杏丁注射液对糖尿病肾病患者血浆尾加压素Ⅱ与肾上腺髓质素水平的影响

目的：观察糖尿病肾病（DN）患者血浆尾加压素Ⅱ（UⅡ）、肾上腺髓质素（ADM）水平的变化,探讨它们在DN发病中的可能作用,并观察杏丁注射液对DN患者血浆UⅡ、ADM水平的影响。方法：130例2型糖尿病患者按MogensenDN分期标准分为无DN、早期DN、临床DN3组,测定患者血浆UⅡ、ADM水平,分析患者血浆UⅡ、ADM水平变化与尿白蛋白排泄率（UAER）的关系。将94例DN患者随机分为常规治疗组（对照组）和杏丁治疗组（治疗组）。治疗组加用杏丁注射液20ml,每日1次,疗程2周。测定治疗前后血浆UⅡ、ADM水平及UAER的变化。结果：DN患者血浆UⅡ、ADM水平较无DN患者明显升高（P〈0.01）,杏丁治疗可使DN患者血浆UⅡ、ADM水平及UAER明显降低（P〈0.01）。结论：血浆UⅡ、ADM水平升高在DN发病机制中起重要作用,杏丁注射液具有降低糖尿病患者血浆UⅡ、ADM水平,减少UAER作用。     

血浆肾上腺髓质素水平与哮喘的临床意义

肾上腺髓质素(adrenomedullin，AM)是日本学者Kitamura在1993年从肾上腺嗜铬细胞瘤中发现的一种血管活性肽，具有舒张血管、降低血压、利尿、利钠、调节细胞增殖、迁移分化等多种作用，参与了机体的病理生理过程。本研究旨在研究血肾上腺髓质素水平在哮喘患者中的表现和意义。     

肾上腺髓质素研究进展

肾上腺髓质素(ADM)是一种体内分布广泛的活性多肽,其受体多样且调控复杂。ADM具有多种生理调节功能,参与兴奋丘脑腺垂体肾上腺轴,影响糖及水盐代谢,舒张血管与气道平滑肌并抑制心肌构形重建及气道的重塑,抑制血小板聚集,参与炎症反应,还可调节子宫和胎盘的血流,在缺血再灌注损伤及脑保护中起重要作用。     

肾上腺髓质素与肾上腺紧张素在血液透析中的变化

肾上腺髓质素(adrenomeduein ADM)是由52个氨基酸组成的多肽,具有持久强大的扩张血管作用,其主要活性片段是ADM 13～52,ADM的前体由185个氨基酸组成,其中153～185片段能强烈地收缩血管,被命名为肾上腺紧张素(ADM 153～185)。我们应用放免法测定了32例维持性血透患者血透前后血浆ADM 13～52,ADM 153～185的水平,结果如下。 一、对象及方法 1.病例:正常对照组25例(男12例,女13例),平均年龄为42岁。血透组32例(男14例,女18例),平均年龄为44.8岁。其中慢性肾小球肾炎17例,慢性肾盂肾炎7例,肾小动脉硬化症6例,其它2例。伴高血压者11例,血压正常者21例。     

肾上腺髓质素与肾脏疾病

肾上腺髓质素是近年发现的一种舒血管活性肽 ,在心肾功能调节中发挥重要作用。本文综述了肾上腺髓质素在肾脏的定位和表达、生理功能以及在肾脏疾病中的研究进展。     

烧伤早期血浆肾上腺髓质素及内皮素的含量变化

目的 探讨肾上腺髓质素（ADM）、内皮素（ET）在烧伤后血浆浓度的改变及意义。方法 用放射免疫法分组测定40例不同面积的烧伤患伤后6、12、24、48h及25例正常人血浆ADM、ET浓度。结果 ADM及ET水平在烧伤后立即升高,与烧伤面积呈正相关,ADM在12h时达到高峰,之后虽然略有下降,但48h仍高于正常水平（P＜0．01）。ET在6h时达高峰,之后下降,但病情较重（Ⅲ组、Ⅳ组）48h仍处于高水平（P＜0．05－0．01）。ET与ADM水平6h内等比例增高,比值接近正常对照值,,6h后各组比值明显下降（P＜0．01）。结论 烧伤早期血浆中ADM、ET含量有明显变化,提示两参与调节烧伤后病理变化的发生与发展。     

肾上腺髓质素与休克的研究进展(文献综述)

