血透患者血浆皮质醇促肾上腺皮质激素及心钠素改变和意义

目的探讨皮质醇(CTS)、促肾上腺皮质激素(ACTH)与心钠素(ANF)等在血透患者血透前后的改变及意义.方法采用放射免疫法检测了慢性肾功能衰竭(CRF)患者血透前后血浆皮质醇(PCTS)、促肾上腺皮质激素(PACTH)及心钠素(PANF)的变化.结果透析前PCTS及PACTH较低,分别为173.4±42.1μg/L及17.5±10.8ng/L;而PANF为406.8±177.1ng/L,则明显高于正常对照组(P＜0.01).透析后PCTS为200±88μg/L,轻微升高(P＞0.05);PACTH31.2±22.2ng/L明显增高(P＜0.05);而PANF201.8±111.7ng/L显著降低(P＜0.01)结论本结果支持PANF浓度是判断细胞外液容量的敏感指标.且进一步提示ANF是ACTH及CTS分泌的抑制剂.     

肝肾综合征患者血浆心钠素水平的变化

应用放射免疫法测定了313例正常人,19例肝硬变腹水和17例肝肾综合征(HRS)患者血浆心钠素(ANP)的含量.结果表明,HRS患者ANP水平((?)±s)为854.5±96.0ng/L,明显高于正常人451.9±47.5ng/L,P<0.01;但与无肾功能损害的肝硬变腹水患者(825.3±90.6ng/L)之间无显著差异,P>0.05.肝硬变腹水患者血浆ANP与肾素、血管紧张素Ⅱ呈显著正相关,伴HRS时却无相关关系.提示HRS并不是因缺乏ANP所致,HRS时,肾脏对ANP的反应性可能进一步降低.     

(RAPID COMMUNICATION) PLASMA LEVELS OF ATRIAL NATRIURETIC PEPTIDE IN HYPERTHYROIDISM

We measured plasma atrial natriuretic peptide (ANP) levels in 17 patients with newly diagnosed thyrotoxicosis. ANP was elevated compared to a group of healthy controls and fell to normal after treatment. Plasma cyclic guanosine monophosphate was also raised in untreated patients. Elevated circulating levels of ANP may play a part in the haemodynamic changes of hyperthyroidism.     

心血管应激和芬太尼对血浆心钠素水平的影响

本实验探讨全麻气管插管心血管应激及芬太尼作用对血浆心纳素水平的影响。结果显示，实验组气管插管心血管应激反应明显，血浆心钠素水平伴随升高，且与血压心率的增加呈高度正相关关系。而对照组在给予６μ８·ｋｇ（－１）芬太尼抑制气管插管应激反应时，插管期间循环兴奋性明显减弱，血浆心钠素水平亦未见升高。因此说明：①血浆心钠素水平与气管插管心血管应激程度密切相关，是气管插管应激指标之一；②芬太尼不参与人类血浆心钠素水平的调节。     

CSF AND PLASMA SOMATOSTATIN LEVELS IN ACROMEGALY

Cerebrospinal fluid (CSF) and plasma levels of somatostatin have been measured in patients with active acromegaly and the results compared to those obtained in patients with non-endocrine diseases. Plasma levels have also been studied in acromegalics given oral glucose. The mean CSF somatostatin level in twenty patients without endocrine disease was 76 pg/ml (range 46-112) which did not differ significantly from that found in eight acromegalics (mean 87 pg/ml, range 48-160). Plasma somatostatin in twenty-two acromegalic patients on no medical treatment was 43 pg/ml (range 9-113), not significantly different from values in a normal control population. There were no differences in the somatostatin levels of non-diabetic acromegalics. After oral glucose, there was a rise in circulating somatostatin in eleven out of twelve acromegalic patients, and this rise did not differ from that seen in normal subjects. It is probable that altered somatostatin secretion is neither the cause nor the result of acromegaly; however it is possible that local changes in somatostatin concentration which are not reflected in peripheral plasma or CSF levels may occur near the site of its production.     

先天性心脏病伴肺动脉高压患者血浆心钠素水平

本文采用放射性免疫分析法测定３１例先天性心脏病患者血浆心钠素水平。结果表明，先天性心脏病伴肺动脉高压患者组（２１例）血浆心钠素水平明显高于无肺动脉高压组（１０例）（Ｐ＜０．０１）及正常对照组（Ｐ＜０．０１）；血浆心钠素水平随平均肺动脉压的升高而升高（ｒ＝０．７４，Ｐ＜０．００１），术后随肺动脉压的下降而降低。结果提示，血浆心钠素水平的升高在肺动脉高压的调节中可能起着重要作用。     

