慢性心力衰竭患者血钠水平与血浆肾素活性、抗利尿激素、脑利钠肽的关系  

Correlation of hyponatremia with plasma renin activity,antidiuretic hormone and brain natriuretic peptide in chronic heart failure

作　　者：富路[1] 葛海龙[1] 李佳[1] 陈光远[1] 李元十[1] 谢荣盛[1] 范春艳[2] 

机构地区：[1]哈尔滨医科大学附属第一医院心内科,150001 [2]哈尔滨医科大学附属第一医院心内科超声科,150001

出　　处：《中华心血管病杂志》2006年第9期781-783,共3页Chinese Journal of Cardiology

基　　金：黑龙江省自然科学基金重点项目(ZJY-0507)

摘　　要：目的探讨慢性心力衰竭(心衰)患者血钠水平与血浆肾素活性(PRA)、抗利尿激素(ADH)、脑利钠肽(BNP)的关系。方法用放射免疫法测定41例伴低钠血症的心衰患者(低血钠组)和35例正常血钠的慢性心衰患者(正常血钠组)的血浆 PRA、ADH、BNP 水平并观察两组患者3个月内的再住院率。结果低血钠组的心衰患者血浆 PRA、ADH、BNP 水平均较正常血钠组相同心功能级别者显著升高。低血钠组与正常血钠组心功能Ⅱ级、Ⅲ级、Ⅳ级的比较:PRA(单位:ng·ml^(-1)·h^(-1))分别为2.7±1.0与1.8±0.7、4.3±1.2与3.0±0.9、5.6±1.3与3.5±1.1,P<0.05,ADH(单位:ng/L)分别为59.7±17.4与48.6±15.3、68.4±17.6与56.3±19.2、75.3±20.0与51.4±16.2,P<0.05,BNP(单位:ng/L)分别为276.4±75.2与185.3±55.3、380.1±113.6与258.5±62.1、564.0±125.2与405.3±102.9,P<0.05;血浆 PRA、ADH、BNP 与血钠呈显著负相关(分别为 r=-0.31、P<0.05,r=-0.28、P<0.05,r=-0.80、P<0.01);低血钠组再住院率增高。结论低钠血症可能促进慢性心衰患者血浆 PRA、ADH、BNP 分泌增加,心衰伴低钠血症患者的神经内分泌水平激活更明显。Objective To observe the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure （CHF） and their correlation with hyponatremia. Methods Plasma levels of PRA, ADH, and BNP were measured by radioimmunology in 76 CHF patients. Forty-one out of 76 CHF patients with hyponatremia and 35 CHF patients without hyponatremia were identified by serum sodium. The rates of rehospitalization within 3 months were compared in two groups. Results Levels of plasma renin activity, ALD, and BNP in CHF patients with hyponatremia were notably higher than those in patients without hyponatremia classified by New York Heart Association （NYHA） grade Ⅱ-Ⅳ： PRA [（2.7±1.0） ng· ml^-1· h^-1 vs. （1.8±0.7）ng· ml^-1· h^-1, （4.3±1.2）ng· ml^-1· h^-1 vs. （3.0±0.9） ng· ml^-1· h^-1, （5.6±1.3） ng· ml^-1· h^-1 vs. （3.5±1.1） ng· ml^-1· h^-1, respectively, P〈0.05] ,ADH [（59.7 ±17.4） ng/L vs. （48.6 ±15.3） ng/L, （68.4 ±17.6） ng/L vs. （56.3±19.2） ng/L, （75.3 ±20.0） ng/Lvs. （51.4±16.2） ng/L,respectively, P〈0.05] and BNP [（276.4 ±75.2） ng/L vs. （185.3 ±55.3） ng/L, （380. 1 ± 113.6） ng/L vs. （258.5 ±62. 1） ng/L, （564.0± 125.2） ng/L vs. （405.3 ± 102.9） ng/L, respectively, P 〈0.05]. In the simple regression analyses, hyponatremia was negative correlated with PRA, ADH and BNP （r = -0.31, P 〈0.05;r = - 0. 28, P 〈 0. 05, r = - 0. 80, P 〈 0. 01 ）. The rate of rehospitalization within 3 months in hyponatremia group was higher than that in control group. Conclusions There is relation of hyponatremia to the changes of plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure. Hyponatremia may accelerate the excretion of plasma PRA, ADH and BNP in chronic heart failure. Neuroendocrine activation in patients of congestive heart failure with hyponatremia is higher than that of normal natremia group.

关 键 词：心力衰竭 充血性 低钠血症 肾素 血管升压素类 利钠肽 脑 

分 类 号：R541.6[医药卫生—心血管疾病]