AVP在老年性高血压发病中的作用及其与血尿酸的关系

测定了３５例低肾素性老年高血压病患者降压治疗前后血浆精氨酸加压素（ＡＶＰ）和血清尿酸浓度的改变，并与３０例正常人作对照。结果表明：①患者ＡＶＰ浓度显著增高（Ｐ＜０．０１），且与血压呈正相关。②患者血清尿酸浓度高于正常（Ｐ＜０．０１），且与血浆ＡＶＰ水平呈正相关，与血压无明显相关；降压治疗均恢复正常。ＡＶＰ的下降与尿酸下降呈正相关。提示ＡＶＰ参与低肾素性老年高血压病的发病过程，促进肾小管对尿酸的重吸收     

粘液水肿病人水负荷前,后水盐代谢激素的变化

在水负荷前,12例重症粘液水肿病人平均血浆抗利尿激素(AVP)高于正常组(n=5)但差别不显著(P>0.05),伴血浆心钠素(血浆ANP)明显升高(P<0.05);在水负荷后,病人组平均血浆渗透压降低,但平均血浆AVP不被水负荷抑制或抑制不全,伴水负荷的清除障碍。水负荷前、后病人组平均血浆ANP和血浆醛固酮(血浆Ald)均无明显波动,符合抗利尿激素不适当分泌增多综合征(SIADH)的改变。9例经甲状腺片替代治疗病人,当甲状腺功能恢复或接近于正常时,上述异常指标多数得到纠正。     

Hypoalbuminaemic hyponatraemia: a new syndrome?

Six patients with severe hyponatraemia had neurological features of hyponatraemia and pronounced hypoalbuminaemia. All had biochemical features typical of the syndrome of inappropriate secretion of antidiuretic hormone with low serum osmolality and an inappropriately high urinary osmolality. All were given infusions of whole plasma or albumin solution, or both, to restore their plasma albumin concentrations to normal, which led to a dramatic increase in plasma sodium concentrations and serum osmolality, with a concomitant fall in urinary osmolality in all patients. Neurological features were reversed in four patients. It is suggested that severe hypoalbuminaemia is an important cause of appreciable hyponatraemia; infusions of plasma and albumin in such patients may reverse the biochemical and clinical features and should form the basis of management.     

偏头痛患者血浆和脑脊液中加压素含量的观察及其临床意义

应用放射免疫分析法对40例偏头痛患者血浆和脑脊液中精氨酸加压素(AYP)含量的变化进行了观察,发现不同类型的偏头痛发作期血浆和脑脊液中 AVP 含量均显著低于正常对照组水平;发作间期脑脊液 AVP 含量仍处于低水平,而血浆 AVP 含量与对照组比较差异不显著.对13例偏头痛血浆 AVP 的动态观察发现,偏头痛发作后24h 内,血浆 AVP 持续处于低水平,之后开始回升.此外,血浆和自身脑脊液 AVP 之间呈显著性相关.可见血浆 AVP 含量的水平也能反映偏头痛 AVP 不足的本质.     

心力衰竭、心房纤颤时血浆心房利钠多肽与cGMP的关系

作者研究了急性心力衰竭、慢性心力衰竭、持续性房颤各30例,阵发性房颤和室上性心动过速27例的血浆心房利钠多肽(ANP)、cGMP、肾素活性(PRA)、血管紧张素Ⅱ(ATⅡ)和精氨酸加压素(AVP)水平,发现4组患者血浆ANP和cGMP均明显升高,两者的相关系数分别为0.840、0.775、0.670和0.842(P<0.01)。前3组血浆PRA、ATⅡ和AVP水平高于第4组,24h尿量和尿钠减少,而第4组有多尿。结果提示,4组患者血浆ANP的生物学活性基本相同,急慢性心力衰竭和慢性房颤患者不出现利尿反应可能与肾素-血管紧张素和AVP系统过度激活以及肾脏对持续高浓度ANP刺激的耐受有关。     

