Clinical Trial of Natriuretic Peptides in Heart Failure

心力衰竭是心脏不能将血液输送到重要器官从而导致死亡的病理状态。心钠素(ANP)和脑利钠肽(BNP)是心脏激素，具有利钠、利尿和扩张血管的活性。为了进一步评价利钠肽在心脏疾病中的临床应用价值，我们在日本、美国和瑞典组织了三种大规模的合作研究。第一项研究旨在前瞻性地确定利钠肽中的一种在94例接受心导管检查的患者中是否优于另一种。血浆脑钠素浓度升高是左…的一个更有力的标志物在第二项研究中，为了评估血浆BNP水平是否可以预测老年人口的死亡率，WE3从瑞典哥德堡85岁的人口中测量了541名受试者的血浆BNP水平。我们发现，BNP水平的升高显著预测了总人口的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水平显著相关。在第三项研究中，我们研究了长期输注ANP对充血性心力衰竭患者血流动力学和肾功能的影响。尽管有报道称短期应用ANP可改善充血性心力衰竭，但长期应用ANP可减少前负荷并增加尿量。尽管有利尿作用，但长期输注ANP并未使血清电解质平衡恶化。我们的结论是，利钠肽在心血管疾病的诊断和治疗中是有临床价值的。较少

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