自发性高血压大鼠代谢物轮廓分析及天麻钩藤饮干预研究

目的：观察自发性高血压大鼠（SHR）血压、血清儿茶酚胺水平、尿液代谢物的改变及天麻钩藤饮的影响,并初步探讨其降压机制。方法：12周龄正常大鼠10只作为空白对照,同周龄雄性SHR大鼠20只随机分为SHR对照组、天麻钩藤饮组。采用尾动脉搏动法测量血压值、酶联免疫法（ELISA）检测用药前后各组大鼠血清儿茶酚胺的变化、气相色谱一质谱联用法检测大鼠尿液代谢物。结论：三组大鼠尿液代谢物没有明显不同,天麻钩藤饮对尿液代谢物无明显影响,但天麻钩藤饮具有一定的降低大鼠血压及明显降低血清儿茶酚胺浓度的作用。     

糖尿病肾病动态血压与儿茶酚胺的相关性研究

目的：探讨尿儿茶酚胺（uCA）与2型糖尿病肾病（DN）动态血压（ABP）的关系。方法：用高效液相色谱-荧光检测器（HPM—EDA）测定22例糖尿病肾病（Ⅲ）UCA浓度;昼、夜UCA包括去甲肾上腺素（NE）、肾上腺索（E）、多巴胺（DA）,同时监测24hABP。结果：DN病人高血压者（HDM）及血压昼夜节律异常（反转及非反转）者24hMBP与日、夜及24h尿的IVE、E水平之间。本资料提供的信息不能认为有相关性（P〉0．05）,UCA与24hABP各指标间亦不能认为有相关性（P〉0．05）。HDM病人日夜DA水平明显低于正常人（P〈0．05）,差别有统计学意义。结论：交感神经肾上腺髓质系统活性与糖尿病肾病高血压及血压昼夜节律异常之间不能认为有相关性,外周DA水平降低有可能与糖尿病肾病变及高血压的发病有关。     

The effects of aerobic exercise on plasma catecholamines and blood pressure in patients with mild essential hypertension

The effects of a 16-week aerobic exercise program on blood pressure and plasma catecholamine levels were evaluated in 56 patients with baseline diastolic blood pressure of 90 to 140 mm Hg. The exercise group significantly improved their physical fitness, and reduced systolic and diastolic blood pressures, compared with controls. To evaluate the relationship between exercise, blood pressure, and plasma catecholamine values, the exercise group was further divided into hyperadrenergic and normoadrenergic subgroups. Reductions in systolic pressures were 6.3 mm Hg, 10.3 mm Hg, and 15.5 mm Hg for control, normoadrenergic, and hyperadrenergic groups, respectively. Diastolic changes were similar and also significant. Within the hyperadrenergic group, changes in blood pressures were associated with changes in values for plasma catecholamines following training. We conclude that an aerobic exercise program reduces blood pressure, which is at least partially mediated by changes in plasma catecholamine levels.     

NIDDM者尿白蛋白排泄率与动态血压及胰岛素抵抗的关系

对非胰岛素依赖型糖尿病（ＮＩＤＤＭ）有微白蛋白尿患者（ＭＡ组）１９例，不合并有微白蛋白尿患者（ＮＭＡ）２５例，进行２４ｈ动态血压及胰岛素敏感性（葡萄糖利用常数，Ｋ１）测定，探讨其彼此间关系。结果显示：尿白蛋白排泄率与夜间平均收缩压呈正相关，与昼夜收缩压差值及Ｋ１呈负相关；ＭＡ组白天及夜间平均收缩压均显著高于ＮＭＡ组，但昼夜收缩差值则ＭＡ组低于ＮＭＡ组，Ｋ１值ＭＡ组亦显著低于ＮＭＡ组。提示ＮＩＤ－ＤＭ患者尿白蛋白排泄率与夜间收缩压、血压昼夜节律以及胰岛素敏感性等有明显的关系。     

