血管紧张素受体拮抗剂对转化酶抑制剂联合应用对高血压大鼠心室重塑的影响

目的：探讨血管紧张素转化酶抑制剂（ACEI）、血管紧张素Ⅱ 1型受体拮抗剂（AT1－ant)单独与联合治疗对高血压大鼠心室重塑的影响。方法：40只雄性8周龄的易卒中自发性高血压大鼠（SHRSP）随机分成5组（n=8):SHRSP对照组、安慰剂组、缬沙坦组、苯那普利组及缬沙坦、苯那普利联用组。另外，取8只雄性8周龄的京都Wistar大鼠（WKY）作为对照。大狼猩红－苦味酸染色测定各组大鼠心肌胶原容积分数（CVF）、心肌壁内血管周围胶在面积（PVCA）。免疫组织化学染色检测大鼠左室心肌中转化生长因子－β1(TGF-β1）的蛋白表达。结果：SHRSP的收缩压（SBP）、左室重量指数（LVMI）、CVF、PVCA及左室心肌中TGF－β1蛋白表达较同龄的WKY显增高。给予苯那普利、缬沙坦单独或联合治疗后SHRSP的LVMI、CVF、PVCA及左室心肌中TGF－β1蛋白表达都显降低。苯那普利、缬沙坦单独应用时的效果没有差异，而联合应用的效果更显。结论：苯那普利和缬沙坦都能降低SHRSP的血压以及逆转其左室重塑，而联合用药的作用更显。     

ACEI联合ARB治疗中重度原发性高血压的临床研究

目的分析血管紧张素转化酶抑制剂(ACEI)联合血管紧张素受体拮抗剂(ARB)治疗中重度原发性高血压的临床效果。方法将我院78例原发性高血压患者按照双盲法随机分为3组,分别采用ACEI、ARB和联合使用2种药物3种治疗方案。比较3组患者一般资料的差异,服用药物治疗前后心功能相关指标变化、血压变化和不良发应的发生情况。结果 3组患者服用药物治疗前一般情况的差异没有统计学意义。服用药物前后3组患者心功能各项指标都有显著提升,ACEI组和ARB组改善程度接近,联合组的改善程度比ACEI组和ARB组效果好,差异有统计学意义。3组血压都明显下降,前2组血压下降程度相似,血压接近正常高值,联合组血压下降到正常值范围。3组患者发生不良反应的情况基本相似,联合组并未产生更加严重或频繁的不良反应。结论本研究通过数据证明,服用ACEI联合ARB类药物治疗原发性高血压有着显著的临床疗效。     

黄葵胶囊联合ACEI及ARB治疗早期糖尿病肾病的临床效果

目的：观察黄葵胶囊联合ACEI及ARB治疗早期糖尿病肾病(DN)的有效性及安全性。方法选取本科2014年1~7月被诊断为早期DN的患者60例,随机分为两组,每组30例。在控制血糖的基础上,对照组给予依那普利、厄贝沙坦治疗,观察组在对照组基础上加用黄葵胶囊治疗。观察两组治疗后24 h尿蛋白排泄率(UAER)、血肌酐(SCr)、血尿素氮(BUN)、血糖、血压等的变化及用药后不良反应。结果随着治疗时间延长,两组UAER、SCr及BUN水平逐渐下降,观察组UAER、SCr及BUN较对照组低,差异有统计学意义(P<0.05);观察组血糖和血压各指标水平均低于对照组,差异有统计学意义(P<0.05);观察组出现2例不良反应,对照组未出现不良反应,差异无统计学意义(P>0.05)。结论黄葵胶囊联合ACEI及ARB治疗早期DN是一种安全、有效的治疗方案。     

血管紧张素受体拮抗剂对糖尿病肾病患者肾小管功能的作用

目的探讨肾小管间质损伤作为糖尿病患者肾损害早期的一项重要特征，评价血管紧张素受体拮抗剂对该指标的作用。方法予对照组患者口服双嘧达莫100mg，一日3次，治疗组患者在此基础上加用口服缬沙坦80mg，一日1次，观察两组患者的肾小管功能。结果治疗组患者经治疗后尿系列蛋白均明显降低。结论缬沙坦具有肾小管保护功能。     

