心力衰竭患者肾上腺髓质素和前体N端20肽的改变  

Changes of plasma adrenomedullin and proadrenomedullin N-terminal 20 peptide concentra- tions in patients with heart failure

作　　者：高玉琪[1] 李志樑[1] 吴宏超[1] 钟萍[1] 陆青[1] 严全能[1] 唐朝枢[2] 

机构地区：[1]第一军医大学珠江医院心内科,广东广州510280 [2]北京大学第一医院,北京100034

出　　处：《第一军医大学学报》2002年第7期630-634,共5页Journal of First Military Medical University

基　　金：国家重大发展基础研究项目基金(G2000056905)

摘　　要：目的　探讨肾上腺髓质素（ADM）和肾上腺髓质素前体N端20肽（PAMP）在心力衰竭发生发展病理过程中的变化和临床意义。方法　应用特异性放射免疫法检测了45例不同程度的充血性心力衰竭（CHF）患者和7名正常人ADM和PAMP的血浆浓度。结果　CHF病人血浆ADM浓度在心功能Ⅱ级者为（51.46±4.52）pg/ml、Ⅲ级者为（70.39±3.22）pg/ml,与正常组[（24.12±1.59）pg/ml]比较有显著性差异（P<0.05）;PAMP血浆浓度在心功能Ⅱ级者为（6.24±1.71）pg/ml、Ⅲ级者为（7.38±1.28）pg/ml,与正常组[（8.56±2.44）pg/ml]比较无显著性差异（P>0.05）。在心功能Ⅳ级者,ADM和PAMP血浆浓度分别为（36.33±2.17）pg/ml、（2.79±0.89）pg/ml,较心功能Ⅱ级和Ⅲ级者显著下降,其中ADM高于对照组,PAMP低于对照组（P<0.05）。结论　ADM和PAMP在心力衰竭不同阶段的变化表明肾上腺髓质素功能片段扩血管活性肽分子内调节紊乱;ADM在心衰的进展过程中可能发挥更重要的作用。Objective To study the changes in plasma adrenomedullin (ADM) and proadrenomedullin N-terminal 20 peptide (PAMP) concentrations and their clinical significance in the pathological process of congestive heart failure (CHF). Methods Plasma ADM and PAMP concentrations in 45 patients with CHF (according to the functional classification of New York Heart Association, NYHA) and 20 control subjects were measured by specific radioimmunoassay. Results Plasma ADM concentrations were 51.46±4.52 pg/ml and 70.39±3.22 pg/ml respectively in patients of NYHA class Ⅱ and class Ⅲ, which were significantly higher than those in control subjects (24.12±1.59 pg/ml, P<0.05 for both comparisons), while significant differences in plasma PAMP concentrations were not identified in the 2 groups of patients (6.24±1.71 pg/ml and 7.38±1.28 pg/ml, respectively) in comparison with the control level(8.56±2.44 pg/ml, P>0.05 for both comparisons). Patients of NYHA class Ⅳ, when compared with the 2 groups of patients mentioned above, had significantly decreased plasma ADM and PAMP concentrations (36.33±2.17 pg/ml and 2.79±0.89 pg/ml respectively, P<0.05 in both cases), but had higher plasma ADM and lower PAMP concentrations when compared with the control subjects, (P<0.05 respectively). Conclusion The changes of plasma ADM and PAMP concentrations at different stages of CHF indicate intramolecular regulation disturbances of vasodilator peptides of proadrenomedullin, and ADM may play a more important role in the development of CHF.

关 键 词：充血性心力衰竭 肾上腺髓质素 肾上腺髓质素前体N端20肽 血管活性肽 特异性放射免疫法 

分 类 号：R541.6[医药卫生—心血管疾病]