尿白蛋白排泄率与多囊卵巢综合征的关系

目的：评价多囊卵巢综合征（PCOS）患者尿白蛋白排泄率（UAER）与其临床特征、性激素水平以及某些代谢指标的相关性。方法：对57例PCOS患者进行临床评估、血清性激素水平及尿白蛋白排泄率的测定。结果：经Pearson相关分析后UAER与体重指数、腰臀比、收缩压、舒张压、空腹血糖、空腹胰岛素、甘油三酯、稳态模型胰岛素抵抗指数（HOMA—IR）成正相关,与高密度脂蛋白成负相关;多元线性逐步回归分析提示：HOMA—IR指数是PCOS患者微量白蛋白尿的独立危险因素。结论：PCOS患者的UAER与其它易导致心血管系统疾病的因素有相关性,对此指标的正确评定将有益于指导临床治疗。     

苯那普利对高血压患者尿微量白蛋白及肾功能的影响

目的研究血管紧张素转换酶抑制剂（ＡＣＥＩ）苯那普利对高血压患者尿微量白蛋白及肾功能的作用。方法４２例高血压患者停用原抗高血压药１周以上，应用苯那普利６周，比较治疗前后血压、微量尿白蛋白、肾素活性改变及肌酐清除率等指标。结果治疗后患者的动脉血压明显降低（Ｐ＜０．００１），尿微量白蛋白减低，肾素活性增高（Ｐ＜０．００１），其他肾功能指标无变化。结论苯那普利在有效降低动脉血压同时具有减少尿微量白蛋白作用，提示对肾有保护作用     

Hypertension and catecholamine levels in sleep apnoea

Background

Sleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association.

Method

In this sleep clinic-based study, 82 newly diagnosed patients of sleep-disordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP).

Results

The prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoea-hypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catechol-amines in both the cases.

Conclusion

Hypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.     

中年男性2型糖尿病患者促甲状腺激素与尿钙/肌酐比值的相关性研究

目的：探讨中年男性2型糖尿病患者促甲状腺激素与尿钙/肌酐比值的相关性。方法：根据血促甲状腺激素（TSH）水平将516例中年男性2型糖尿病患者分为低TSH组、正常TSH组和高TSH组,测量身高、体质量、血压、空腹血糖、血肌酐、碱性磷酸酶、血钙、血磷、TSH、24 h尿钙、尿磷、尿肌酐。结果：随着TSH水平升高,中年男性2型糖尿病患者尿钙及尿钙/肌酐比值逐步降低（均P趋势〈0.05）。多元线性回归分析经年龄、糖尿病病程等因素调整后仍显示TSH是影响尿钙/肌酐比值的相关因素（β=-0.024,P〈0.05）。结论：中年男性2型糖尿病患者TSH与尿钙/肌酐比值呈负相关,TSH是影响尿钙排泄率的独立影响因素。     

Hypertension and catecholamine levels in sleep apnoea

Background

Sleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association.

Method

In this sleep clinic-based study, 82 newly diagnosed patients of sleep-disordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP).

Results

The prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoea-hypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catechol-amines in both the cases.

Conclusion

Hypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.Key Words: catecholamines, hypertension, sleep apnoea, sleep-disordered breathing, sympathetic     

Use of plasma catecholamines in diagnosing pheochromocytoma and neuroblastoma

The diagnosis in two cases of neural crest tumours was confirmed by the measurement of concentration of plasma catecholamines. A histamine provocative test monitored by values of plasma catecholamines provided support for a diagnosis of pheochromocytoma in a patient with normal blood pressure and elevated values of urinary amines. In the second case the presence of a ganglioneuroblastoma secreting abnormal amounts of catecholamines was detected by plasma epinephrine and norepinephrine measurements when values of urinary free catecholamines were normal.     

Effect of propranolol on cyclic AMP excretion and plasma renin activity in labile essential hypertension

Labile hypertension is often associated with elevated cardiac output, increased plasma renin activity (PRA) and urinary cyclic AMP excretion in response to upright posture and to isoproterenol. The β-blocking agent propranolol was demonstrated to be an effective therapeutic agent in this condition. The effect of posture on cyclic AMP, PRA, pulse rate and blood pressure was therefore studied during the administration of propranolol and a placebo in patients with labile hypertension. With the patient on placebo, upright posture induced an increase in pulse rate, cyclic AMP excretion and PRA. Propranolol administration decreased the recumbent and upright blood pressures, pulse rate and PRA. Cyclic AMP excretion remained unchanged in the recumbent position but the postural increase was abolished. No appreciable changes in catecholamine excretion occurred during propranolol administration. Propranolol normalizes some humoral as well as hemodynamic abnormalities of labile hypertension and therefore may be of benefit in long-term treatment and possibly also in the prevention of stable hypertension.     