Hypothalamic disease in association with dysgenesis of the corpus callosum

We describe two cases of dysgenesis of the corpus callosum demonstrated by magnetic resonance. The first patient presented with chronic hyponatraemia. Investigation demonstrated re-setting of the osmoreceptor and thirst centres. The calculated threshold for arginine vasopressin (AVP) release was reduced at 252 mosmol/kg while severe thirst was perceived at a plasma osmolality of 260 mosmol/kg. Insulin-induced hypoglycaemia produced an exaggerated AVP response. The second patient presented with hypothermia. The calculated threshold of AVP release was 296 mosmol/kg with increased sensitivity of AVP response to hypertonic saline. The plasma AVP response to insulin-induced hypoglycaemia was absent. Both cases had normal anterior pituitary function and psychological assessment showed a similar prefrontal defect. Specific tests of callosal function were normal. These cases illustrate the importance of undertaking complete neuroradiological assessment of cases of unexplained hypothalamic disease regardless of the age of presentation to avoid overlooking this rare congenital association.     

Mechanisms of the therapeutic effect of astragalus membranaceus on sodium and water retention in experimental heart failure.

OBJECTIVE: To investigate the therapeutic effect of Astragali on sodium and water retention in aortocaval fistula-caused experimental congestive heart failure and its involved mechanisms. METHODS: In aortocaval fistula-caused chronic (5 wk), heart failure rats treated with and without Astragali 1.0 g/day intraperitoneally, changes of cardiac and renal function, renal response to atrial natriuretic peptide (ANP) were examined. Dot blot analysis was used to determine the effect of Astragali on hypothalamic arginine vasopresin (AVP) mRNA expression, and mRNA expressions of aortic and renal AVP V1a receptor, renal AVP V2 receptor and aquaporin-2 (AQP2) were simultaneously detected by RT-PCR method. RESULTS: Rats with aortocaval fistula impaired cardiac and renal functions evidenced by higher right atrial pressure (RAP), left ventricular end-diastolic pressure (LVEDP), lower + dP/dtmax of left ventricle, glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume (UV), urinary sodium excretion (UNaV) and free water clearance (CH2O) compared with sham-operated control (P < 0.05). There was no change in serum sodium, hematocrit and plasma osmolality. Astragali could remarkably improve the cardiac and renal functions. Dot blot analysis demonstrated upregulated hypothalamic AVP mRNA expression in this experimental heart failure. The AVP V1a receptor mRNA level of aortic arch and renal medulla were reduced, while in renal cortex it was elevated. The mRNA expressions of AVP V2 receptor and AQP2 were increased in renal cortex while decreased in medulla. Astragali could partially or completely correct those abnormal mRNA expressions. Analysis on plasma atrial natriuretic peptide (ANP), urinary cyclic guanidino monophosphate excretion (UcGMP V), urinary cyclic guanidino monophosphate excretion/plasma atrial natriuretic peptide (UcGMP V/pANP), and further correlation and linear regression analysis between UcGMP V and plasma ANP showed that there was blunted renal response to ANP in heart failure rat, and astragali could improve the renal reaction to ANP significantly. CONCLUSION: Chinese herb, astragali have therapeutic effects on sodium and water retention in aortocaval fistula-induced heart failure, the mechanisms of which might be the improvement of cardiac and renal functions, partly correction of abnormal mRNA expressions of AVP system and AQP2, and amelioration of blunted renal response to ANP.     

健康人加压素释放和渴感的渗透压阈值

报道１２名受试者在静滴５％ＮａＣｌ２ｈ（每分钟０．０６ｍｌ／ｋｇ）的过程中血钠、血渗、血浆精氨酸加压素（ＡＶＰ）浓度和渴感等级的变化。结果显示，血浆ＡＶＰ浓度及渴感等级分别与血渗呈线性相关，回归方程分别为：血浆ＡＶＰ浓度（ｐＡＶＰ）－０．２４［血浆渗透压（ｐＯｓｍ）－２７４］（ｒ＝０．７２，Ｐ＜０．００１）；渴感等级（Ｔｈ）＝０．２３（ｐＯｓｍ－２７９）（ｒ＝０．６２，Ｐ＜０．００１）．两者灵敏度及阈值均较国外文献报道的结果低，认为加压素释放及渴感的渗透压阈值可能与遗传因素及生活习俗有关，ＡＶＰ分泌及渴感的渗透压调节可能存在种族差异。     

