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Kokyu to Junkan Volume 46, Issue 6 （June 1998）

呼吸と循環 46巻6号（1998年6月発行）

Japanese English

研究

軽症心不全患者における血中h-ANP,BNP濃度と心臓超音波検査のEFの関係—心嚢水貯留例を含む各種心疾患での検討 Relationship between the Blood Concentration on h-ANP, BNP and Ejection Fraction on Echocardiography of a Patient with Mild Heart Failure:Study of patiellts with several heart diseases including patients with pericardial effusion 小川拓男 ¹ , 石川恭介 ¹ , 須藤幸夫 ¹ , 浅野博 ² , 味岡正純 ² , 松井裕之 ² , 酒井和好 ² , 沼口靖 ³ , 土岐幸夫 ³ , 奥村健二 ³ , 伊藤隆之 ³ Takuo Ogawa ¹ , Kyosuke Isikawa ¹ , Yukio Sudo ¹ , Hiroshi Asano ² , Masazumi Ajioka ² , Hiroyuki Matsui ² , Kazuyoshi Sakai ² , Yasushi Numaguchi ³ , Yukio Toki ³ , Kenji Okumura ³ , Takayuki Ito ³ ¹名古屋市立守山市民病院内科 ²公立陶生病院内科 ³名古屋大学医学部第2内科 ¹Internal Medicine, Moriyama Hospital, Nagoya City ²Internal Medicine, Tousei Public Hospital, Seto City ³2nd Department of Internal Medicine, Nagoya University キーワード： h-ANP , BNP , 心嚢水 , pericardial effusion Keyword: h-ANP , BNP , 心嚢水 , pericardial effusion pp.591-595

発行日 1998年6月15日 Published Date 1998/6/15

DOI https://doi.org/10.11477/mf.1404901710

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Abstract 文献概要
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　目的：軽症心不全患者，特に心嚢水を伴った患者に心エコーを施行し，併せて血中BNPとh-ANPを測定し，その関係を検討した．対象と方法：当院に入院した軽症心不全（NYHA 1-2度）と診断された患者65名と心不全を伴わない26名のコントロール（C）群の計91名に心エコーによるEFを計測し，血中BNPとhANPを測定した．心不全は大動脈弁閉鎖不全症（AR）群（N＝12），僧帽弁閉鎖不全症（MR）群（N＝11），虚血性心疾患（I）群（N＝14），拡張型心筋症（DCM）群（N＝8），肥厚性心筋症（HCM）群（N＝8）と心嚢水を伴った（PE）群（N＝12）の6群に分けた．結果：全患者対象では，血中BNPはh-ANPに比較してEFの低下度をより鋭敏に反映していた．各疾患別検討ではhANPは，PE,1,MR，HCM,AR,DCM,C群の順に増加していた．BNPはPE,HCM,AR,MR,I，DCM,C群の順に増加していた．しかも，DCM群では有意にEFがC群に比し低下していたが，BNP,h-ANPは有意な増加は認められなかった．反対にPE群では他疾患群に比し有意なEFの低下は認められなかったが，BNP,h-ANPは他群に比し有意に増加していた．結語：軽症心不全例では，BNPはh-ANPより鋭敏にEFの低下度を反映し，また心嚢水貯留例では他疾患のEF低下例よりBNP,h-ANPがさらに著明に増加していた．

This study was designed to clarify whether the blood concentration on h-ANP and BNP increases in correla-tion with the ejection fraction (EF) on echocardiography, and also to study the difference in the increase of these concentrations in patients with various heart diseases with mild heart failure.

91 patients with or without mild heart failune were treated in our hospital and studied regarding echocar-diography and their h-ANP and BNP concentrations. 26 patients were without heart failure (control group). The other 65 patients were divided into 6 groups. That is. the aortic regurgitation group (n=12), the mitral regur-gitation group (n=11), the ischemic heart disease group (n=14). the dilated cardiomvopathv (DCM) group (n= 8), the primary hypertrophic cardiomyopathy group (n= 8), and the pericardial effusion (PE) group (n=12).

First, in all patients with severe EF reduction (to less than 50%). h-ANP and BNP concentrations were significantly increased. But in the mildly-moderately reduced group (EF=50-70%). BNP concentrations in creased only gradually compared with the increase in h ANP concentrations.

Secondly, in the PE group. there was no significant reduction of EF, and except for the DCM group, LVDd was not significantly enlarged in any of the other five heart disease groups involved in this study.

The h-ANP and BNP concentrations variously in-creased in the 6 heart-disease groups included in our study, but the increase was greater in patients in the PE group, than in patients in the other groups.

These results indicated that BNP increases more than h-ANP in cases of mild heart failure, but both BNP and h-ANP concentrations increase remarkably in patients with PE.