血管紧张素转换酶基因多态性与血管紧张素转换酶抑制剂疗效的相关性

目的　研究原发性高血压 (EH)患者的血管紧张素转换酶 (ACE)基因多态性与血管紧张素转换酶抑制剂 (ACEI)疗效的相关性。方法　 ( 1)用ACEI对 5 17例EH患者进行为期 6周的降压治疗 ,所用药物为咪达普利或苯那普利。 ( 2 )用聚合酶链反应 (PCR)方法检测患者的ACE基因多态性 ,ACE基因有 3种表现型 :II型、DD型和DI型。 ( 3 )治疗前后及治疗过程中对患者的收缩压、舒张压和心率进行监测。结果　 ( 1)在总共 5 17例患者中 ,ACE基因型为DD者有 13 2人( 2 5 5 % ) ,II者有 13 0人 ( 2 5 2 % ) ,ID者有 2 5 5人 ( 4 9 3 % )。 ( 2 )不同基因型组间的性别、年龄、体重指数及心率等的差异无统计学意义。 ( 3 )在这三组患者中 ,治疗前后收缩压的降幅分别为 ( -14 5± 12 7)mmHg ,( -14 3± 13 1)mmHgand( -14 0± 12 2 )mmHg (P =0 94) ,舒张压的降幅分别为 ( -8 7± 7 4)mmHg ,( -8 7± 7 7)mmHgand ( -8 5± 6 7)mmHg (P =0 96)。结论　本研究没有发现EH患者的ACE基因多态性与ACEI的降压疗效相关 ,据此 ,不能根据EH患者的ACE基因型来指导ACEI的降压治疗     

转换酶抑制剂、血管紧张素受体阻滞剂与心房颤动

心房颤动(Af)为最常见的心律失常,常与心血管发病率和死亡率相关,Af常常需要触发机制诱发及有利的电生理或解剖底物维持,近年对触发Af底物发展这一新的治疗策略产生了兴趣,基础和临床试验资料提示调节肾素-血管紧张素-醛固酮系统(RAAS)或许可减少心脏重塑和Af,现对RAAS抑制剂治疗和预防Af的机制、基础和临床研究结果以及正在进行的临床研究等进行简要综述。     

Secondary Prevention After Acute Myocardial Infarction and Coronary Revascularisation: Focus on Angiotensin Converting Enzyme Inhibitors

INTRODUCTION: Cardiovascular disease (CVD) is responsible for an estimated one third of all deaths worldwide. PATIENTS AND METHODS: One group of patients who are at a particularly high risk of cardiovascular events and death are those with stable coronary artery disease (CAD), especially if they have had a previous myocardial infarction (MI) or revascularisation. DISCUSSION: Lifestyle changes (smoking, alcohol intake, diet, exercise) and cardiac rehabilitation play an important part in reducing risk of recurrent events. In patients with a history of MI and/or those who underwent myocardial revascularisation these have to be supplemented with medication. Several pharmacological agents are known to improve prognosis in these patients, i.e. beta-blockers, antiplatelet agents, statins, and angiotensin converting enzyme inhibitors (ACEi). The present article focuses mainly on the role of ACEi in the prevention of cardiovascular events in patients with a history of MI or myocardial revascularization.     

Role of Endogenous Angiotensin II and Prostaglandins in the Antihypertensive Mechanism of Angiotensin Converting Enzyme Inhibitor in Hypertension

The role of endogenous angiotensin II and prostaglandins (PGs) in the antihypertensive effect of converting enzyme inhibitor, captopril, was studied in essential hypertension by the separate and the combined administration of captopril and indomethacin. Although plasma angiotensin II was similarly suppressed by the separate and the combined administration of captopril and indomethacin, captopril lowered and indomethacin increased the mean blood pressure. There were negative correlations between the changes in mean blood pressure and in urinary sodium excretion as well as in urinary PGE excretion. These results suggest that endogenous PGs may be implicated in the antihypertensive effect of captopril through the alteration of sodium balance.     

