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With Cardiac Disease with Special Emphasis on -ANP Clinical Significant of Atrial Natriuretic Peoptide in Patients

心脏病特别强调-ANP心房利钠肽的临床意义

基本信息

批准号：
01480217
负责人：
MARUMO Fumiaki
金额：
$ 2.24万
依托单位：
Tokyo Medical and Dental university, School of Medicine
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1989
资助国家：
日本
起止时间：
1989 至 1990
项目状态：
已结题

项目摘要

Circulating atrial natriuretic peptide (ANP) consists predominantly of alpha-form in normal subjects. Plasma ANP levels are elevated in patients with heart failure, which increase in relation to its seventy. However, circulating forms of ANP in patients with heart failure remain unknown. To elucidate clinical significance of ANP in heart failure, we have analyzed the molecular forms of plasma ANP in patients with conjestive heart failure by gel filtration and reverse-phase HPLC. As the seventy of heart failure progressed, the proportion of beta-form to the total ANP in plasma increased, and gamma-form also appeared. Circulating beta-form conversely decreased after successful treatment for heart failure. During cardiac surgery with extracorporeal circulation, plasma ANP levels did not significantly decrease after total aortic cross claming (TACC), remarkably increased after the release of TACC, where alpha-form predominated without distinct beta- or gamma-form. In patients with chronic renal failure, the predominant circulating ANP was alpha-form, although beta-form was also present in some cases. After hemodialysis, plasma ANP levels, mostly alpha-form, decreased these rats suggest that 1) the enhanced biosynthetic activity of ANP in the faility heart is associated with the increased processing from gamma- to alpha- and beta-form, 2) the processing of ANP secreted after the release of ATCC due to immediate rise in atrial pressure appears to be essentially similar to that of normal subjects, 3) the appearance of circulating beta-form in some renal failure patients may be due to delayed metabolism, increased body fluid and or metabolic change of myocardium, although its pathophysislogical function remains undetermined. From our results it appears that circulating beta-ANP should be a useful marker as a noninvasive parameter for assessment of heart failure as well as its therapeutic outcome.

在正常人中，循环心钠素（ANP）主要由α型组成。心力衰竭患者血浆心钠素水平升高，其增加与其严重程度有关。然而，心力衰竭患者中循环形式的ANP仍不清楚。为了阐明心钠素在心力衰竭中的临床意义，我们采用凝胶过滤和反相高效液相色谱法分析了充血性心力衰竭患者血浆心钠素的分子形式。随着心力衰竭程度的加重，血浆中β型心钠素占总心钠素的比例逐渐增加，同时也出现了γ型心钠素。在成功治疗心力衰竭后，循环β-型反而减少。在体外循环心脏手术中，血浆ANP水平在全主动脉阻断（TACC）后没有显著降低，在TACC释放后显著升高，其中α形式占主导地位，没有明显的β或γ形式。在慢性肾功能衰竭患者中，主要的循环ANP是α型，尽管在某些情况下也存在β型。血液透析后，血浆ANP水平，主要是α-型，降低。这些大鼠表明：1）衰竭心脏中ANP生物合成活性的增强与γ-型到α-型和β-型的加工增加有关，2）由于心房压力立即升高，释放ATCC后分泌的ANP的加工似乎与正常受试者基本相似，（3）部分肾功能衰竭患者循环β型的出现可能是由于代谢延迟、体液增多和（或）心肌代谢改变所致，但其病理生理功能尚不明确。从我们的研究结果来看，循环β-ANP应该是一个有用的标志物，作为一个非侵入性参数评估心力衰竭以及其治疗结果。