Clinical Trial of Natriuretic Peptides in Heart Failure

心力衰竭是指心脏不能将血液泵送到重要器官而导致死亡的病理状态，心房利钠肽（ANP）和脑利钠肽（BNP）均为心脏激素，具有利尿、利钠和扩血管等作用。越来越多的证据表明，利钠肽系统，特别是心钠素和脑钠素，不仅在心脏病的诊断中，而且在充血性心力衰竭的治疗中具有临床应用价值。为了进一步评价利钠肽在心脏病中的临床应用价值，我们在日本组织了三种大规模的合作研究，第一项研究的目的是前瞻性地确定一种利钠肽-ANP或BNP-在94例心导管检查中，左室功能不全的检出率为上级，优于其它两种方法。血浆BNP浓度升高是左室肥厚的一个更有力的标志物， 关于我们 通过超声心动图评价的心室收缩、舒张功能障碍和左心室肥大比血浆ANP升高的情况level.in第二项研究，为了评价血浆BNP水平是否预测老年人群的死亡率，我们3测量了来自瑞典哥德堡85岁人群的541名受试者的血浆BNP水平。我们发现，BNP水平升高显著预测总人群的5年死亡率。在已知心血管疾病的受试者中，5年死亡率与血浆BNP水平升高显著相关。在第三项研究中，我们检查了长期输注ANP对充血性心力衰竭患者血流动力学和肾功能的影响。虽然短期输注ANP可改善充血性心力衰竭，但长期输注ANP可降低前负荷并增加尿量。尽管有利尿作用，但长期输注ANP并没有恶化血清电解质平衡。我们认为利钠肽在临床上对心血管疾病的诊断和治疗是有用的。少

Heart failure is the pathological state in which the heart is unable to pump blood to vaital organs and thereby sometimes causes the death.Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are cardiac hormones, posessing natriuretic, diuretic and vasodilating activities. Accumulating evidence indicates that the natriuretic peptide system especially, ANP and BNP,is clinically useful for not only the diagnosis of heart diseases but also treatment of congestive heart failure.To further evaluate clinical usefulness of natriuretic peptides in cardiac diseases, we organize three kinds of large scale cooperative studies in Japan, United States of America and Sweden.The first study was designed to prospectively determine whether one of the natriuretic peptides-ANP or BNP-is superior to another for ditection of left ventricular dysfunction in 94 consecutive patients referred for cardiac catheterization. The elevated plasma BNP concentration was a more powerful marker of left … More ventricular systolic, diastolic dysfunction and left ventricular hypertrophy evaluated by echocardiography than the elevated plasma ANP level.in the second study, to evaluate whether the plasma BNP level predicts mortality in old population, we3 measured the plasma BNP level in 541 subjects from the 85-year old population in Gothenburg, Sweden. We found that the incr ased BNP level significantly predicted 5-years mortality in the total population. In subjects witl a known cardiovascular disorder, 5-yeare mortality was significantly correlated with the ele ated plasma BNP level.In the third study, we examined the effect of a long-term infusion of ANP on hemodynamics and renal functions in patients with congestive heart failure. Although the short-term infusion of ANP was reported to improve congestive heart failure, the long-term infusion of ANP decreased preload and increased urine volume. In spite of the diuretic action, the long-term infusion of ANP did not deteriorate serum electrolyte balance. Any side effects were observed during the infusion.We concluded that natriuretic peptides are clinically useful for diagnosis and treatment of cardiovascular diseases. Less