体积状态与利尿剂治疗收缩性心力衰竭及早期肾/肾功能异常的检测
文献 Volume Status and Diuretic Therapy in Systolic Heart Failure and the Detection of Early Abnormalities in Renal and Tubular Function 发表在 Journal of The Ameican College of Cardiology 原文链接
Abstract:
OBJECTIVES:
This study sought to determine the pharmacodynamic effect of modulation of volume status by withdrawal and reinstitution of diuretic treatment on markers of renal and tubular function.
BACKGROUND:
Decreased renal perfusion and increased congestion are associated with renal dysfunction in patients with heart failure.
METHODS:
In this study, 30 patients with chronic systolic heart failure in a presumed euvolemic state and on standard oral furosemide therapy (40 to 80 mg) were examined. At baseline, subjects were withdrawn from their loop diuretics. After 72 h, their furosemide regimen was reinstated, and patients were studied again 3 days later. Serum creatinine, atrial and B-type natriuretic peptide, urinary kidney injury molecule (KIM)-1, urinary N-acetyl-beta-D-glucosaminidase (NAG), and serum as well as urinary neutrophil gelatinase-associated lipocalin (NGAL) were determined at various time points.
RESULTS:
Diuretic withdrawal resulted in increases in atrial and B-type natriuretic peptide (both p < 0.05). Serum creatinine was unaffected. Both urinary KIM-1 (p < 0.001) and NAG (p = 0.010) concentrations rose significantly, after diuretic withdrawal, whereas serum and urinary NGAL were not significantly affected. After reinitiation of furosemide, both urinary KIM-1 and NAG concentrations returned to baseline (both p < 0.05), but NGAL values were unaffected.
CONCLUSIONS:
Subclinical changes in volume status by diuretic withdrawal and reinstitution are associated with increases and decreases of markers of tubular dysfunction in stable heart failure. Diuretic therapy may favorably affect renal and tubular function by decreasing congestion.
摘要：
目的：
本研究旨在确定通过测定利尿剂治疗对肾功能和肾小管功能标志物调节体积状态的药效学效应。
背景：
心脏衰竭患者肾脏灌注减少和充血增加与肾功能不全有关。
方法：
在这项研究中，检测了30例慢性收缩性心力衰竭患者，推测其为南欧型血容量状态，标准口服利尿剂治疗（40-80mg）。在基线时，受试者不在使用袢利尿剂。 72小时后，他们的速尿方案恢复，3天后再次对患者进行研究。血清肌酐，心房和B型利钠肽，尿肾损伤分子（KIM）-1，尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和尿中性粒细胞明胶酶相关脂笼蛋白（NGAL），分别检测这些指标各个时间点情况。
结果：
停止使用利尿剂导致心房和B型利钠肽增加（均p <0.05）。血清肌酸酐未受影响。利尿撤药后尿KIM-1（p <0.001）和NAG（p = 0.010）浓度均显着升高，而血清和尿NGAL没有显着影响。恢复使用利尿素后，尿KIM-1和NAG浓度均恢复至基线水平（均p <0.05），但NGAL值未受影响。
结论：
通过使用或停用利尿素的体积状态的亚临床变化与稳定性心力衰竭中管状功能障碍标志物的增加和减少相关。利尿剂治疗可能通过减少充血来有利地影响肾脏和肾小管功能。
使用试剂原文信息：ANP was analyzed by enzyme-linked immunosorbent assay (ELISA, USCN Life Science Inc., Wuhan, China) at St. George’s Hospital. The detection limit was 0.14 pg/ml, intra-assay coefficient of variation (CV) was <5%, and interassay CV was <14%. The assay range was 0 to 25 pg/ml, with the normal range being 10 to 70 pg/ml.