休克的过程是许多细胞因子参与肌体多种生理和病理活动的调节过程。肾上腺髓质素 (AM)是一种强效舒血管活性多肽 ,是血管内皮源的舒血管因子 ,具有较强的扩血管、降压、排钠利尿作用。AM在休克的发展过程中起非常重要的作用     

肾实质性高血压患者血浆肾上腺髓质素测定的初步分析

探讨肾实质性高血压（ＲＰＨ）时肾上腺髓质素水平变化。方法应用放免法测定了１１例肾实质性高血压、３３例原发性高血压（ＥＨ）和２５例正常人的血浆肾上腺髓质素［ＡＤＭ（１３－５２）］、内皮素－１（ＥＴ－１）、血管紧张素Ⅱ（ＡＴⅡ）水平。结果肾实质性高血压患者ＡＤＭ（１３－５２）、ＥＴ－１较ＥＨ和正常人明显增高，ＡＴⅡ较正常人高但与ＥＨ组相似；ＡＤＭ（１３－５２）与ＥＴ－１、ＢＵＮ、平均动脉压（ＭＡＰ）有显著的正相关关系，与ＡＴⅡ无相关性。结论肾实质性高血压患者血浆ＡＤＭ（１３－５２）增高可能是继发于高血压代偿性分泌增多，并可能与肾功能减退代谢障碍、排泄减少有关     

原发性高血压肾功能损害患者血浆肾上腺髓质素及内皮素的改变

目的 观察肾上腺髓质素（ＡＤＭ）及内皮素（ＥＴ）在原发性高血压肾功能损害患者血浆浓度的改变，探讨ＡＤＭ及ＥＴ在高血压肾功能损害时的意义。方法 用特异性的放射免疫法（ＲＩＡ）测定１８例健康志愿者及５２例原发性高血压患者［３６例Ｉ期高血压（Ｉ期组），１６例高血压合并肾功能损害（肾损组）］。血浆ＡＤＭ及ＥＴ的浓度。结果 Ｉ期组血浆ＡＤＭ和ＥＴ水平较正常组显著升高，而肾损组血浆ＡＤＭ、ＥＴ水平较Ｉ期组又显     

Plasma and urinary adrenomedullin levels in children with renal parenchymal scar and vesicoureteral reflux

Adrenomedullin (AM) is a strong vasodilator peptide with proven antimitogenic and antiproliferative effects in renal mesangial cells, as well as diuretic and natriuretic actions. Its gene expression is stimulated by endotoxins (lipopolysacharides) and cytokines. Consequently, its plasma and urinary levels are known to deviate from normal levels in many renal diseases. The purpose of this study is to determine plasma and urinary AM levels in children with renal parenchymal scar (RPS) and vesicoureteral reflux (VUR). The study was carried out on 74 children with recurrent urinary tract infections, arranged in groups: 25 patients with RPS with VUR (group I), 16 patients with RPS without VUR (group II), 12 patients with VUR without RPS (group III) and 21 healthy children as the control group. Plasma and urinary AM concentrations were both determined by high performance liquid chromotography (HPLC). Plasma AM was measured as picomoles per milliliter (pM/ml) and urinary AM as pM/mg urinary creatinine. In addition, serum creatinine, creatinine clearance and fractional sodium excretion (FE_Na) were measured. All cases with RPS and VUR had normal blood pressure levels. The plasma AM levels were higher, although not significantly, in the control group (56.2±14.0 pM/ml) than in group I (50.6±4.2 pM/ml), group II (49.6±3.7 pM/ml) and group III (50.6±3.6 pM/ml) ( P =0.162). The urinary AM levels were higher in the control group (80.1±33.9 pM/mg) than in the three study groups (52±7.6 pM/mg, 58.6±7.5 pM/mg and 44.2±6.4 pM/mg; P =0.003, P =0.002 and P =0.002, respectively). There were no differences among the 4 groups (group I, group II, group III and the control group) in terms of FE_Na and creatinine clearance ( P >0.05 and P >0.05, respectively). The finding that diminished urinary AM levels in patients with RPS and VUR implies that AM can be a prognostic factor in the long-term follow-up of cases with these diseases.     

