冠状动脉狭窄时某些血管活性物质的变化  

CHANGES OF PLASMA CARDIOVASCULAR ACTIVE FACTORS IN CORONARY ARTERY STENOSIS─ANIMAL EXPERIMENT AND CLINICALSTUDY

作　　者：冯常森[1] 郭衡山[1] 钱学贤[1] 吴宏超[1] 邓鹤秋[1] 刘映锋 聂道海[1] 陈爱华[1] 张勇[1] 朱福兴[1] 刘金华[1] 王佳勇[1] 

机构地区：[1]中国人民解放军第一军医大学珠江医院心内科

出　　处：《中国循环杂志》1995年第1期12-14,共3页Chinese Circulation Journal

摘　　要：１３只麻醉开胸犬，分级缩窄冠状动脉左旋支，直到血流中断。临床分３组：对照组、冠心病（ＣＨＤ）组、急性心肌梗塞（ＡＭＩ）组。均测定血浆心钠素（ＡＮＰ）、内源性洋地黄样物质（ＥＤＬＳ）、醛固酮（Ａｌｄｏ）、血浆肾素活性（ＰＲＡ）、血管紧张素Ⅱ（ＡｎｇⅡ），动物实验还增加左心功能检测。结果显示，实验性冠状动脉血流（ＣＢＦ）减少时心功能进行性减退；肾素－血管紧张素－醛固酮系统（ＲＡＡＳ）激活；ＡＮＰ分泌增加；ＥＤＬＳ减少。ＡＭＩ患者早期ＲＡＡＳ激活，ＡＮＰ增加，ＥＤＬＳ无改变，恢复期ＡＮＰ降低而ＥＤＬＳ增加。探讨了血管活性物质变化和机制，以及ＡＭＩ时应用血管紧张素转换酶抑制剂及外源性ＡＮＰ的意义。To investigate the effect of coronary blood flow (CBF) on the changes of cardiac function, LVSP,LVEDP, and±dp/dtmax and/or certain cardiovascular active factors (plasm ANP, Ang Ⅱ, Aldo, PRA and serum EDLS, by radioimmunoassay) were studied both in experimental animals and patients with coronary heart disease (CHD).For the animal experiments, 13 healthy hybrid dogs were divided into experimental (E, n=8) and control (C, n=5) groups. The left circumflex coronary artery was dissected and an adjustable constrictor was used to reduce CBF to 70% ,30% and 0% of basal level in the E group. Cardic function,plasma ANP, AngⅡ,Aldo and PRA, and serum EDLS were determined. The clinical study included (1) 20 controls;(2) 15CHD patients, diagnosed by coronary angiography and left ventriculography;(3) 14 patients with acute myocardial infarction (AMI);before (within 6 hrs after onset of AMI) and after treatment (5 wks after the onset).Animal experiment showed that 30% reduction in CBF caused no significant decrease in LVEDP, but significant decrease in±dp/dtmax and plasma ANP.With increasing reduction of CBF, LVEDP significantly increased together with gradual increase of ANP,AngⅡ.Aldo, and PRA showing that the RAAS was activated due to deterioration of cardiac function, meanwhile serum EDLS decreased.Significant negative correlation was found between ANP and EDLS (r=-0.38, p<0.05 ).CHD patients showed significantly higher PRA and EDLS than controls, while ANP, PRA, AngⅡ,and Aldo of AMI patients before treatment were significantly higher than those of both CHD patients and controls,but after treatment,all of the above mentioned items except EDLS were significantly lowered and EDLS was significantly increased. The activation of RAAS in CBF reduction and AMI, decrease of ANP in 30% reduction of CBF, and the negative correlation between ANP and EDLS might have certain implications in the treatment of congestive heart failure and AMI by using ACEI and exogenous ANP.

关 键 词：冠心病 冠状动脉 心钠素 洋地黄样物质 血流量 

分 类 号：R541.402[医药卫生—心血管疾病]