中药利尿降压作用的研究进展

根据中药作用机制,对利尿降压中药的主要化学成分及药理作用的研究进展作一综述,主要包括具有清热、利水渗湿、祛风湿、平肝熄风、补益及其他作用的中药在利尿降压中的应用,从而为临床辨证论治与辨病论治相结合提供用药参考和依据。     

桂苓神术汤及其有效部位的利尿作用

目的:研究桂苓神术汤的利尿作用,筛选利尿作用的有效部位并探讨其作用机制.方法:SD大鼠,随机分为18组:正常组、模型组,呋噻米组,桂苓神术汤及石油醚部位、乙酸乙酯部位、正丁醇部位、剩余部位分别设10.0,5.0,2.5 g·kg-13个剂量组.每组大鼠均按40 mL· kg-生理盐水ig,形成盐水负荷模型.45 min后,ig给予不同剂量的桂苓神术汤及不同极性部位,用大鼠代谢笼法观察大鼠6h的尿量,并测定尿液pH及Na+,K+,Cl-的浓度.结果:桂苓神术汤组(5.0,2.5 g·kg-1),乙酸乙酯部位组(5.0 g·kg-1),剩余部位组(5.0 g·kg-1)均能显著增加盐水负荷大鼠6h的尿量;尿中K+排出量较模型组均显著升高,分别为(850.3±78.8),(816.6±91.1),(826.3±84.9),( 776.7±69.1)mmol·L -1,Na+,C1-排出量较模型组无显著差异.结论:桂苓神术汤及有效部位具有缓和持久的利尿作用,其利尿作用机制可能为增加大鼠尿液中K+的排泄.     

防己黄芪汤加减结合西药治疗高血压肾损害水肿的临床观察

目的:观察防己黄芪汤加减结合西药治疗高血压肾损害水肿的临床疗效。方法:将50例符合条件的患者随机分为对照组和治疗组,对照组采用西药治疗,治疗组在西药基础上运用加减防己黄芪汤,10d为1个疗程,观察2个疗程。结果:治疗组水肿改善有效率92%,对照组水肿改善有效率60%;治疗组血肌酐、尿素氮、血尿酸水平较治疗前略有下降,利尿剂剂量明显低于对照组。结论:防己黄芪汤加减结合西药治疗对高血压病肾损害水肿有显著疗效。     

中药广防己与粉防己总提取物利尿效应及肾毒性比较研究

目的在药效剂量下,观察中药广防己总提取物利尿效应及其肾脏毒性出现程度,并与粉防己总提取物进行比较。方法采用大鼠代谢笼法,观察广防己和粉防己对正常大鼠尿量和尿液电解质的影响以及与肾功能相关指标的变化,比较两者利尿效应及产生肾毒性情况。结果广防己、粉防己各组在给药第3、5天广防己高、中剂量组在0-2 h时间段及24 h总尿量显著增加,与对照组比较差异有显著性（P〈0.05,P〈0.01）;广防己、粉防己各剂量组大鼠尿液中Na^＋、K^＋、Cl^-浓度及尿渗量（Uosm）与对照组比较未出现明显差异;广防己各剂量组尿素氮（BUN）均显著升高,中、低剂量组尿液肌酐（CR）升高,高剂量、中剂量组均能增加尿液中β2-微球蛋白的表达（P〈0.05）。结论广防己各剂量组单位时间段尿量及总尿量均略高于等剂量粉防己各组,但无统计学意义;相关指标显示广防己在药效剂量范围内就具有一定的肾毒性,且其肾毒性主要与近曲小管病变有关;粉防己在等剂量下未见明显肾脏毒性表现。     

Effects of antihypertensive drug treatments on fracture outcomes: a meta-analysis of observational studies

OBJECTIVE: To quantitatively pool findings from observational studies on the risk of fracture outcomes associated with exposure to five antihypertensive drug classes: angiotensin-converting enzyme (ACE) inhibitors, diuretics (in particular thiazide diuretics), beta-blockers, calcium-channel blockers and alpha-blockers. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Publications listed in the MEDLINE, EMBASE and LILACS databases, the ISI proceedings, and bibliographies of retrieved articles. Sources were searched from the earliest possible dates through December 2005. REVIEW METHODS: We included case-control and cohort studies presenting relative risks and confidence intervals (CIs) for the association between exposure to antihypertensive agents and fracture outcomes. Data were extracted onto a standardized computer worksheet. Study quality was assessed using a 10-point questionnaire specific to case-control or cohort study design. RESULTS: Fifty-four studies were identified. Pooled estimates were computed using the software HEpiMA. The pooled relative risk (RR) of any fracture with use of thiazide diuretics was 0.86 (95% CI 0.81-0.92) and 1.14 (95% CI 0.84-1.54) with use of nonthiazide diuretics. There was a statistically significant reduction of any fracture with use of beta-blockers, (RR 0.86, 95% CI 0.70-0.98). The one study with ACE inhibitor data showed protection (RR 0.81, 95% CI 0.73-0.89). No significant associations were found between fractures and exposure to alpha-blockers or calcium-channel blockers. CONCLUSIONS: Thiazide diuretics and beta-blockers appear to lower the risk of fractures in older adults. However, these agents cannot be recommended as preventive therapies for fractures until data from randomized controlled trials have established their efficacy. Patients who use these inexpensive drugs as treatments for hypertension may also benefit from a reduction in fracture risk.     