Role of urotensin II and its receptor in health and disease

Urotensin II (U-II) is currently the most potent vasoconstrictor identified. This action is brought about via activation of a G_q/11-protein coupled receptor (UT receptor). U-II activation of the UT receptor increases inositol phosphate turnover and intracellular Ca²⁺. In addition to producing vasoconstriction, dilation and ionotropic effects have also been described. There is considerable variation in the responsiveness of particular vascular beds from the same and different species, including humans. Receptors for U-II are located peripherally on vascular smooth muscle (contractile responses) and endothelial cells (dilatory responses via nitric oxide). In humans, plasma U-II is elevated in heart failure, renal failure, liver disease, and diabetes. Iontophoresis of U-II in healthy volunteers produces vasodilation (of the forearm) while in patients with heart failure or hypertension a constriction is observed. To date there is only one clinical study using a UT receptor antagonist (palosuran) in diabetic patients with macroalbuminuria. This antagonist reduced albumin excretion, probably by increasing renal blood flow. Studies in other disease conditions are eagerly awaited. In summary, the U-II / UT receptor system has clinical potential, and for the anesthesiologist, this novel peptide-receptor system may be of use in the intensive care unit.     

Plasma and urinary adrenomedullin levels in children with acute pyelonephritis

AIM: Adrenomedullin (AM), a novel peptide recently isolated from pheochromocytoma, eliciting vasorelaxing activity, is the strongest among all known peptides. AM has been detected in the adrenal medulla, cardiac tissue, lung and kidney. Immunohistochemical studies have demonstrated the localization of AM in glomeruli, tubules and collecting cells of the kidney. Clinically, plasma and urinary AM levels are altered in patients with different renal disease. The present study aims to determine plasma and urinary AM levels in children with acute pyelonephritis (APN) and compare the results with a control group. MATERIALS AND METHODS: The study group was comprised of 19 patients with APN aged 11.6 +/- 3.7 months (range, 6-18 months) and the control group consisted of 16 cases aged 11.5 +/- 3.2 months (range, 7-16 months). Acute pyelonephritis was diagnosed by clinical, laboratory and imaging methods. Plasma and urinary AM levels were measured by high performance liquid chromotography (HPLC). RESULTS: The plasma AM levels were lower in APN patients (33.40 +/- 2.27 pmol/mL) than in the control group (43.76 +/- 4.27 pmol/mL) (P < 0.001), whereas the urinary AM levels were higher in APN patients (248.58 +/- 140.63 pmol/mg urinary creatinine) than in the control group (49.42 +/- 45.23 pmol/mg) (P < 0.001). Coefficients of correlation between urinary AM levels and C-reactive protein and white blood cells were statistically significant (r = 0.472, P = 0.041; r = 0.555, P = 0.014, respectively). CONCLUSION: Adrenomedullin, a smooth muscle relaxant peptide that is synthesized in urinary tract tissue might have a role in acute pyelonephritis. However, the importance of AM in the pathogenesis of acute pyelonephritis remains to be determined by further detailed studies.     

Plasma and sputum erythromycin concentrations in chronic bronchitis.

Plasma and sputum concentrations of erythromycin were measured in 10 patients with chronic bronchitis during an eight-day course of a new formulation of erythromycin stearate. The plasma erythromycin levels compared favourably with the minimal inhibitory concentrations for common respiratory pathogens and indicated adequate gastrointestinal absorption when the drug was taken immediately before food. Sputum erythromycin levels were variable and in some patients low or undetectable. Measurable sputum erythromycin levels were approximately 10% of plasma levels with no evidence of accumulation and were of similar order of magnitude to the minimal inhibitory concentrations for common respiratory pathogens except Haemophilus influenzae. There was no correlation between sputum and plasma erythromycin levels. There was a trend for higher erythromycin levels in sputum containing increasing amounts of pus and also when plasma levels increased.     

Interaction between adrenomedullin and angiotensin II in DNA synthesis and extracellular matrix accumulation in cultured rat kidney interstitial cells