血管紧张素转换酶2研究进展

血管紧张素转换酶2是一种金属钛酶,它将血管紧张素I、血管紧张素Ⅱ分别水解为血管紧张素（1～9）及具有血管舒张、抗增殖的血管紧张素（1～7）。血管紧张素转换酶2参与了肾素-血管紧张素-醛固酮系统中多种肽的代谢过程,与高血压、肾脏疾病、糖尿病等发生相关,对心脏、肾脏有一定保护作用,进一步研究其参与保护的机制,有可能为心血管病治疗提供新的靶点。     

Thyroid Hormones Affect Serum Angiotensin I Converting Enzyme Levels

ABSTRACT Serum angiotensin I converting enzyme (ACE) was measured in 10 patients with Graves' disease and 2 with thyroiditis during different stages of the diseases. The effect of thyroxine on serum ACE levels was also recorded in 12 patients with thyroid cancer, who were on thyroxine suppression. Serum ACE levels correlated positively with clinically assessed thyroid function and peripheral thyroid hormone levels, especially during hyper-or hypofunction. ACE was measured both with an enzyme kinetic and a new, quantitative inhibitor binding assay. The methods gave similar results, which indicates that ACE increments during thyroid hyperfunction were quantitative, and not a result of increased enzyme activity. Serum ACE increments associated with high lysozyme concentrations are signs of immunologic activation or proliferation of monocytic cells. In this study there was no correlation between the two enzymes, which may indicate either increased synthesis or possibly shedding of ACE from endothelial cells or delayed metabolic clearance of this enzyme. Serum ACE measurements may provide a useful tool for assessing thyroid function and the effect of thyroxine treatment.     

Possible Role of Vascular Angiotensin Converting Enzyme in the Genesis of Hypertension

This study was designed to evaluate changes in angiotensin converting enzyme (ACE) activity in 2-kidney, 1-clip renal hypertensive dogs. Blood pressure increased and remained elevated for eight months after partial clamping of the left renal artery. Plasma renin activity was increased for one month after surgery, but then returned to the pre-clamping level. SA-446, a potent ACE inhibitor, reduced blood pressure in 8 M-hypertensive dogs. Plasma ACE activities was not altered during the course of hypertension, but vascular ACE activities in the pulmonary and mesenteric arteries and the aorta were significantly increased in 8 M-hypertensive dogs. These results may indicate that ACE plays an important role in the maintenance of chronic phase of 2-kidney, 1-clip renal hypertension and that suppression of vascular ACE activities might be a mechanism underlying the hypotensive effect of ACE inhibitors.     

血管紧张素转换酶抑制剂联合钙离子通道阻滞剂在高血压治疗中的应用进展

高血压是一种临床常见的心血管综合征,由于其发病机制复杂,单药治疗血压控制达标率低,而联合治疗通过干预多种升压机制,不仅使血压控制达标率明显增高,而且具有良好的靶器官保护作用。研究表明在众多联合治疗方案中血管紧张素转换酶抑制剂联合钙离子通道阻滞剂可能是最优化的一种,现将对此进行综述。     

CGS 35601, a Triple Inhibitor of Angiotensin Converting Enzyme,Neutral Endopeptidase and Endothelin Converting Enzyme

CGS 35601 (L‐tryptophan, N‐[[1‐[[(2S)‐2‐mercapto‐4‐methyl‐1‐oxopentyl]amino]‐cyclopentyl]carbonyl]) is one of a few single molecules capable of inhibiting the activities of angiotensin‐converting enzyme (ACE), neutral endopeptidase (NEP) and endothelin converting enzyme (ECE) simultaneously, with IC₅₀ values of 22, 2, and 55 nM, respectively. Through the inhibition of ACE and ECE, it blocks the conversion of angiotensin I (AI) and big endothelin‐1 (big ET‐1) into the two most potent peptidic vasoconstrictors, angiotensin II (AII) and ET‐1, respectively. By inhibiting NEP, CGS 35601 also prevents the degradation of peptidic vasodilators such as bradykinin (BK), natriuretic peptides (NPs) and adrenomedullin (ADM) and, hence, modulates the secondary release of other vasoactive mediators such as nitric oxide (NO) and prostaglandins. In chronic (30 days) experiments, CGS 35601 is well tolerated with a very good safety profile in healthy normotensive, hypertensive and type 2 diabetic rats. The antihypertensive efficacy of CGS 35601 was demonstrated in chronically instrumented, unrestrained and conscious rat models of hypertension (SHR and DSS) and type 2 diabetes (ZDF‐fatty). It lowered blood pressure effectively as well as modulated plasma concentrations of a number of circulating vasoactive peptidic mediators that are keys to the regulation of the vascular tone. These data suggest that CGS 35601, a triple vasopeptidase inhibitor (VPI), may represent a novel class of antihypertensive drugs and may have the potential to reduce morbidity and mortality from cardiovascular disorders, diabetes and subsequent renal complications. Similar in vivo ACE, NEP, and ECE inhibitory activities were also observed with the orally active prodrug, CGS 37808 (L‐tryptophan, N‐[[1‐[[(2S)‐2‐(acetylthio)‐4‐methyl‐1‐oxopentyl]amino]cyclopentyl]‐carbonyl]‐, methyl ester.     

