慢性肺部疾患病人血浆 PRA、ATⅡ测定

本文对30例健康人和85例慢性肺部疾患病人进行了血浆肾素活性(PRA)和血管紧张素Ⅱ(ATⅡ)的测定。实验结果显示某些慢性肺部疾患病人的 PRA 和 ATⅡ水平常呈现升高现象,重症病人组 PRA、ATⅡ水平显著高于病情较轻组。同一病人在其病程中随着病情的转化而改变。     

心力衰竭患者血浆肾素活性和血管紧张素Ⅱ浓度变化及其与钠的关系

作者报告不同类型心衰患者血浆中PRA、ATⅡ、血清钠和24h尿钠排出量,并探讨钠对心衰患者PRA和ATⅡ浓度的影响。结果表明:①左心衰患者PRA和ATⅡ浓度高于健康人和右心衰患者;②左心衰患者属高肾素型,右心衰患者属低肾素型或正常肾素型;③心衰患者PRA和ATⅡ浓度与尿钠排出量呈负相关。我们认为按肾素活性或钠指数对心衰分型,有利于选择治疗心衰的药物。     

肺心病并发呼吸衰竭时血管紧张素及其酶系统的改变

研究了肺心病合并Ⅱ型呼衰病人,健康人及慢阻肺病人的血管紧张素Ⅱ(ATⅡ),血管紧张素转换酶(ACE)与肾素活性(PRA).结果呼衰组ATⅡ升高,ACE 下降而 PRA 则升高;死亡病例 ATⅡ高于缓解者;氧疗后病人 ATⅡ及 ACE 降低;PRA 也有下降趋势。呼衰组 ATⅡ及 ACE 与 PaO_2密切相关。由此认为低氧时人体对高 ATⅡ反应之一是 ACE 下降,呼衰者 PRA 高且 ACE 下降不足使 ATⅡ增高。ATⅡ水平与病情变化相关,单纯氧疗不能降至正常范围。用抑制 PRA 及 ACE 方法降低 ATⅡ水平及用 ATⅡ为病情追踪指标有实际意义。     

抗AT1和α1受体自身抗体与高血压病合并肾损害的关系

目的: 探讨抗血管紧张素Ⅱ受体1型(AT1-受体)和α1-肾上腺素受体(α1-受体)自身抗体是否与高血压病合并肾损害有关. 方法:以合成的AT1和α1受体多肽片段为抗原,应用酶联免疫吸附测定(ELISA)技术,检测61例高血压病合并肾损害患者和60例高血压病无肾损害患者及40例正常人,血清中抗G-蛋白偶联型AT1受体(165～191),和α1受体(192～218)自身抗体. 用放射免疫法,测定血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)浓度,用荧光分析法测定儿茶芬胺:肾上腺素(E)和去甲肾上腺素(NE). 结果:高血压病合并肾损害组抗AT1和α1受体抗体阳性率分别为59.0%和54.1%,明显高于高血压组的13.3%和10.0%及正常对照组10.0%和7.5%(P<0.01). 神经内分泌激素指标(PRA,AngⅡ,ALD,E,NE),高血压病合并肾损害组,明显高于高血压组及正常对照组. 结论: 抗G-蛋白偶联型AT1和α1受体自身抗体可能与高血压病合并肾损害发病有关,同时伴有神经内分泌激活.     

肾综合征出血热患者血浆肾素、血管紧张素Ⅱ和前列环素水平及临床意义

目的探讨肾综合征出血热(HFRS)患者血浆肾素(PRA)、血管紧张素Ⅱ(ATⅡ)和前列环素(PGI2)含量与患者病情的关系。方法采用放射免疫法测定PRA、ATⅡ含量,饱和竞争放射免疫分析法测定PGI2含量,日本CL-7200全自动生化分析仪检测血清尿素氮(BUN)、肌酐(Cr)水平。结果HFRS患者各病期(或病型)血浆PRA、ATⅡ及血清BUN、Cr含量显著高于对照组,而血浆PGI2水平显著低于对照组,其中以少尿期、重型及危重型患者指标变化更为明显。结论HFRS血浆PRA、ATⅡ、PGI2及血清BUN、Cr等指标与患者病情密切相关,可作为判断HFRS分期及严重程度的指标。     