心钠素对肾血管性高血压的临床作用

肾血管性高血压有复杂的病理生理特点,适于全面评价心钠素的生理、药理作用。给7例患者静脉滴注心钠素0.025μg·kg~(-1)/min×60min,引起肾素—血管紧张素—醛固酮系统及交感神经系统的抑制,血浆加压素浓度的降低,产生了利尿、利钠效应并伴有红细胞压积和肌酐清除率的增加,血压轻度平续的下降。一些因素参与了肾血管性高血压的形成和维持。本研究提示,心钠素对这些因素均有一定作用     

经皮球囊二尖瓣成形术患者血浆心钠素和血管加压素水平的改变

选择１６例风湿性二尖瓣狭窄患者进行经皮球囊二尖瓣成形术。术后心功能改善Ⅰ～Ⅱ级。术前，左右心房血浆心钠素水平明显高于外周静脉。研究发现，心房心钠素分泌增加可分为两型：右房分泌为主型者（ｎ＝５）；左房分泌为主型者（ｎ＝１１）。前一型的左心房平均压和右心房平均压均明显高于后一型。两型的外周血浆心钠素水平均无显著差异。术后５ｍｉｎ、２０ｍｉｎ、１ｈ、２４ｈ等时点，左右心腔和外周血浆心钠素水平均较术前显著下降。１６例患者术后２０ｍｉｎ时的左心腔血浆心钠素水平的降低幅度与二尖瓣跨瓣压差降低幅度显著相关（ｒ＝０．５０２，Ｐ＜０．０５）。术后血管加压素水平也显著下降，术后２４ｈ下降达７７．９±２．９％。这提示，成功地经皮球囊二尖瓣成形术可使风湿性心脏病患者血浆心钠素和血管加压素水平显著下降。     

血浆心钠素在糖尿病的变化及临床意义

48例糖尿病患者血浆心钠素高于正常人(875.2±50vs 542.5±23.8ng/L)。血浆ANF与同期胰岛素、左房内径呈正相关;与植物神经功能积分有一定相关但无统计学意义;与病程、24小时尿钠、血糖、糖化血红蛋白、右房横径无相关性。9例糖尿病性心脏病患者和6例糖尿病性肾病患者血浆ANF高于无明显临床合并症者。OGTT中,ANF在服糖1、2、3小时均明显低于空腹水平。     

POSTURAL SUPPRESSION OF PLASMA ATRIAL NATRIURETIC POLYPEPTIDE CONCENTRATIONS IN MAN

The effects of sequential changes in posture, from recumbency, to sitting and then to the upright position, each for 60 min, respectively, on the levels of plasma immunoreactive atrial natriuretic polypeptide (ANP) in healthy human subjects were studied using a radioimmunoassay (RIA) method. At the end of each change in posture, plasma ANP levels were respectively 150±16-4 pg/ml (recumbent), 103±11-2 pg/ml (sitting), and 78-1±7–90 pg/ml (upright). In contrast, plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) determined concomitantly with ANP showed a significant increase in response to the sitting and upright postures. Plasma ANP levels determined in normal subjects who remained in the recumbent posture for the same period did not show any significant change. This suggests that ANP is involved in the maintenance of haemodynamic homeostasis under physiological conditions and emphasizes that postural factors must be taken into account and controlled in order to evaluate plasma ANP levels properly, as well as those of PRC and PAC.     

高原心肌低氧症患者血浆肾素系统和心钠素的变化

为研究高原心肌低氧症患者血浆肾素系统和心钠素的变化，对３０例高原心肌低氧症（ＨＡＭＨ）患者用放免法测定了血浆肾素活性（ＰＲＡ）、血管紧张素ＩＩ（ＡＩＩ）、醛固酮和心钠素（ＡＮＦ）含量，结果发现ＨＡＭＨ患者血浆ＡＩＩ与ＡＮＦ间浓度比例与慢性高原心脏病、长期移居高原健康成人明显不同。并讨论了这些生物活性物质紊乱可能在ＨＡＭＨ发生发展中的作用。     

肝硬变患者血浆内皮素和心钠素的变化

探讨内皮素(ET)与肝硬变水纳潴溜的关系。方法:应用放免法测定了血浆内皮素(ET)和心纳素(ANP)的含量。结果:①68例肝硬变患者血浆ET水平与正常人相比明显低下(P<0.01),按Child-Pugh分级,可见ET在伴腹水的患者下降明显(B、C级);②ET与门静脉直径呈负相关(r=-0.769,P<0.05),门静脉直径>1.6cm者与直径<1.6cm者相比,ET含量差异亦有显著性意义(P<0.01);③肝硬变患者ANP值明显高于正常对照组(P<0.01),且ANP与ET水平呈负相关(r=-0.786,P<0.01)。结论:ET水平与肝硬变严重程度密切相关,ET可能在腹水形成机制中发挥了重要作     

GROWTH HORMONE RESPONSIVENESS TO HUMAN PANCREATIC GROWTH HORMONE RELEASING FACTOR IN ACROMEGALY: MODULATORY EFFECTS OF BASAL HORMONE LEVELS AND OF CONCOMITANT SOMATOSTATIN ADMINISTRATION

