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目的:观察慢性肺原性心脏病患者急性加重期和缓解期血浆精氨酸加压素(AVP)及心钠素(ANP)的变化及其与肺动脉压的关系。方法:慢性肺心病患者(肺心病组)33例,分别于急性发作期和缓解期应用放射免疫法测定血浆AVP和ANP水平,同时选择30例健康志愿者为对照。肺心病患者经彩色多普勒测定右室射血前期时间/加速时间(RVPEP/AT)以估测肺动脉压。结果:①正常对照组、肺心病组缓解期与急性加重期AVP((4.62±4.14)ng/L,(53.98±26.18)ng/L,(138.28±57.18)ng/L)与ANP((67.00±63.88)ng/L,(298.50±141.06)ng/L,(627.89±177.77)ng/L)呈升高趋势,3组间比较,差异有统计学意义(F分别为92.85,127.40,P均<0.05)。肺心病组缓解期RVPEP/AT低于急性加重期((1.24±0.26)vs(1.63±0.36),t=8.86,P<0.05)。②肺心病急性加重期和缓解期AVP、ANP与RVPEP/AT以及AVP与ANP均有相关性,P均<0.05。结论:AVP、ANP均可能参与肺动脉压的调节,检测血浆AVP或ANP水平可用于评估肺心病的严重程度和预后。
Objective: To observe the changes of plasma arginine vasopressin (AVP) and atrial natriuretic peptide (ANP) in acute exacerbation and remission of patients with chronic pulmonary heart disease and their relationship with pulmonary arterial pressure. Methods: Thirty-three patients with chronic cor pulmonale (pulmonary heart disease group) were divided into two groups. The levels of AVP and ANP in plasma were measured by radioimmunoassay in acute attack and remission respectively. Thirty healthy volunteers were selected as control. Pulmonary heart disease was measured by color Doppler right ventricular ejection time / acceleration time (RVPEP / AT) to estimate pulmonary artery pressure. Results: ① In the normal control group, the levels of AVP ((4.62 ± 4.14) ng / L, (53.98 ± 26.18) ng / L and (138.28 ± 57.18) ng / L) ± 29.88 ng / L, (298.50 ± 141.06) ng / L, (627.89 ± 177.77) ng / L, respectively). There was a significant difference between the three groups (F = 92.85,127.40, P = <0.05). The RVPEP / AT in remission stage of pulmonary heart disease group was lower than that of acute exacerbation stage (1.24 ± 0.26 vs 1.63 ± 0.36, t = 8.86, P <0.05). ② The levels of AVP, ANP, RVPEP / AT, AVP and ANP in acute exacerbation and remission stage of pulmonary heart disease were all correlated (P <0.05). Conclusion: Both AVP and ANP may participate in the regulation of pulmonary arterial pressure, and the detection of plasma AVP or ANP level can be used to evaluate the severity and prognosis of pulmonary heart disease.