Controlled trial of enalapril in patients with chronic fluid overload undergoing dialysis

About one third of patients receiving dialysis for end stage renal failure have chronic fluid overload despite advice to restrict their oral fluid intake. To investigate the potential of an angiotensin converting enzyme inhibitor in reducing the urge to drink and consequent gain in weight, a double blind, placebo controlled crossover trial of enalapril was conducted in 25 patients receiving dialysis who had fluid overload. The trial comprised a baseline period of four weeks; two periods of treatment, each of four weeks, during which patients received either placebo or enalapril 5 mg twice each week; and a follow up period of four weeks. Five patients withdrew from the trial, one because of an adverse drug reaction to enalapril. A range of biochemical and behavioural variables was measured during the baseline period, at the completion of periods 1 and 2, and during follow up. These variables included gain in weight between dialysis sessions; blood pressure; plasma concentrations of sodium, angiotensin II, and vasopressin; plasma renin and angiotensin converting enzyme activities; osmolality; and estimations of thirst, intake of fluid, and control of drinking. Enalapril caused a significant reduction in gain in weight between dialysis sessions, thirst, and oral intake of fluid in parallel with significantly increased renin activity, significantly decreased angiotensin converting enzyme activity, and decreased concentrations of angiotensin II. Gain in weight and angiotensin converting enzyme activity returned to baseline values once patients stopped taking enalapril. These results suggest that enalapril may act on the renin-angiotensin system and reduce intake of fluid by inhibiting angiotensin converting enzyme.     

精氨酸加压素和心钠素与高血压病左室肥厚的关系

目的　探讨精氨酸加压素 (AVP)和心钠素 (ANF)在高血压病左室肥厚 (LVH)发生中的作用。方法　观察 36例高血压病合并LVH、36例不合并LVH患者及 2 4例正常人血压、血浆AVP、ANF和ANF/AVP比值变化。结果　LVH组和非LVH组血浆AVP和ANF浓度均高于正常对照组 ;LVH组收缩压、AVP和ANF高于非LVH组 ,ANF/AVP比值低于非LVH组。非LVH组血浆AVP与收缩压、舒张压和血浆ANF呈正相关。结论　循环AVP和ANF水平改变及其平衡失调可能参与高血压病LVH的形成过程     

Reduced plasma apelin levels in patients with autistic spectrum disorder

BACKGROUND: Dysregulation of the vasopressin (AVP) system has been implicated in the pathogenesis of autistic spectrum disorder (ASD). Apelin is a recently discovered neuropeptide that could counteract AVP actions and whose receptors are colocalized with vasopressin in hypothalamic magnocellular neurons. Aims of the present study were to investigate circulating levels of apelin in patients with ASD and to assess their correlation with plasma AVP concentrations. METHODS: Plasma levels of apelin and AVP were measured in a total of 18 patients with ASD and 21 age- and gender-matched healthy comparison subjects. The Childhood Autism Rating Scale (CARS) was used to assess the severity of autistic symptoms. RESULTS: Significantly reduced levels of apelin (p < 0.001) and elevated concentrations of AVP (p = 0.02) were found in ASD patients as compared to controls. Additionally, a significant inverse correlation between apelin and AVP levels was found within the ASD group (r = -0.61; p = 0.007), but not in healthy participants (r = -0.26; p = 0.25). Multivariate linear regression analysis showed that only AVP concentrations independently predicted apelin values in ASD individuals (beta = -0.42, t = 2.63, p = 0.014). No correlation was seen between apelin levels and CARS scores (r = -0.10; p = 0.68). CONCLUSIONS: Our findings of a significantly reduced peripheral level of apelin coupled with elevated AVP point to a subtle but definite vasopressinergic dysfunction in autism that could play a role in the etiopathophysiology of this disorder in humans.     