血管紧张素受体拮抗剂对粮尿病肾病患者肾小管功能的作用

目的 探讨肾小管间质损伤作为糖尿病患者肾损害早期的一项重要特征,评价血管紧张素受体拮抗剂对该指标的作用.方法 予对照组患者口服双嘧达莫100mg,一日3次,治疗组患者在此基础上加用口服缬沙坦80mg,一日1次,观察两组患者的肾小管功能.结果 治疗组患者经治疗后尿系列蛋白均明显降低.结论 缬沙坦具有肾小管保护功能.     

联合使用ACEI和ARB对高血压患者尿蛋白影响的观察(附64例分析)

目的 观察血管紧张素转换酶抑制剂(ACEI)与血管紧张素Ⅱ-Ⅰ型受体拮抗剂(ARB)联合应用对高血压病患者尿蛋白排泄的影响.方法 将66例确诊为原发性高血压的老年患者随机分为ACEI(洛汀新)组、ARB(代文)组和联合治疗组,三组于治疗前及治疗6个月后测血压、血肌酐、血钾、24 h尿蛋白定量.结果 三组治疗6个月后收缩压、舒张压较治疗前明显下降(P<0.05),治疗6个月后24 h尿蛋白定量较治疗前明显下降(P<0.05),且联合治疗组效果优于其他两组(P<0.05).三组治疗前后血肌酐及血钾水平无明显改变(P>0.05).结论 ACEI和ARB联合应用对原发性高血压减少尿蛋白排泄的作用优于任一种药单独应用.     

ACEI和ARB联合治疗糖尿病肾病

肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂——血管紧张素转换酶抑制剂（ACEI）问世30年、血管紧张素Ⅱ受体（AT1）拮抗剂（ARB）问世20年来，围绕二组药物的安全性、疗效、适应证等展开了大量的研究，在ONTARGET研究结果公布之前，     

血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂在IgA肾病中的应用

IgA肾病(IgA nephropathy，IgAN)为一免疫病理诊断名称，指IgA或以IgA为主的免疫球蛋白弥漫沉积在肾小球系膜区及毛细血管袢引起的一系列临床症状及病理改变。除IgAN外，一些全身性疾病也可以合并IgA在肾小球系膜区沉积及引起相应的临床症状，如：系统性红斑狼疮，过敏性紫癜等疾病。前者通常称为原发性IgAN，后者则称为继发性IgAN。     

ACEI类药物联合其他药物对慢性心力衰竭的治疗

<正>慢性心力衰竭(chronic or congestive heart failure, CHF)是各种严重心脏疾病终末阶段所表现出来的一种临床综合征,一是原发性心肌功能异常,二是继发性代偿过程。病情复杂,发病率高,预后不良。心力衰竭患者5年内死亡率高达40%～60%。ACEI可适用于各级心功     

红花注射液对早期高血压肾病尿微量蛋白的影响

目的观察红花注射液对早期高血压肾病尿微量蛋白的影响。方法将68例患者随机分为两组,均用洛丁新和波依定控制血压。治疗组（36例）用红花注射液20mL加5%葡萄糖注射液250mL静脉滴注,对照组（32例）予丹参注射液250mL静脉滴注。结果治疗组尿4项微量蛋白均较对照组明显降低（P〈0.05）。结论红花注射液是治疗高血压肾病的安全、有效药物之一。     

对心血管具有保护作用的醛固酮受体拮抗剂依普利酮

目的：介绍一种新型的醛固酮受体拮抗剂依普利酮(eplerenone)对心血管的保护作用。方法：从临床有效性、安全性和药理学阐述依酱利酮在心血管疾病中的作用。结果：依普利酮能有效降低血压，减轻心血管内皮损伤，减少危险事件和终点事件的发生．与螺内酯相比不良反应小。结论：临床医师应重视选择性醛固酮受体拮抗剂在治疗心血管疾病中的应用。     