Efficacy and Safety of an Oral Fixed Low-Dose Perindopril 2 mg/Indapamide 0.625 mg Combination: A Randomized,Double-Blind,Placebo-Controlled Study in Elderly Patients with Mild to Moderate Hypertension

The efficacy and safety of 12 weeks treatment with an oral fixed low-dose perindopril 2 mg + indapamide 0.625 mg (Per/Ind) combination in elderly and very elderly patients (65-85 years) with mild to moderate systolic and diastolic     

Pharmacological studies on hypotensive, diuretic and vasodilator activities of chrysin glucoside from Calycotome villosa in rats

The present study was undertaken in normotensive anaesthetized male rats that received a continuous perfusion of a chrysin glucoside isolated from the flowers and leaves of Calycotome villosa subsp intermedia at a dose of 2.5 mg/kg, or furosemide (control diuretic) at a dose of 0.5 mg/kg. Compared with the control rats receiving NaCl (0.9%), the urine flow, glomerular filtration and electrolyte excretion (Na+, K+) increased significantly in rats treated with chrysin glucoside (p < 0.001). A similar effect was observed in the rats perfused with furosemide. Intravenous injections of bolus doses (1-3 mg/kg) of the chrysin glucoside to anaesthetized rats elicited an immediate and dose-dependent decrease in mean arterial blood pressure (MABP). Pretreatment of the rats with the nitric oxide synthase inhibitor, l-NOArg (10 mg/kg), reduced partially, but significantly (p < 0.01), the maximal decrease in MABP elicited by chrysin glucoside. In the rat isolated aorta preparation, chrysin glucoside (10-100 microm) inhibited in a concentration-dependent manner the noradrenaline (1 microm) induced contractions (IC(50) = 52 microm). This relaxant activity of chrysin glucoside was significantly reduced by incubation of the endothelium-intact rings with l-NOArg (100 microm), (80 +/- 4.7% vs 48 +/- 5.06% in the absence of L-NOArg). In conclusion, these results demonstrate a diuretic and hypotensive action of a chrysin glucoside from Calycotome villosa in anaesthetized rats and indicating an action on renal function, and an active vascular relaxation mediated partially through nitric oxide release.     

长期服用氢氯噻嗪后RAAS活性变化与血糖变化关系

目的:探讨长期服用氢氯噻嗪(HCTZ)后肾素-血管紧张素-醛固酮系统(RAAS)活性变化与血糖(GLU)变化之间的关系。方法:选择119例高血压患者,测定基线RAAS活性和GLU水平等指标后,给予HCTZ12.5mg,qd,1年后测定RAAS活性和GLU水平,分析服用HCTZ1年后RAAS活性变化与GLU水平之间的关系。结果:服用HCTZ1年后,血清肾素活性(PRA)水平升高组与不升高组患者GLU水平下降幅度分别是(-0.26±0.26)mmol·L-1、(-1.36±0.23)mmol·L-1,差异有统计学意义(P<0.05);血清血管紧张素Ⅱ(AngⅡ)水平升高组与不升高组患者GLU水平下降幅度分别是(-0.17±0.18)mmol·L-1、(-1.07±0.21)mmol·L-1,差异有统计学意义(P<0.05)。服药后AngⅡ水平升高的患者中,GLU水平同时也升高的人数比例(40.5%)明显高于AngⅡ水平不升高患者中的相应患者比例(16.9%),差异有统计学意义(P<0.05)。校正年龄、性别、基线GLU水平等其他因素影响后,服用HCTZ1年后的血清AngⅡ水平变化与GLU水平变化独立相关。结论:服用HCTZ1年后的RAAS活性变化与GLU变化之间存在相关关系。     

利钠肽与黄芪对慢性心衰患者的利尿作用

本文从利尿的角度探讨黄芪在治疗心衰方面的优势，并明确了心衰时体内水钠潴留、利尿剂抵抗、ANP／BNP抵抗的机制等，以便为了解黄芪的作用打下铺垫。     

动态血压监测评价小剂量利尿剂治疗原发性高血压的疗效观察

目的:评价利尿剂在老年人高血压尤其收缩期高血压的降压作用。方法:20例3级高血压患者在原有至少两种降压药物(不包括利尿剂)治疗,血压控制仍不理想,加用小剂量利尿剂,氢氯噻嗪6.25mg~12.5mg/d一次或阿米洛利1.25mg~2.5mg/d一次,清晨6时服药。加用利尿剂前及加用利尿剂后2周各行ABPM及实验室检查一次。结果:ABPM显示2周后24小时、日间、夜间平均血压(SBP/DBP)分别下降(15.1±7.9/7.2±4.2)mmHg、(14.1±9.6/6.8±5.4)mmHg、(17.5±11.7/7.8±6.6)mmHg;降压谷/峰(T/P)比值,SBP为61%,DBP为63%。无严重不良反应。结论:小剂量利尿剂降压作用显著、长效、平稳