Background. To investigate the role of adrenomedullin (AM) in the regulation of renal fibrosis, we assessed the effects of AM on angiotensin II (AT II)-induced cell proliferation and extracellular matrix (ECM) accumulation in cultured NRK 49F cells, a cell line derived from normal rat kidney fibroblasts. Methods. Northern blot analysis was performed, using cDNA probes against rat AM, human calcitonin-receptor-like receptor (CRLR), human receptor-activity-modifying protein 2 (RAMP 2), human collagen α-1 (I) (Col-I), human fibronectin (FN), and rat transforming growth factor (TGF)-β1. Polymerase chain reaction (PCR) analysis for CRLR was amplified for 35 cycles. Cell proliferation was determined by the measurement of [³H]thymidine incorporation. Results. We have shown that NRK 49F cells express AM and its receptor, which consists of a CRLR and RAMP 2. Rat AM significantly inhibited cell proliferation and mRNA expression of ECM in the absence and presence of AT II through an AM receptor, because calcitonin gene-related peptide (8-37) [CGRP (8-37)], an antagonist to AM receptor, completely reversed these inhibitory actions. The inhibitory effects appeared to be mediated by a marked increase in intracellular cAMP. While AT II enhanced ECM accumulation by a process depending upon autocrine TGF-β1 secretion in NRK 49F cells, AM suppressed the induction of TGF-β1. Conclusions. The inhibitory action of AM on ECM accumulation may be caused by the suppression of TGF-β1. AM may play an important role in the inhibition of renal interstitial fibrosis under pathological conditions, through acting in an autocrine and/or paracrine fashion. Received: May 2, 2001 / Accepted: November 27, 2001     

失血性休克患者血浆肾上腺髓质素与血管阻力变化的关系

目的：观察失血性休克患者血浆肾上腺髓质素（ARM）与血管阻力变化，探讨ARM在失血性休克病理生理过程中的作用。方法：应用放射免疫检测30例休克患血浆ARM浓度，无创胸导生物电阻抗方法测定平均动脉压（MAP）、全身血管阻力指数（SVRI）和心脏指数（CI）。结果：休克组治疗前血浆ARM浓度明显高于正常对照组（P＜0．01）。结论：ARM与血管阻力变化相关，并参与了失血性休克的病理生理过程。     

全麻对手术病人血浆尾加压素Ⅱ和肾素、血管紧张素活性的影响

目的：研究全麻诱导地患者血浆加压素Ⅱ和肾素、血管紧张素活性的影响。方法：20例全麻手术患者，于麻醉诱导前20分钟和诱导后10分钟分别抽取静脉血测定血浆尾加压素Ⅱ和肾素、血管紧张素活性。结果：与麻醉前比较，麻醉后尾加压素Ⅱ的浓度明显下降（P＜0．01）；肾素活性及血管加压素Ⅱ含量均明显升高（P＜0．01）。结论：全麻后，血浆尾加压素Ⅱ与肾素、血管紧张素含量呈反向变化。     

布地奈德和盐酸氨溴索联合使用超声雾化吸入治疗婴幼儿毛细支气管炎的疗效观察

目的：探讨布地奈德和盐酸氨溴索合用使用超声雾化治疗婴幼儿毛细支气管炎的临床效果。方法选80例来我院就诊的患儿随机分为实验组和对照组,各40例,实验组在采取基础治疗外加用布地奈德＋盐酸氨溴索使用超声雾化吸入治疗,对比两组患儿临床症状、体征消失时间以及治愈率。结果实验组临床症状、体征时间均比观察组时间短,并且治愈率也明显高于对照组。结论布地奈德和盐酸氨溴索联合使用超声雾化吸入治疗婴幼儿毛细支气管炎,可以有效缩短患儿呼吸困难、憋喘等临床症状和体征缓解时间,并且提高治愈率,对于临床应用安全方便,值得临床推广。     

风湿性心脏病合并肺动脉高压瓣膜置换病人血浆肾上腺髓质素的变化及作用

目的　观察风湿性心脏病(风心病)合并肺动脉高压病人瓣膜置换术前后血浆肾上腺髓质素(AM)、内皮素-1（ET-1）、一氧化氮(NO)及肺血流动力学的变化。方法　37例风心病病人手术前后采用放射免疫法测定血浆AM、ET-1浓度,采用测定血浆亚硝酸盐/硝酸盐含量来反映NO水平,采用Swan-Ganz浮导管测定肺血流动力学指标。结果　严重肺动脉高压组病人术前血浆AM、ET-1水平明显高于正常肺动脉压组(P＜0.05);术后1周各组血浆AM水平都有不同程度的下降,而严重肺动脉高压组血浆ET-1水平无明显下降;术后严重肺动脉高压、肺动脉高压组血浆NO水平有一个降低及再恢复的过程;术前血浆AM/ET-1比值水平与肺血管阻力呈负相关(r=－0.503,P＜0.01),术后48h血浆AM/ET-1比值与平均肺动脉压、肺血管阻力呈负相关（r=－0.524、－0.551,P＜0.05）。结论　AM在风心病肺动脉高压的形成和术后缓解过程中发挥了拮抗ET-1的作用,血浆AM/ET-1的比值与术后肺动脉高压的改善有关。