Angiotensin Converting Enzyme Gene Polymorphism in Turkish Asthmatic Patients

Asthma is a chronic inflammatory disease of the airways. Several candidate genes have been identified with a potential role in the pathogenesis of asthma, including the angiotensin converting enzyme (ACE) gene. We aimed to investigate the frequency of an ACE gene polymorphism in Turkish asthmatic patients and to determine its impact on clinical parameters and disease severity. Ninety-seven asthmatic patients (M/F 25/72, mean age 39 ± 13 years) and 96 healthy subjects (M/F 26/70, mean age 38 ± 12 years) were included. At baseline, all participants completed a questionnaire on demographics, symptoms, triggering factors, severity of asthma, and the presence of atopism. Blood samples were obtained from all patients and genomic DNA was isolated.

The frequency of the ACE genotypes (I = insertion and D = deletion) among asthmatics and controls were compared: asthmatics showed a 40.2% prevalence of the DD genotype (n = 39), ID was 45.4% (n = 44), and II was 14.4% (n = 14.4). In the control subjects, the frequency of DD was18.8% (n = 18), ID was 50% (n = 48) and II was 31.3% (n = 30). The DD ACEgenotype was significantly more frequent in asthmatics compared with controls (p < 0.001). Asthmatics with the ID ACE genotype showed a higher frequency of drug allergies, although this was not statistically significant (p = 0.08). Asthmatics with the DD genotype appeared to have a higher incidence of asthmatic episode exacerbations due to viral infections, but again this was not statistically significant (p = 0.08). Patients with mild or moderate-severe asthma had similar frequencies of these mutations.

We found a higher frequency of the ACE DD gene mutation in Turkish asthmatic patients compared with non-asthmatics, suggesting that this ACE gene polymorphism may be a risk factor for asthma but does not increase the severity of the disease.     

血管紧张素转换酶基因多态性与原发性高血压之间的关系

目的探讨中国人群中血管紧张素转换酶基因（ＡＣＥ）多态性与原发性高血压之间的关系。方法应用多聚酶链（ＰＣＲ）技术检测ＡＣＥ基因１６含子中２８７ｂｐＤＮＡ片段的插入／缺失（Ｉ／Ｄ）多态性；对７０例原发性高血压患者与４５例正常对照组之间进行比较。结果在原发性高血压组Ｄ等位基因频率（０．５５）高于正常对照组０．４３，但统计学并无意义，在有高血压家族史患者中，Ｄ等位基因频率０．５８高于对照组（Ｐ＜０．０５）。结论，表明在有家族史人群中ＡＣＥ基因多态性与原发性高血压具有相关性。     

Regulation of Prostacyclin Generation by Angiotensin Converting Enzyme Related Substances in Cultured Human Vascular Endothelial Cells

The regulation of prostacyclin (PGI₂) generation by angiotensin I-converting enzyme (ACE) related substances was investigated using cultured human vascular endothelial cells. Angiotensin I (AI) or bradykinin (BK) increased PGI₂ generation and ACE activity, while the ACE inhibitor, captopril decreased both of them, and angiotensin II (AII) did not show any effect. The increasing rate of PGI₂ generation induced by AI or BK was not affected by the pretreatment with captopril. These results suggest that the accumulation of AI or BK via the inhibition of ACE by captopril did not cause the enhancement of PGI₂ generation. Rather, it was proposed that the enhanced PGI₂ generation by AI or BK might be regulated by ACE activation derived from these substances, as an autoregulation mechanism.     