Studies on the Absorption and Distribution of Doxycycline in Normal Patients and in Patients with Severely Impaired Renal Function

Doxycycline, a recently synthesized analogue of tetracycline, was given to 16 patients with normal renal function and to 14 patients with severely impaired renal function. Serum concentrations in the two groups following a single dose were followed after absorption. The rate of clearance from the plasma following a single dose did not differ significantly in the two groups despite low urinary concentrations in patients with renal failure. No accumulation of doxycycline occurred in the serum of three normal patients or of nine patients with renal failure when treated with either 200 mg. daily or 200 mg. initially followed by 100 mg. daily for up to 15 days.     

Effect of acute water loading on plasma levels of antidiuretic hormone AVP aldosterone, ANP fractional excretion of sodium and plasma and urine osmolalities in myxedema.

We monitored the plasma and urine osmolalities, fractional excretion of sodium, fractional excretion of chloride, plasma levels of antidiuretic hormone (ADH, AVP), aldosterone and atrial natriuretic peptide (ANP) before and after acute water ingestion in 12 patients with overt hypothyroidism. The ability of the patients to dilute and concentrate urine was found impaired and the ability of excretion of water load decreased and delayed. Acute water load test was proved to be effective in evaluating the urinary excreting function for the patients. We hypothesize that inappropriate secretion of anti-diuretic hormone and elevated plasma ANP may be homeostatic factors for abnormal urinary excretion in patients with hypothyroidism.

     

Enalapril in the treatment of hypertension with renal artery stenosis

The converting enzyme inhibitor enalapril, in single daily doses of 10-40 mg, was given to 20 hypertensive patients with renal artery stenosis. The blood pressure fall six hours after the first dose of enalapril was significantly related to the pretreatment plasma concentrations of active renin and angiotensin II and to the concurrent fall in angiotensin II. Blood pressure fell further with continued treatment; the long term fall was not significantly related to pretreatment plasma renin or angiotensin II concentrations. At three months, 24 hours after the last dose of enalapril, blood pressure, plasma angiotensin II, and converting enzyme activity remained low and active renin and angiotensin I high; six hours after dosing, angiotensin II had, however, fallen further. The rise in active renin during long term treatment was proportionally greater than the rise in angiotensin I; this probably reflects the fall in renin substrate that occurs with converting enzyme inhibition. Enalapril alone caused reduction in exchangeable sodium, with distinct increases in serum potassium, creatinine, and urea. Enalapril was well tolerated and controlled hypertension effectively long term; only two of the 20 patients required concomitant diuretic treatment.     

急性脑梗塞患者血浆精氨酸加压素和内皮素及一氧化氮动态变化与脑梗塞的关系

目的：观察急性脑梗塞患者血浆精氨酸加压素（AVP）和内皮素（ET）及一氧化氮（NO）的动态变化,探求这些物质与脑梗塞严重程度的关系。方法：用放射免疫法（RIA）和Green's法检测36例急性脑梗塞发病48、168、480h共3次30例正常人（作为正常值）AVP、ET、NO水平。结果：脑梗塞后48和168h的AVP、ET显著高于正常值,P＜0．001和0．01;而480h后与正常值接近,P＞0．05。NO在脑梗塞后48和168h,非常显著低于正常值,P＜0．001和0．01;而480h接近正常值,P＞0．05。脑梗塞大梗塞灶组AVP、ET显著高于小梗塞灶组,P＜0．01;而NO大梗塞灶组显著低于小梗塞灶组,P＜0．01。结论：AVP、ET、NO与急性脑梗塞发病后的时间和梗塞范围有密切的相关性,可作为观察急性脑梗塞严重程度的指标。     