小儿肾脏疾病尿微量蛋白动态变化与临床转归

本文应用 ELISA 法测定68例小儿肾脏及相关疾病四种尿微量蛋白:白蛋白(ALb)、免疫球蛋白(IgG、IgA、Igm)的变化,并观察预后。发现肾炎组 AIb、IgG 明显增高(P<0.05),且微量蛋白增高者病程长平均53天,而正常者平均34天;肾病组四种均高,尤以 AIb最明显(P<0.01),微量蛋白升高明显者86%复发,53%对激素无效应或部分效应;过敏性紫癜仅 Alb 和 IgA 增高(P<0.05),增高者73%发生肾损害。结果表明尿微量蛋白的测定有助于判定预后也是判定最终治愈的标准之一。     

KRH-594, a new angiotensin AT1 receptor antagonist, ameliorates nephropathy and hyperlipidaemia in diabetic spontaneously hypertensive rats

1. We examined whether KRH-594, a new angiotensin AT1 receptor antagonist, ameliorates the progression of diabetic nephropathy and hyperlipidaemia in streptozotocin (STZ)-induced diabetic unilateral nephrectomized spontaneously hypertensive rats (DM-1K-SHR) or not. 2. The oral administration of KRH-594 (3 and 10 mg/kg per day) and candesartan cilexetil (1 mg/kg per day) for 16 weeks significantly reduced systolic blood pressure, urinary albumin and urinary total protein in DM-1K-SHR. 3. In a histological study, KRH-594 (3 and 10mg/kg per day) and candesartan cilexetil (0.3 and 1 mg/kg per day) dose-dependently improved glomerulosclerosis and the hyalin cast of tubules in DM-1K-SHR kidneys. Both KRH-594 (10 mg/kg per day) and candesartan cilexetil (0.3 and 1 mg/kg per day) dose-dependently inhibited cardiac hypertrophy. 4. KRH-594 (3 and 10 mg/kg per day), but not candesartan cilexetil, dose-dependently reduced the levels of triglyceride, total cholesterol and phospholipids in DM-1K-SHR. 5. These results suggest that KRH-594 improves diabetic complications, such as nephropathy and hyperlipidaemia, with hypertension.     

Effect of the aldosterone antagonist canrenone on plasma aldosterone concentration and plasma renin activity,and on the excretion of aldosterone and electrolytes by man

Summary Canrenone was administered in doses of 2×82 mg and 2×164 mg per day over a period of 10 days to diabetic patients without cardiovascular, liver or kidney involvement. Aldosterone excretion and plasma aldosterone increased only slightly during both regimes. There was a clear-cut increase in aldosterone excretion only after discontinuation of carenone. Excretion of sodium potassium and fluid was not significantly changed either during or after treatment. The lack of effect of canrenone on the kidney was in contrast to the significant decrease in serum sodium and increase in serum potassium, and the significant, dose-dependent rise in plasma renin activity following canrenone administration. The increased plasma renin activity persisted for some days after discontinuation of canrenone. It is suggested that canrenone primarily exerted its effect in the distal part of the large intestine where ionic movements are most affected by aldosterone. The disproportionately slight increase in plasma aldosterone concentration and aldosterone excretion, in spite of the greatly elevated plasma renin activity and serum potassium level, is considered to be due to a direct inhibitory effect of canrenone on aldosterone production in the adrenals.     