急性肾炎高血压和充血性心力衰竭患儿的血浆肾素活性和血管紧张素Ⅱ浓度测定及其临床意义

本文报道作者对154例正常儿童(男83例,女71例,年龄1～12岁),18例急性肾炎高血压患儿(男12,女6,年龄4～12岁)和18例充血性心力衰竭患儿(简称心衰)(男6,女12,年龄2.5～12岁),基础状态下的血浆肾素活性(PRA)和血管紧张素Ⅱ浓度(AT Ⅱ)进行了测定。结果:急性肾炎高血压患儿的PRA、AT Ⅱ值基本与对照组相同,两组差异无显著意义(P>0.05);心衰患儿的PRA和AT Ⅱ值均高于对     

腹主动脉狭窄性高血压大鼠肾素—血管紧张素系统的动态变化

用Wistar大鼠进行实验。以银夹缩窄腹主动脉。分批检查、测量颈动脉和股动脉血压,称重心脏及测定外周血肾素活性(PRA),血管紧张素Ⅱ(ATⅡ)浓度。发现外周血液肾素活性、ATⅡ浓度在狭窄后2h就有升高,3天达高峰,以后逐渐下降,8周后恢复到正常水平。狭窄术后前3天肾素活性、ATⅡ浓度与颈动脉血压间有显著正相关(P<0.01),3天后则无相关性。表明肾素—血管紧张素—醛固酮(RAA)系统在腹主动脉狭窄性高血压的发生中为始动因素之一,对高血压维持不起主要作用。     

尿激酶对急性心肌梗死患者ERAANPS的影响

目的　观察尿激酶对急性心肌梗死 (AMI)患者血浆 -内皮素 -肾素 -血管紧张素 -心钠素系统(ERAANPS)的影响。方法　用放射免疫法测定AMI患者和正常对照组的血浆内皮素 (ET)、肾素活性 (PRA)、血管紧张素Ⅱ (ATⅡ )、心钠素 (ANP)的浓度。结果　与对照组相比 ,AMI后ERAANPS活性明显增强 ;尿激酶可使ET、PRA、ATⅡ浓度升高 ,与对照组相比具有显著性差异 (P <0 0 5 )。结论　急性心肌缺血坏死可激活ERAANPS ;溶栓剂尿激酶可增强其活性     

急性心肌梗塞患者肾素系统活性的变化及其与病情的关系

作者采用RIA法检测了急性心肌梗塞(AMI)不同病期和并发心衰及休克患者和陈旧性心肌梗塞(OMI)患者血浆肾素活性(PRA)、血管紧张素Ⅱ(ATⅡ)和醛固酮(ALD)浓度,并对其临床意义作初步探讨。结果表明:①AMI患者PRA,ATⅡ和ALD浓度均高于正常组和OMⅠ组(P<0.05～0.001),ATⅡ浓度与PRA和ALD浓度均呈正相关(r=0.4511,r=0.7843)。②AMI患者PRA,ATⅡ和ALD浓度以急性期最高,恢复期最低,亚急性期居中。各期间比较,差异非常显著(P<0.01)。③AMⅠ合并心衰或休克患者的PRA,ATⅡ和ALD浓度明显高于无并发症者(P<0.05～0.01)。并指出AMⅠ患者RAS活性有自身动态变化规律,故测定其活性将有利于监测病情进展和判断并发症发生及估计予后,亦可将其作为判断治疗效果的指征。     

巯甲丙脯酸在高血压临床中的应用

巯甲丙脯酸(Captopril,SQ14225,以下简称Cp)是一种血管紧张素转换酶抑制剂,能抑制血管紧张素Ⅰ(AT Ⅰ)转化为血管紧张素Ⅱ(AT Ⅱ),后者是强烈血管收缩物质,故Cp是以降低周围血管的张力使血压下降。 Cp最初应用于肾素依赖型的高血压,包括肾血管性高血压和高肾素性原发性高血压。除了治疗以外,还可用于肾血管性高血压的筛选。肾血管性高血压在应用Cp后,血浆肾素活性(PRA)明显增高,且显著区别于原发性高血压。这种药物反应的机制尚不太明确,可能与全身或肾内的压力感受     

血浆肾素活性测定对肾血管性高血压诊断价值的临床观察

自1986年以来,我们曾对10例非高血压病人和5例肾血管性高血压病人的周围循环血浆肾素活性及分肾静脉不同时间的血浆肾素活性进行了测定。周围血浆肾素活性及分肾静脉肾素活性对肾血管性高血压的诊断和预后以及肾素分泌的时间差别对临床诊断的意义进行了初步评价。     

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.     

