慢性心力衰竭患者血浆肾上腺髓质素前体N端20肽与缩血管活性物质关系的探讨  

Relationship of proadrenomedullin N terminal 20 peptide and the other vasoconstrictive substance in patients with chronic heart failure

作　　者：费宇行[1] 朱智明[1] 高连如[1] 徐洪涛[1] 陈永鹏[1] 杨晔[1] 石湘芸[1] 唐朝枢[2] 

机构地区：[1]海军总医院,北京100037 [2]北京大学医学部

出　　处：《中华心血管病杂志》2003年第8期600-602,共3页Chinese Journal of Cardiology

摘　　要：目的　观察心力衰竭患者血浆肾上腺髓质素前体N端 2 0肽 (proadrenomedullinNterminal 2 0peptide ,PAMP)水平的变化并探讨其病理生理作用。 方法　 (1)对照组 :健康体检人员 18例 ,男性 9例 ,女性 9例 ,年龄 3 0～ 60岁 ,平均 50 2 5岁。 (2 )慢性心力衰竭组 :符合NYHA心力衰竭标准 2 2例 ,男 15例 ,女 7例 ,年龄 3 9～ 70岁 (平均 65 5岁 ) ,心功能Ⅱ～Ⅲ级。用放免方法测定血浆PAMP、血管紧张素Ⅱ (AngⅡ )、内皮素 (ET)含量 ,高压液相测定血浆去甲肾上腺素 (NE)和肾上腺素(E)水平。采用二维超声心动图测定左室舒张期末径 ,Simpson法测定左室射血分数。结果　对照组PAMP为 (18 42± 2 3 3 )ng/L ,慢性心力衰竭组PAMP为 (2 9 3 7± 3 14 )ng/L(P <0 0 5) ;病情严重者 ,PAMP升高明显。慢性心力衰竭组患者血浆PAMP水平与AngⅡ、ET、NE、E呈显著正相关(P <0 0 5) ,与左室射血分数呈显著负相关。结论　慢性心力衰竭组血浆PAMP水平明显高于对照组 ,病情严重者 ,PAMP升高明显 ;AngⅡ等缩血管物质可能刺激PAMP的合成或分泌。升高的PAMP参与了心力衰竭的病理过程 。Objective The novel hypotensive peptide, proadrenomedullin N-terminal 20 peptide (PAMP) is processed from the adrenomedullin precursor The PAMP has many function on cardiovascular physiology In this study the plasma levels in the patients with heart failure(HF) were investigated and the pathophysiological effect was discussed Methods Venous blood samples at rest were obtained from patients with HF in New York Heart Association functional classes II and III and from normal subjects The plasma levels of PAMP, angiotensin II(Ang II) , endothilin(ET) were measured with radioimmunoassay and norepinephrine(NE)?epinephrine(E) were measured with HPLC Left ventricular ejection fraction(LVEF) and Left ventricular end diastolic diameter (LVEDD) were measured by echocardiography in all the patients Results The mean plasma level of PAMP was 18 42±2 33ng/L in control group, and 29 37±3 14 ng/L in HF group ,which was 1 53 times higher in HF than that in control group (P<0 05) There was a positive correlation between plasma levels of PAMP and Ang II,ET,NE,E(P<0 05) significantly LVEF inversely correlated with plasma levels of PAMP (P<0 05) Conclusion The plasma levels of PAMP were higher in HF patients than that in control group The vasoconstrictive substance such as Ang II probably be related to its synthesis or secretion, which may involved in the pathophysiological process of HF The elevation of plasma level of PAMP may play the protective role for the patients with HF

关 键 词：心力衰竭 血浆肾上腺髓质素前体 缩血管活性物质 ADM 氨基酸 

分 类 号：R541.6[医药卫生—心血管疾病]