阿魏酸哌嗪与贝那普利联用对早期糖尿病肾病患者尿白蛋白排泄率的影响

目的 探讨阿魏酸哌嗪联合贝那普利对早期糖尿病肾病患者尿白蛋白排泄率(UAER)的影响。方法 将符合纳入标准患者随机分成试验组和对照组。试验组使用阿魏酸哌嗪和贝那普利,对照组仅使用贝那普利。比较治疗前及治疗后3个月的UAER、24 h尿蛋白、血肌酐、血糖、糖化血红蛋白、CRP和血压的差异。结果 ①两组治疗后UAER、24 h尿蛋白、CRP和血压均较治疗前显著下降,差异有统计学意义(P<0.05),但血肌酐、血糖和糖化血红蛋白无显著变化,差异无统计学意义(P>0.05);②治疗后试验组UAER、24 h尿蛋白和CRP显著低于对照组,差异有统计学意义(P<0.05)。结论 阿魏酸哌嗪与贝那普利联用可进一步降低UAER从而提高糖尿病肾病(DN)的治疗效果。     

Renal effects of nicardipine,a calcium antagonist,in hypertensive type 2 (non-insulin-dependent) diabetic patients with and without nephropathy

Summary The renal effects of oral maintenance doses of nicardipine 60–120 mg/day have been studied in 18 hypertensive patients with Type 2 (non-insulin-dependent) diabetes mellitus: 6 with normoalbuminuria (urinary albumin excretion rate, AER <20 μg · min⁻¹, Group A); 6 with incipient nephropathy, (AER 20–200 μg · min⁻¹, Group B); and 6 with overt nephropathy (AER >200 μg · min⁻¹, Group C). Treatment for 4 weeks significantly lowered the systolic and diastolic blood pressures and reduced total renal vascular resistance in all three groups. Nicardipine increased renal blood flow significantly in Group C and slightly in Group B, and had no effect in Group A. Glomerular filtration rate remained unchanged in all three groups. It significantly reduced AER and the fractional clearance of albumin in Group B, whereas AER in Groups A and C was not altered. Plasma renin activity, aldosterone concentration, osmotic pressure, serum total protein and albumin concentrations and haemoglobin A_1c level were similar in the control and nicardipine phases in all three groups. The results suggest that nicardipine may preserve renal function whilst having a concomitant hypotensive action in hypertensive Type 2 diabetic patients with normoalbuminuria and incipient nephropathy, and that the drug may improve renal blood flow in patients with overt nephropathy. The effect of the drug on urinary albumin excretion may deserve further investigation.     

IgA肾病尿沉渣的表现及与肾脏病理改变的相关性研究

目的：探讨IgA肾病患者尿沉渣的表现与肾脏病理改变的相关性。方法收治的IgA肾病患者282例,检测其尿沉渣谱、病理改变及损伤类型,根据尿沉渣谱将患者划分为血尿型、活动型和进展型,应用对应分析明确三分型与肾脏病理改变类型的相关性;根据肾脏病理活动与否,将患者划分为活动性病变组和非活动性病变组,对比2组尿沉渣表现;采用Logistic回归分析,明确尿沉渣改变是否为肾脏病理活动与否的影响因素。结果尿沉渣三分型与肾脏病理改变类型存在较强的对应性（χ2＝183．143,P＜0．05）。活动性病变组中尿沉渣活动型、进展型明显多于非活动性病变组,而血尿型明显少于非活动性病变组,差异有统计学意义（P＜0．05）。尿沉渣谱改变是影响IgA肾病活动与否的独立危险因素（ P＜0．05）。结论尿沉渣表现与IgA肾病患者肾脏病理改变有一定相关性,值得关注。     