血管紧张素转换酶基因与高血压性脑卒中

血管紧张素转换酶（ＡＣＥ）是肾素－血管紧张素系统（ＲＡＳ）的重要酶,在心血管疾病发生中起重要作用。作为心血管疾病重要候选基因的ＡＣＥ基因与原发性高血压、心肌梗塞等心血管疾病之间的关系受到国内外广泛关注。在此基础上,近几年国外学者应用扩增片断长度多肽性分析等分子生物学技术就ＡＣＥ基因与脑卒中的关系进行了病例－对照研究,结果显示ＡＣＥ基因与高血压性脑卒中存在关联,认为ＡＣＥ基因是高血压脑卒中发生的重要遗传因素,为指导用药及高血压并发症预防提供新的启示。     

Lack of Association of Angiotensin Converting Enzyme Gene Polymorphism or Serum Enzyme Activity With Coronary Artery Disease in Japanese Subjects

The association of an insertion/deletion (I/D) polymorphism in the angiotensin converting enzyme (ACE) gene or the serum activity of ACE with coronary artery disease (CAD) was investigated in Japanese men and women. The ACE genotype of 947 CAD subjects who underwent coronary angiography and of 893 control subjects was determined by polymerase chain reaction analysis. No association of the DD genotype or the D allele with CAD was observed in men or women. In a low risk group (defined by a body mass index below the median value and the absence of a history of hypertension, diabetes mellitus, and hypercholesterolemia), there was also no association between the ACE gene polymorphism and CAD. No significant difference in serum ACE activity was detected between CAD subjects and controls of all genotypes or of the same genotype, whereas a significant association was apparent between serum ACE activity and ACE genotype for both CAD subjects and controls among both men and women. These results indicate that the ACE I/D polymorphism and genotype associated variation in serum ACE activity are not risk factors for CAD in Japanese men or women.     

Characterization of Angiotensin Converting Enzyme from Different Rat Vascular Beds

The tissue renin angiotensin system may play a role in cardiovascular pathophysiology. Angiotensin converting enzyme in tissues is now a target for pharmacological inhibition. It is therefore important to determine whether ACE is evenly distributed throughout the vascular tree and whether the enzyme has the same characteristics in different vascular beds. We have thus measured angiotensin converting enzyme density in three functionally different vascular beds with three different methods: the enzyme kinetic assay, a radioligand binding assay and in vitro autoradiography. All three methods demonstrated a significantly higher binding density and activity of ACE in resistance arteries from the mesenteric vascular bed of rats than in microvessels from the brain, or in a conduit artery, the aorta. The dissociation constant (K_d) of the enzyme-radioligand complex was the same in the three functionally different vessel types. Radioligand displacement studies for ACE from plasma and the mesenteric vessels in vitro utilizing a panel of different ACE inhibitors have shown a similar rank order of inhibitory potency suggesting that catalytic sites of ACE were the same in plasma and the mesenteric microvessels. In vivo, the enzyme inhibition in plasma, mesenteric and brain vessels measured by enzyme kinetic and radioligand binding assay were well correlated. There was a similar degree of inhibition between different vessels and tissues (mesenteric vessels, aorta, kidney, left ventricle and coronaries) measured by in vitro autoradiography.     

血管紧张素转换酶基因型与高血压左室肥厚的相关性研究

目的研究血管紧张素转换酶（ＡＣＥ）基因型与高血压患者左室肥厚的关系。方法用ＰＣＲ方法分别检测１５１例原发高血压患者ＡＣＥ基因型,并做超声心动图检查,测量左室舒张末径（ＤＬＶｄ）、左室收缩末径（ＳＬＶｄ）、心脏室间隔厚度（ＩＶＳ）及左室后壁厚度（ＬＶＰＷ）,计算左室重量（ＬＶＭ）。结果各基因型组中ＤＤ型的ＤＬＶｄ、ＳＬＶｄ、ＩＶＳ、ＬＶＰＷ、ＬＶＭ分别为４９．９±５．６ｍｍ、３０．５±６．５ｍｍ、１１．２±１．６ｍｍ、１１．７±１．５ｍｍ、２５９．５±６２．１ｇ,ＩＤ型组的ＤＬＶｄ、ＳＬＶｄ、ＩＶＳ、ＬＶＰＷ、ＬＶＭ分别为４８．９±５．３ｍｍ、３１．５±５．２ｍｍ、１１．４±１．７ｍｍ、１１．９±１．６ｍｍ、２６１．３±７０．３ｇ,Ｉ型组的ＤＬＶｄ、ＳＬＶｄ、ＩＶＳ、ＬＶＰＷ、ＬＶＭ分别为４８．９±５．５ｍｍ、３１．８±６．５ｍｍ、１１．１±１．９ｍｍ、１１．５±１．８ｍｍ、２５０．８±８２．５ｇ,各基因型组间ＤＬＶｄ、ＳＬＶｄ、ＩＶＳ、ＬＶＰＷ、ＬＶＭ并无显著性差异（Ｐ＞０．０５）。结论国人ＡＣＥ基因型与高血压左室肥厚无关。     

