four patients survived long enough to receive heart transplants.