血塞通软胶囊对2型糖尿病性肾病患者补体-炎症受体系统的影响

目的观察血塞通软胶囊对2型糖尿病性肾病患者补体-炎症受体系统的影响。方法将92例2型糖尿病性肾病患者,通过随机数字表法分为对照组和观察组,各46例。对照组患者给予基础治疗方案(包括低盐低蛋白饮食、戒烟戒酒、适当运动、降压、降糖、降脂等),观察组患者在对照组治疗的基础上口服血塞通软胶囊,每次0.55 g,每日3次。两组疗程均为4周。比较两组患者的肾功能[24 h尿蛋白定量、血清肌酐(Scr)、血尿素氮、肾小球滤过率(GFR)]、空腹血糖、糖化血红蛋白、补体因子[C3、C5、补体因子H(CFH)、C5b-9]、炎症因子[白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)、IL-6、单核细胞趋化蛋白1(MCP-1)]、肾小管损伤标志物[β₂-微球蛋白(β₂-MG)、视黄醇结合蛋白4(RBP4)、中性粒细胞明胶酶相关脂质运载蛋白]水平;并分析观察组患者治疗前后肾小管损伤与补体-炎症受体系统的相关性。结果与治疗前比较,治疗后两组患者的24 h尿蛋白定量、Scr、C3、IL-1、TNF-α、MCP-1、β₂-MG、RBP4均显著降低,GFR、CFH均显著升高,且除C3外观察组均显著优于对照组(P<0.05);观察组患者的C5在治疗后显著降低且显著低于对照组(P<0.05)。两组患者的其他指标在治疗前后及组间比较,差异均无统计学意义(P>0.05)。C3、MCP-1、TNF-α与患者的肾小管损伤显著相关(P<0.05),其中与C3的相关性最大。结论血塞通软胶囊能够通过作用于补体系统和减轻炎症,从而减轻2型糖尿病性肾病患者的肾小管损伤,改善其肾功能。     

Differences in the determinants of eplerenone, spironolactone and aldosterone binding to the mineralocorticoid receptor

The importance of mineralocorticoid receptor (MR) antagonists in the treatment of cardiovascular disease has been emphasised by two recent clinical trials, one using spironolactone and the other using a new selective MR antagonist, namely eplerenone. Eplerenone has a very low affinity for the glucocorticoid receptor (GR). Determinants of binding specificity of eplerenone to the MR were investigated using chimeras created between the ligand-binding domains (LBD) of the MR and the GR. These chimeras had been used previously to investigate aldosterone and spironolactone binding specificity to the MR. Eplerenone competed strongly for [(3)H]-dexamethasone binding to a MR/GR chimera containing amino acids 804-874 of the MR and weakly to a chimera containing amino acids 672-803 of the MR. Within the 804-874 region, eplerenone competed for [(3)H]-dexamethasone binding to a chimera containing amino acids 820-844 of the MR, although the calculated affinity was approximately 10-fold lower than for binding to the full-length MR LBD. Similar results were obtained using another MR antagonist, namely spironolactone. Modelling of eplerenone binding to the MR LBD, based on the GR LBD crystal structure, suggests that amino acids 820-844 affect the overall shape of the ligand-binding pocket and that eplerenone acts as an MR antagonist because it fails to stabilize the active conformation of the receptor. In contrast with results with the MR antagonists eplerenone and spironolactone, amino acids 820-844 are sufficient in themselves to confer high-affinity aldosterone binding to the MR, suggesting that the binding determinants of the two antagonists are similar to each other but differ from those of aldosterone.     

福辛普利和氯沙坦单用或合用治疗早期糖尿病肾病90例

目的:探讨福辛普利联合氯沙坦对早期糖尿病肾病的治疗作用。方法:90例合并早期糖尿病肾病的2型糖尿病病人,随机分为3组。维持原治疗不变,福辛普利组加用福辛普利10mg,po,qd,氯沙坦组加用氯沙坦50mg,po,qd,合用组加用福辛普利与氯沙坦,用法同前2组,疗程均为12wk。观察治疗前后尿清蛋白排泄率(UAER)、糖化血红蛋白(HbA1c)、肾功能、平均动脉压(MAP)等指标的变化。结果:3组治疗后,UAER均下降(P<0.01),合用组下降幅度大于福辛普利组和氯沙坦组[(76±39)mg·24h-1,vs(55±36),(46±42)mg·24h-1,P<0.05]。各组治疗后MAP均降低(P<0.01),各组间治疗后血压水平差异无显著意义(P>0.05)。结论:福辛普利氯沙坦均可降低早期糖尿病肾病病人的蛋白尿,且联合应用显示协同作用,肾素血管紧张肽系统药物具有独立于降血压之外的肾脏保护作用。