肾静脉肾素水平与肾动脉介入治疗疗效的相关性研究

目的探讨肾静脉肾素活性,血浆内皮素(ET)、一氧化氮(NO)、钙素基因相关肽(CGRP)水平对肾动脉狭窄介入治疗疗效的预测价值。方法60例冠心病合并高血压患者经肾动脉造影,证实为肾动脉狭窄,予肾动脉支架植入术;测定所有病例介入治疗前后的肾静脉肾素活性和血浆ET、NO、CGRP水平。并对病人的血压进行2年随访。结果60例患者根据术前肾素水平分为肾素比值(RVRR)>1.5组和RVRR<1.5组。所有患者肾动脉狭窄侧肾静脉肾素活性高于对侧[(3.89±3.14)nmol/L/h和(2.01±1.93)nmol/L/h,P<0.05],介入治疗后患侧肾静脉肾素浓度明显下降,RVRR>1.5组低于RVRR<1.5组[(1.92±2.15)nmol/L/h和(2.42±0.56)nmol/L/h,P<0.05],血浆ET和NO水平与RVRR<1.5组相比有统计学差异(P<0.05),术后血压明显下降,血压有效率75.68%,与RVRR<1.5组比P<0.05。结论测定肾静脉肾素活性,血浆ET、NO的水平对肾动脉血管成形术近期疗效有预测价值。     

Hypertension and unilateral parenchymal renal disease. Evidence for abnormal vasoconstriction-volume interaction.

Hypertension was not renin-dependent in the majority of 62 hypertensive patients with seemingly unilateral renal parenchymal disease, as indicated by plasma renin activity: low in 14 (23%), normal in 40 (56%), and high in only 8 (13%). By a weighted scoring system for analysis of differential renal-vein and peripheral renin levels, 70% (16 of 23) of these patients did not give scores predictive of cure by nephrectomy. Thus, occult bilateral disease reflected by attendant volume expansion and consequent reactive renin suppression may explain the well-known disappointing cure rate after uninephrectomy in this group. Since unilateral hypersecretion of renin with a completely normal contralateral kidney is rare in this group, abnormal renal-vein and peripheral renin values should be a prerequisite for advising nephrectomy, especially when the suspected kidney shows considerable excretory function.     

Role of nephrectomy in hypertension with renal artery occlusion.

Nephrectomy was performed in 12 patients with complete renal artery occlusion and hypertension refractory to intensive medical therapy. Renal vein renin was assayed preoperatively in 10 of the 12, and in 8 the ratio was at least 1.5:1, strongly suggesting renal artery occlusion on the side with the higher concentration of renin in venous blood. In two patients peripheral plasma renin activity was very high before operation, then decreased greatly afterwards. Three patients were considered cured and eight improved (overall improvement rate, 92%). The results were predicted by the renin ratio.     

快速静脉尿路造影及血浆肾素活性在肾血管性高血压诊断中的价值

本文对23例肾动脉狭窄性高血压患者作肾动脉造影,快速静脉尿路造影和血浆肾素活性(包括外周静脉、肾静脉、下腔静脉),并有肾动脉正常的原发性高血压15例进行对比分析,显示快速静脉尿路造影是安全而可靠的筛选检查方法之一,如果以二项或二项以上阳性作标准,则可减少假阳性。血浆肾素活性测定,单项指标阳性意义不大,假阳性与假阴性都很多。若二项或二项以上阳性,则可减少假阳性,因此,如与快速静脉尿路造影结果合并考虑,则诊断意义更大。     

Predictive value of renin determinations in renal artery stenosis

The prognostic value of renal vein and peripheral renin levels was analyzed in 66 patients with unilateral renal artery stenosis who underwent corrective surgery. Patient selection for operation was independent of renin results. Fifty-three percent of those with confirmed renovascular hypertension had renal vein renin ratios less than 2.0, ie, within the 95% confidence limit for the control group of 82 patients with essential hypertension. Thirty-four patients with clearly lateralizing renin data (ipsilateral:contralateral greater than or equal to 1.5 and contralateral:peripheral less than or equal to 1.3) were benefited by operation, but 23 additional patients with nonlateralizing data also benefited. No proposed scheme for renin data analysis detected more than 75% of those with renovascular hypertension. Although lateralizing renin data are highly predictive of operative benefit, nonlateralizing data do not necessarily herald operative failure and should not be dogmatically used to exclude surgical intervention.     