Renin Angiotensin System Gene Polymorphisms Modify Angiotensin‐Converting Enzyme Inhibitors' Effect on Cognitive Function: The Health,Aging and Body Composition Study

OBJECTIVES: To investigate the effect of polymorphisms in renin angiotensin system genes on the association between angiotensin‐converting enzyme inhibitor (ACEI) exposure and global and executive cognitive function in the Health, Aging and Body Composition study. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: Three thousand seventy‐five participants: mean age 73.6, 58% Caucasian, 52% female, 15% taking ACE‐Is, 8 years of follow‐up. MEASUREMENTS: The outcomes were longitudinal change in Executive Clock Drawing Test‐1 (CLOX1), the Digit Symbol Substitution test, and the Modified Mini‐Mental State Examination. The genetic polymorphisms included angiotensin‐converting enzyme insertion deletion (ACEID) in the ACE gene and the M235T and 6AG polymorphisms in the angiotensinogen (AGT) gene. RESULTS: For the CLOX1 outcome, there was significant interaction between 6AG and M235T polymorphisms in the AGT gene and angiotensin‐converting enzyme inhibitors (ACE‐Is) in Caucasian participants (P=.01 for both polymorphisms) independent of blood pressure levels. Specifically, ACE‐I exposure was protective against CLOX1 score decline in carriers of the AA genotype of the 6AG and the CC genotype of the M235T (for the ACE‐I vs non‐ACE‐I groups, P=.01 for 6AG and P=.005 for M235T) but not the other genotypes. These associations were not significant with other cognitive tests, with ACEID, or in African Americans. CONCLUSION: ACE‐Is may provide a protective effect on executive function in Caucasians with AGT gene polymorphisms known to be associated with greater renin angiotensin system activity. If confirmed in a pharmacogenetic trial, ACE‐Is may be found to have additional cognitive protection in a select group of elderly individuals.     

血管紧张素转换酶抑制剂对心肌梗塞后QT间期离散度的影响

QT间期离散度对急性心肌梗塞的预后具有重要价值 ,血管紧张素转换酶抑制剂 (ACEI)对缺血心肌具有保护作用 ,但ACEI是否影响QT间期离散度 ?本文将 12 0例患急性心肌梗塞的病人分为服用ACEI组和对照组 ,在服药前后分别测定QT间期离散度并统计在观察期间再次心梗的发生率。结果服用ACEI组QT间期离散度明显下降 (P <0 0 1) ,再次心梗的发生率也下降 (P <0 0 5)。急性心肌梗塞后服用ACEI可降低QT间期离散度和再次心梗的发生率。     

Difference in Response of Vascular Angiotensin Converting Enzyme Activity to Cilazapril in Shr

Angiotensin I converting enzyme (ACE) activity was found in all rat arteries and veins examined, considerably varied among these vessels, and usually higher in arteries than in corresponding veins except for femoral and subclavian pairs. Decrease of vascular ACE activity in response to cilazapril at hypotensive doses varied in vessels and was not dependent on their ACE activity levels.     

Angiotensin Converting Enzyme in Sarcoidosis and in Silicosis

Angiotensin converting enzyme(ACE) activities of broncho-alveolar lavage fluid(BALF) and serum in patients with sarcoidosis and with silicosis were measured. Serum ACE was measured by enzymic assay and radioimmunoassay. There was a close relationship between ACE activity and content (r=0.78). Serum ACE activities in patients with active sarcoidosis (37.5 ± 11.1 nmol/min/ml, mean ± SD) and with silicosis (25.5 ± 9.3) were significantly elevated from the control (18.6 ± 6.0). BALF ACE activities in the control, patients with active sarcoidosis and with silicosis were 0.23 ± 0.19 nmol/min/ml, 0.94 ± 0.97 and 0.38 ± 0.05, respectively. BALF ACE in patients with active sarcoidosis and with silicosis were significantly different from the control. When BALF ACE was corrected by the cell count of alveolar macrophage (per 10⁶ cells), activity was significantly different from control only in the patients with sarcoidosis. Moreover, only the alveolar macrophages in sarcoidosis were stained by immunofluorescence and immunocytochemistry using rabbit anti-human ACE antibody. Induction of ACE in alveolar macrophage might have an important role for the activity or progression of sarcoidosis.