慢性原发性肾小球疾病尿视黄醇结合蛋白的改变

尿ＲＢＰ排泄量是近端肾小管损伤的灵敏指标。用双抗体夹心型酶免疫法测定本组７２例原发性肾小球疾病患者尿ＲＢＰ排泄量。慢性肾炎５２例，其中２２例血压增高；ＩｇＡ肾病２０例。结果表明，慢性肾炎患者尿ＲＢＰ排泄量增加，血压增高的慢性肾炎患者尤甚。     

Moderate sodium restriction with angiotensin converting enzyme inhibitor in essential hypertension: a double blind study

Fifteen unselected patients who had essential hypertension and whose average supine blood pressure when they were not receiving any treatment and their usual sodium intake was 162/107 mm Hg were treated with captopril 50 mg twice daily. After one month's treatment their supine blood pressure had decreased to 149/94 mm Hg. They were then instructed to reduce their sodium intake to about 80 mmol(mEq)/day. After two weeks of moderate sodium restriction they were entered into a double blind randomised crossover study comparing the effect of 10 Slow Sodium tablets (100 mmol sodium chloride) with matching placebo tablets while continuing to take captopril and restrict sodium in their diet. After one month of taking placebo their mean supine blood pressure was 137/88 mm Hg with a urinary sodium excretion of 83 mmol/24 h, while after one month of taking Slow Sodium tablets their mean supine blood pressure was 150/97 mm Hg (p less than 0.001) with a sodium excretion of 183 mmol/24 h. The mean supine blood pressure during moderate sodium restriction therefore decreased by 9% and correlated significantly with the reduction in urinary sodium excretion. These results suggest that the combination of treatment with a moderate but practical reduction in sodium intake and an angiotensin converting enzyme inhibitor is effective in decreasing the blood pressure in patients with essential hypertension. This combined approach overcomes some of the objections that have been made to salt restriction alone and to converting enzyme inhibitors alone.     

运动对幼儿尿中去甲肾上腺素和肾上腺素排泄量的影响

测定学龄前幼儿静息时和运动后尿中去甲肾上腺素(NA)和肾上腺素(A)的排泄量,结果表明,运动后男女幼儿 NA 和 A 的排泄量均较静息时增高,儿茶酚胺指数(NA/A)运动后降低,表明学龄前儿童在体力运动中心血管系统功能状况的改变,虽仍以神经调节为主,但体液调节也占有重要地位。     

A Meta-analysis of angitensin-converting enzyme inhibitors on normotensive early diabetic renal diseases

Objective: To make a systematic assessment on whether the progression of early diabetic renal disease with normotension may be slowed down by angiotensin-converting enzyme (ACE) inhibitors. Methods: Randomized clinical experiments published on MEDLINE from January 1990 to April 1999 and on China Biological Medicine were reviewed for studying the effects of ACE-inhibitors on normotensive patients with early diabetic renal diseases. Based on the inclusion criteria, 10 studies were selected. Their results were combined and analyzed with RevMan3.1 software.Results: The pooled effect of urinary microalbumin excretion rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were -77.502 mg/24 h [-100.748 to-54.256], -5.002 mmHg [-9.630 to 0.685], -2.949mmHg [-4.005 to 1.892], -4.284 mmHg [-5.444 to 3.123] respectively. Using clinical albuminuria as the end-point, the pooled odd ratio was 0.27 [95% CI 0.18 0.40]. The sub-group analysis showed that those results had no difference between type 1 and type 2 diabetes. There was no significant correlation between the pooled effects of urinary micro-albuminutia excretion rate and systolic blood pressure, diastolic blood pressure or mean arterial blood pressure. Conclusion:ACE inhibitors can decline urinary micro-albuminuria excretion rate in normotensive patients with early diabetic renal disease and delay the progression of early diabetic renal disease to clinical albuminuria. These effects may not be dependent on its blood pressure-reduction effect.     

Localization of pheochromocytoma by selective venous catheterization and assay of plasma catecholamines.

