厄贝沙坦治疗高血压患者的临床效果观察

目的：观察厄贝沙坦治疗高血压患者的临床效果。方法：选择2007年1月～2009年1月来本院就诊的高血压患者200例，随机分为两组，厄贝沙坦组100例，采用厄贝沙坦治疗4周；对照组100例采用依那普利治疗，观察患者用药前后动态血压、心脏功能变化，并评价临床疗效。结果：厄贝沙坦组患者治疗总有效率为97％，均未出现明显不良反应：与对照组比较．差异有统计学意义，P〈0．05。厄贝沙坦组治疗后24h、白昼和夜间平均收缩压和舒张压与治疗前比较，差异有统计学意义，P〈0．05；用药后血压晨峰也显著降低，与治疗前比较，差异有统计学意义，P〈0．05：但与对照组间比较，差异无统计学意义，P〉0．05。结论：厄贝沙坦治疗高血压疗效满意，安全性较高，还可降低患者的心脑血管意外的风险。     

Angioedema due to angiotensin-converting enzyme inhibitor use: Radiographic findings in 3 patients

Angioedema of the oropharynx and hypopharynx due to oral angiotensin-converting enzyme (ACE) inhibitors is a potentially life-threatening event and has not been well described in the radiology literature. A retrospective review of the clinical and radiologic findings in three patients with angioedema due to ACE inhibitor use was performed.Our subgroup of patients treated with ACE inhibitors presented with varying degrees of dysphagia, dyspnea, and facial swelling. Plain radiographic findings included enlargement of the epiglottis, aryepiglottic folds, and prevertebral and submental soft tissue. Computed tomography confirmed extensive retropharyngeal and subcutaneous edema. Clinical symptoms resolved in each case in 24–48 hours with cessation of the ACE inhibitor and concomitant steriod therapy.Our cases demonstrate the typical clinical and radiographic presentation of neck angioedema in the setting of ACE inhibitor use. As ACE inhibitors are increasingly being used as first-line agents in the treatment of hypertension, we caution that neck angioedema may be encountered with increased frequency in adults. Early recognition and immediate intervention result in rapid resolution of this potentially life-threatening event.     

依那普利治疗高血压病的临床观察

本文报告应用新的转换酶抑制剂依那普利(enalapril)治疗59例原发性高血压的临床疗效。采甩随机单盲及双盲法进行,对照药为巯甲丙脯酸。结果表明:依那普利使收缩压及舒张压均降低10％以上(由21.5±1.6/13.8±0.9kPa降至19.2±2.2/12.3±1.0kPa),总有效率为74.2％,与巯甲丙脯酸相仿,但前者作用持续时间显著延长。半数患者的有效剂量为10mg/d,80％在20mg/d以下。本药对血像、肝肾功能、血电解质及糖、脂类代谢未见明显影响。     

Renoprotective effects of combination of angiotensin converting enzyme inhibitor with mycophenolate mofetil in diabetic rats

Objective and design Previously it was shown that blocking of the renin-angiotensin system (RAS) by angiotensin converting enzyme (ACE) inhibitors, or suppression of inflammatory responses by immunosuppressive drugs such as mycophenolate mofetil (MMF) could attenuate renal injury in diabetic rats. Whether RAS blockade combined with an immunosuppressive drug provides superior renoprotection against diabetic nephropathy has not been clearly delineated. Materials Diabetes was induced by injection of streptozotocin after uninephrectomy. Treatment Rats were randomly separated into five groups: control, diabetes, diabetes treated with enalapril (an ACE inhibitor, 10 mg/kg/d by gastric gavage), diabetes treated with MMF (10 mg/kg/d by gastric gavage), or diabetes treated with a combination of both agents and were followed for 8 weeks. Methods 24 h urinary albumin excretion rate (AER) was determined, renal injury was evaluated, immunohistochemistry for ED-1 macrophage marker, intercellular adhesion molecule-1 (ICAM-1) and monocyte chemoattractant protein-1 (MCP-1) were performed, and expression of transforming growth factor (TGF)-β1 protein was determined by Western blotting analysis. Results Diabetes was associated with a considerable increase in AER. Both enalapril and MMF retarded the increase in albuminuria, which was nearly completely abrogated by combination therapy. Increased glomerular volume and tubulointerstitial injury index in diabetic rats was attenuated by treatment with either enalapril or MMF and further reduced by the combination of the two. Elevated malondialdehyde levels in renal tissue were reduced by enalapril or MMF and, more effectively, by combined enalapril with MMF. Renal overexpression of ICAM-1 was not retarded by enalapril and attenuated by MMF or combined enalapril with MMF. Combination therapy was associated with a superior suppression of diabetes-induced macrophage recruitment and overexpression of MCP-1 and TGFβ1 compared to either monotherapy in renal tissue. Conclusion The combination of enalapril and MMF confers superiority over monotherapy in renoprotection, a mechanism which may be at least partly correlated with synergistic suppression of increased macrophage recruitment and overexpression of MCP-1 and TGF-β1 in renal tissue in diabetic rats. Received 26 July 2005; returned for revision 5 October 2005; returned for final revision 9 January 2006; accepted by M. Katori 23 January 2006     

