血液透析患者におけるHANP濃度(人心房性ナトリウム利尿ペプチド)測定の臨床的意義 : D.W.(ドライウェイト)決定の指標としてのHANP

Abstract

1)心不全・高血圧などの血中HANP濃度を上昇せしめる因子がなければ, 血中HANP濃度は腎機能の悪化と相関して高値をとることはない.2)透析患者の血中HANP濃度はいずれも有意に上昇しているが, 年齢, 透析期間とは相関しない.3)透析による除水の量に従って血中HANP濃度は有意に低下する.4)心不全・高血圧などの合併症のない3群G4の透析患者で, CTRが50%以上の者は50%未満の者より透析後でも血中HANP濃度は有意に高かった.透析患者における血中HANP濃度の上昇は循環血液量の増加を反映していると考えられる.従って臨床的には血中HANP濃度は, 透析患者における至適体重(D.W.)を決定するための良い指標となりえることが推定された

Human atrial natriuretic peptide (HANP) is a hormone with the physiological characteristics of a regulator of body fluid volume. We studied whether, or not, it is possible to use HANP as a parameter to determine the so-called dry weight (D.W.) in patients on maintenance dialysis. Subjects for experiments included 117 hemodialysis (HD) patients, 18 chronic renal failure (CRF) patients under conservative treatment and 20 normal controls. Plasma HANP level was much higher in HD patients than in controls. In CRF patients treated conservatively, there was no significant correlation between plasma HANP and the degree of renal dysfunction. In HD patients plasma HANP showed a significant positive correlation with CTR (r = 0.408, p less than 0.001), but no correlation with the age or duration of hemodialysis. During hemodialysis, the plasma HANP level fell with the lapse of time significantly (p less than 0.001). In HD patients without complications, plasma HANP level after HD were significantly higher (p less than 0.001) in ones with CTR of 50% or more than with CTR of less than 50%. Plasma HANP may play an important part in regulating the balance of body fluid volume. These findings suggest that plasma HANP is useful as a parameter to determine the D.W. in patients on hemodialysis.