Human pancreatic growth hormone releasing factor 1-44 (hpGRF), 100 micrograms was administered as an i.v. bolus injection to eleven patients with acromegaly. The mean serum growth hormone (GH) levels rose (P less than 0.001) from 54 +/- 20 ng/ml to 215 +/- 126 ng/ml (+/- SEM) 20 min after the injection. Although the maximum response of GH levels was highly variable it correlated positively with the individual GH levels (P less than 0.01, Rs = +0.80). Thus the higher the GH levels, the greater the responsiveness to hpGRF. Administration of somatostatin (SRIF), 300 micrograms/h, lowered basal GH levels from 76 +/- 38 ng/ml to 13 +/- 5 ng/ml (P less than 0.01) after 1 h. hpGRF administration during concomitant SRIF infusion also led to highly variable growth hormone responses. The maximum GH responses again correlated positively with the GH level before hpGRF after 1 h of SRIF administration (P less than 0.05, Rs = +0.79). GH responses to hpGRF were completely blocked by SRIF in three out of four patients whose GH levels decreased to normal levels during SRIF infusion. Our data illustrate that the pituitary in acromegaly is normally responsive to both SRIF and hpGRF but at a higher setting of basal GH levels.     

风湿性二尖瓣狭窄患者心钠素与血液动力学关系研究

应用超声心动图(M型、二维及多普勒)检查法和放射性免疫测定法,对31例风湿性二尖搏狭窄患者的心房大小、心功能及血液动力学与血浆心钠素浓度之间的关系进行研究。结果显示:血浆心钠素浓度水平,在二尖瓣狭窄组明显高于正常对照组,且与左心房容量、压力、张力及肺动脉压等明显相关。     

心钠素和精氨酸加压素对血液透析患者高血压的影响

采用放射免疫学方法测定血液透析患者和正常人血浆心钠素（ＡＮＰ）及精氨酸加压素（ＡＶＰ）的浓度。结果：慢性肾功能衰竭（ＣＲＦ）患者血浆ＡＮＰ和ＡＶＰ水平明显高于正常人（Ｐ＜０．０１）；血透后血压正常组随着透析、超滤，血浆ＡＮＰ和ＡＶＰ浓度下降，但高血压组ＡＶＰ水平明显增高，并与血压上升、血钠改变呈显著正相关（分别为ｒ＝０．７８，Ｐ＜０．０１；ｒ＝０．６３，Ｐ＜０．０５）。提示血透患者高血压发病除与Ｃ     

BROMOCRIPTINE THERAPY IN ACROMEGALY: EFFECTS ON PLASMA GH LEVELS, SOMATOMEDIN-C LEVELS AND CLINICAL ACTIVITY

Thirty-one patients with active acromegaly were treated with 10-20 mg bromocriptine daily for a period of 6-9 months. The clinical response was evaluated both by a subjective 'score of symptoms', and by a combined subjective and objective 'clinical and metabolic improvement score' (c-m score). The biochemical response was evaluated both by measurement of the mean of four plasma growth hormone (GH) determinations during the day and by measurement of plasma somatomedin-C (Sm-C) concentration. The clinical response as assessed by both methods showed a better correlation with changes in plasma GH levels (respectively r = 0.33; r = 0.50) than with changes in Sm-C levels (r = 0.20; r = 0.36). The study confirms that in some patients clinical improvement is not accompanied by a decrease of plasma GH concentration. However, it is not possible to identify a subgroup of patients who showed clinical improvement with a decrease of Sm-C levels, but whose plasma GH levels remained constant. It is concluded that measurement of plasma GH levels still appears to be the most useful biochemical assessment of disease activity in bromocriptine-treated acromegaly.     

SUPPRESSION OF PLASMA GROWTH HORMONE LEVELS WITH GLUCOSE INFUSION IN PATIENTS WITH ACROMEGALY

Intravenous glucose infusion which increased blood glucose levels over 27.8 mmol/1 suppressed plasma GH levels by 41–74% in five acromegalic patients with basal concentrations of less than 20 mu/1, but not in six patients with basal levels over 80 mu/1. Oral 100 g glucose loading had little suppressing effect in both groups. These results appear to indicate that the suppressibility with hyperglycaemia is partially retained or restored in some, if not all, patients of acromegaly with lower GH secreting activity.     

心钠素对兴奋后肾素系统的作用

在卒中型自发性高血压大鼠(SHRsp)及WKY大鼠的肾素系统受刺激时,静脉或侧脑室输注心钠素均能:1.降压(SHRsp大于WKY大鼠);2.抑制血浆肾素系统,两种大鼠间无明显差异3.刺激SHRsp的下丘脑血管紧张素Ⅱ含量上升。但对WKY大鼠无影响。结果提示在一定条件下,中枢心钠素也参与血压调节。讨论了中枢心钠素的降压机理。