依那普利辅助治疗肺心病心衰疗效观察

目的：了解依那普利辅助治疗肺心病心衰的疗效。方法：在抗炎、改善通气基础上观察加用依那普利后心衰改善情况。结果：依那普利组与对照组相比肺心病心衰症状改善明显,心率下降明显,而血压无明显变化。结论：依那普利可改善肺心病心衰,提高生活质量。     

Enalapril对实验性糖尿病大鼠肾脏的保护作用机理研究

目的　研究血管紧张素转换酶抑制剂 Enalapril对糖尿病的肾病治疗作用机理。方法　以Enalapril治疗实验性糖尿病大鼠 ,并将正常组、糖尿病对照组及治疗组尿蛋白水平及肾组织转化生长因子 β、糖基化终末产物含量进行比较。结果　 Enalapril治疗组大鼠肾组织转化生长因子 β及糖基化终末产物含量与糖尿病对照组相比无下降。结论　 Enalapril的肾脏保护作用并非通过抑制肾组织转化生长因子 β上调或糖基化终末产物积聚     

依那普利治疗高血压左室肥厚和左室舒张功能

目的：探讨依即普利对高血压左室肥厚与左室舒张功能的治疗作用。方法：对符合ＷＨＯ诊断标准的原发性高血压左室肥厚,服用依那普 治疗,用彩色普勒超声心电图测定治疗前后左室肥厚、左室收缩及舒张功能指标。结果：治疗后室间隔厚度、左室后壁厚度、左室心肌重量均明显减少,舒张早期流速峰值明显增大,房缩期最大流速下降,两比值下降,左室射血分数无变化。结论：依那普利可有效地抑制并逆转左室肥厚,改善左室舒张功能。     

Enalapril和Captopril对急性心肌梗塞后大鼠心脏形态学影响的比较

目的　旨在观察Enalapril和Captopril对心肌梗塞大鼠心脏形态学的影响 ,比较两药的差异 ,以探讨左室重构的机制。方法　选用大鼠心肌梗塞模型 ,分为假手术组、心肌梗塞组、梗塞给药Enalapril组和梗塞给药Captopril组 ,梗塞前 3天开始饲以Enalapril和Captopril。 结果　心梗后左室重量指数及左室腔半径分别比假手术组增加 10 .4 %和 2 4 .5% ,使用Enalapril和Captopril后左室腔半径降低 13.2 %和 12 .7% ,但两给药组无差异 (P <0 .0 1)。结论　心梗后应用Enalapril和Captopril可减轻左室重构 ,改善心功能 ,两药无差异     

Angiotensin converting enzyme inhibitor-induced angioedema: a report of two cases

Angioedema is a rare but potentially fatal side effect of angiotensin converting enzyme (ACE) inhibitors. We report for the first time, two children with systemic lupus erythematosus who developed acute angioedema after the long-term use of enalapril. Prompt recognition and appropriate management of ACE-induced angioedema prevented life-threatening complications. This report highlights the potential risks of angioedema associated with the use of ACE inhibitors in children. Patients should be advised to seek medical treatment immediately if they experience swelling of the face, neck, or tongue, and especially if they have trouble breathing, speaking, or swallowing. Received: 12 March 1999 / Revised: 8 June 1999 / Accepted: 8 June 1999     

Study on the Mechanism Responsible for the Incompatibility of Enalapril Maleate with Sodium Starch Glycolate

Enalapril maleate (EM) is known to suffer from incompatibilities in the solid state. This study investigates the destabilizing effect of sodium starch glycolate (SSG) on EM. This was done by varying the mixing ratio and moisture content of binary mixtures. Differential scanning calorimetry and microscopy show a loss of crystallinity of EM at the contact surface with SSG. It is shown that this is followed by decomposition of E to diketopiperazine (DKP). These phenomena are modulated by moisture. The environmental pH turned out to be crucial; when the zwitterion is formed at the appropriate pH, ring closure into DKP is promoted.