Renal vein plasma adenosine 3'',5''-cyclic monophosphate in renovascular hypertension.

The concentration of plasma adenosine 3',5'-cyclic monophosphate (cyclic AMP) and plasma renin activity (PRA) were measured concomitantly in blood from both renal veins and in arterial blood in 22 hypertensive patients. In the nine patients with true renovascular hypertension the concentration of plasma cyclic AMP was greater in the venous effluent of the kidney affected by the renal artery stenosis than in that of the unaffected or less affected kidney. The arteriovenous difference in cyclic AMP concentration was less on the affected side in all but one patient. The arteriovenous differences in PRA identified the affected kidney as the source of hyper-reninemia and showed that renin release from the other kidney was suppressed. In the 13 patients with hypertension associated with but unrelated to renal artery stenosis there were no consistent patterns of cyclic AMP concentration or PRA in the venous effluent of the kidneys or of their arteriovenous differences. In renovascular hypertension the venous effluent of the kidney affected by renal artery stenosis contains not only more renin but also more cyclic AMP, owing to either increased cyclic AMP production or decreased excretion or extraction of cyclic AMP by the affected kidney. This unilateral increase in cyclic AMP concentration may become a complementary diagnostic feature of true renovascular hypertension.     

高盐饮食上调肾局部肾素-血管紧张素系统参与大鼠高血压肾损害的发生

目的：探讨肾脏局部肾素-血管紧张素系统（renin-agiotensin system,RAS）在高盐诱发大鼠高血压及其肾损害发病机制中的作用。方法：8周龄雄性Wistar大鼠随机分为3组：对照组（NS,n=9）,普通饲料喂养;高盐组（HS,n=9）,含8%（质量分数）NaCl的高盐饲料喂养;高盐饮食+氯沙坦组（HS+L,n=9）,高盐饲料喂养同时每日给予氯沙坦20 mg/kg灌胃。实验共6周,期间每2周监测血压和24 h尿蛋白,6周后处死大鼠,放射免疫法测定血浆、肾脏匀浆以及尿液的肾素活性、血管紧张素Ⅱ水平,Real-time PCR、免疫组织化学染色分别检测肾脏血管紧张素原（angiotensinogen,AGT）mRNA、蛋白表达水平,ELISA测定血、肾皮质匀浆液以及尿AGT水平。结果：与NS组相比,HS组大鼠第2周始血压显著升高［（156±2） mmHg vs. （133±3） mmHg （1 mmHg=0.133 kPa）, P<0.05）］,第6周时尿蛋白显著增加［（14.07±2.84） mg/24 h vs. （7.62±3.02） mg/24 h, P<0.05］;HS+L组与HS组大鼠血压差异无统计学意义（P>0.05）,但第6周时HS+L组尿蛋白比HS组显著降低［（9.69±2.73） mg/24 h vs. （14.07±2.84） mg/24 h, P<0.01］。与NS组相比,HS组血浆肾素活性、AGT和血管紧张素Ⅱ（angiotensin Ⅱ,ANGⅡ）水平无显著变化（P>0.05）,肾皮质肾素活性、AGT 和ANGⅡ水平均显著升高（P<0.05）,尿AGT和ANGⅡ排泄率均显著升高（P<0.05）;与HS组相比,HS+L组大鼠血浆肾素活性、AGT和ANGⅡ水平均显著升高（P<0.05）,肾皮质肾素活性、ANGⅡ和AGT水平均显著降低（P<0.05）,尿AGT和ANGⅡ排泄率均显著降低（P<0.01）,尿AGT排泄率与肾皮质AGT水平呈显著正相关（P<0.05）。结论：高盐可能通过上调肾脏局部RAS的表达参与大鼠的肾损害,尿AGT排泄率可能反映肾脏局部RAS激活的程度。     

速尿-卡托普利肾功能显像诊断肾血管性高血压

目的:探讨速尿-卡托普利肾功能显像(CRS)诊断肾血管性高血压(RVH)临床价值及相关因素.方法:对比研究50例怀疑RVH患者的速尿-CRS和选择性数字减影肾血管造影资料.计算速尿-CRS诊断RVH的敏感性、特异性和准确性.结果:速尿-CRS对诊断RVH的总体敏感性、特异性和准确性分别为77.8%,98.2%,89%;速尿-CRS诊断双侧、单侧肾动脉狭窄(RAS)的敏感性分别为67.8%,95.3%.结论:速尿-CRS对RVH的诊断有重要的价值.