The diagnosis of pheochromocytoma rests primarily on determination of the 24-hour urinary excretion of catecholamines and their metabolites. In most cases nephrotomography and selective arteriography or venography, or both, are sufficient to localize the tumour. Selective venous catheterization and the assay of plasma catecholamines should be considered for pheochromocytoma localization in: (a) patients in whom standard techniques fail to localize the tumour; (b) patients who exhibit idiosyncratic reactions to the angiographic contrast materials; (c) young patients or patients with familial pheochromocytoma, including those with multiple neurofibromatosis or multiple endocrine adenomatosis, type 2; (d) patients with recurrent, malignant, or suspected multicentric or extra-adrenal tumours; and (e) patients excreting only norepinephrine in the urine. The validity of the results is particularly dependent on the skill with which venous catheterization is carried out.     

中老年体位性高血压与尿微量白蛋白排泄率及左心室质量指数的相关性研究

目的 旨在分析中老年患者体位性高血压与尿微量白蛋白排泄率及左心室质量指数的相关关系。 方法 选取2018年1月—2019年7月至杭州市第三人民医院就诊的中老年原发性高血压患者556例为研究对象,其中观察组(125例)为体位性血压增高(即直立性高血压)的患者,收缩压变化低于20 mm Hg(1 mm Hg=0.133 kPa)即直立性血压正常的患者为对照组(431例);评价的内容包括24 h尿微量白蛋白排泄率和左心室质量指数以及两者与患者体位性高血压的关联。 结果 观察组尿微量白蛋白排泄率[(22.3±3.1)mg/24 h]和左心室质量指数[(111.3±5.8)g/m2]较对照组[(14.2±3.7)mg/24 h、(94.8±5.7)g/m2]均显著增加,差异有统计学意义(均P<0.001);相关性分析显示直立性性收缩压、直立性性舒张压均与尿微量白蛋白排泄率和左心室质量指数呈线性正相关关系,差异具有统计学意义(均P<0.05);回归方程分别为Y=30.62+0.40X;Y=25.95+0.90X;Y=26.02+0.53X;Y=27.88+1.33X。 结论 中老年原发性高血压患者体位性血压增高可能与尿微量白蛋白排泄率与左心室质量指数的异常之间存在相关关系,提示可能存在靶器官的损害,临床实践中应予以注意,早期进行干预。      

肾胺酶与心血管疾病研究进展

肾胺酶(renalase)是近年发现的一种由肾脏分泌的胺氧化酶,它可以通过降解儿茶酚胺来调节心功能与血压。肾脏分泌的激素与心血管疾病密切相关,肾胺酶作为反映心肾关系的新标志,具有降压、保护缺血心肌、改善心功能、降解儿茶酚胺等重要作用。     

高效液相色谱法检测糖尿病肾病尿儿茶酚胺含量

目的: 研究一种简便、准确、易于临床推广的儿茶酚胺(CAs)检测方法,进行尿中 CAs测定,探讨 2 型糖尿病肾病(DN)动态血压(ABP)与尿儿茶酚胺(UCA)的关系。方法: 利用高效液相色谱及荧光检测器,对正常人和糖尿病肾病病人24 h尿中去甲肾上腺素(NE)、肾上腺素(E)和多巴胺(DA)进行测定。结果: NE浓度在3~15 ng/ml范围及E浓度在0.3~1.5 ng/ml、DA浓度在1.5~120 ng/ ml范围内时,与色谱峰峰高的线性关系良好( r=0.999 1);NE、E回收率为 75%~82%,DA回收率为 76%;NE、E、DA的精密度 RSD(%)分别为 1.11%、7.21%、1.43% (n=5)。结论: 高效液相色谱法检测尿CAs具有简单、准确、特异性高的优点。通过对正常人及糖尿病肾病病人24 h尿样分析,不能认为交感神经肾上腺髓质系统活性与糖尿病肾病高血压及血压昼夜节律异常之间有相关性。     

正常血压的Ⅱ型糖尿病患者动态血压的改变

为观察非胰岛素依赖型糖尿病（NIDDM）患者动态血压的改变及其与尿白蛋白排泄率（UAE）、自主神经病变的关系，我们对57例血压正常的NIDDM患者进行了24小时动态血压监测（ABPM）。结果发现，NIDDM患者白天血压和24小时血压无明显改变，但夜间血压升高，昼夜血压差值明显降低，该改变与自主神经病变计分、UAE、偶测收缩压、夜间收缩压和夜间舒张压呈显著负相关。