肺动脉高压大鼠血浆肾素—血管紧张素,精氨酸加压素的改变

观察心外左向右分流(LRS)、低压性缺氧(HH)及分流附加低压性缺氧(SHH)所致肺动脉高压(PH)大鼠血浆肾素活性(RA)、血管紧张素Ⅰ(AⅠ)、血管紧张素Ⅱ(AⅡ)浓度及AⅠ转变为AⅡ的比率和精氨酸加压素(AVP)的改变。结果LRS组及SHH大鼠RA呈升高趋势,但与对照组比较无显著差异(P>0.05);HH组无改变。LRS组AⅡ浓度显著高于对照组(P<0.05),AⅠ及AⅡ/AⅠ亦呈升高趋势,但未达显著差异(P>0.05);而HH及SHH组较LRS组降低,尤以HH组为著。LRS大鼠AVP显著升高(P<0.05);其他组也呈升高趋势,但未达统计学显著意义(P>0.05)。本文对体液因素在PH形成中的作用进行了分析。     

体外循环冠状动脉旁路移植术围术期血浆血管加压素变化及对血液动力学的影响

目的探讨体外循环(ECC)冠状动脉旁路移植术(CABG)围术期血浆血管加压素(AVP)变化及对血液动力学和术后转归的影响。方法随机选择择期ECC下行CABG患者40例。分别在麻醉诱导前、切皮前、ECC开始、复温、ECC结束、手术结束、术后24h采集动脉血液样本测定血浆AVP浓度,并在切皮前和ECC结束后10min监测血液动力学指标。详细记录患者围术期临床资料。根据血浆AVP浓度的不同水平通过聚类分析将40例患者分为高值组(n=22)和低值组(n=18)。结果围术期血浆AVP浓度呈现完全不同的变化趋势。与高值组相比,低值组患者ECC后高排低阻的发生率较高(P0.01);ECC后平均动脉压较低(P0.01);ECC时间(P0.01)、术后带管时间(P0.01)、ICU停留时间(P0.05)和术后住院时间(P0.05)较长;血管收缩药的使用人数较多(P0.01)。结论ECC下CABG围术期血浆AVP浓度呈现两种完全不同的变化,低值组患者的血液动力学及术后转归较差。     

老年心力衰竭患者肾素-血管紧张素系统与纤溶活性变化的意义

目的探讨老年心力衰竭（HF）患者血浆肾素-血管紧张素系统（RAS）与纤溶活性的变化。方法老年HF患者46例（HF组）,非器质性心脏病住院患者18例（对照组）,取静脉血分别检测血浆纤溶酶原激活剂抑制物1（PAI-1）、组织纤溶酶原激活剂（t-PA）活性、血浆肾素活性（RA）及血管紧张素Ⅱ（AngⅡ）含量。结果老年HF患者血浆RA、PAI-1活性、AngⅡ含量明显高于对照组（P〈0.05）,t-PA活性则降低（P〈0.05）;血浆PAI-1活性与AngⅡ含量水平呈显著正相关（r=0.396,P〈0.01）。结论老年HF过程中血浆RAS激活对纤溶活性改变有重要影响。     

The effect of moderate alcohol intake on serum apolipoproteins A-I and A-II. A controlled study

High serum concentrations of apolipoprotein (apo) A-I are associated with a decreased risk of coronary heart disease. To study the effect of alcohol intake on serum apo A-I and A-II concentrations, 24 healthy male drinkers (37.8 +/- 13.9 mL [1.3 +/- 0.5 oz] of ethanol per day, mean +/- SD) were randomized into treatment and control groups after a three-week baseline period. The treatment group abstained from all intake of alcohol for the six weeks following randomization and then reverted to its usual level of intake for a five-week period. The control group continued its usual level of drinking throughout the trial. The concentrations of apo A-I and apo A-II of abstainers decreased significantly compared with the corresponding changes in controls. After drinking was resumed, apo A-I and apo A-II concentrations were significantly increased in the treatment group compared with the corresponding changes in the control group. These results suggest that the association between moderate alcohol intake and reduced risk of coronary heart disease may be mediated in part by increased levels of serum apo A-I or apo A-II, or both.     

血管加压素对酒精戒断大鼠下丘脑-腺垂体-肾上腺皮质功能的影响

目的:观察在长期低浓度酒精处理及酒精戒断过程中,大鼠血浆中血管加压素(AVP)、促肾上腺皮质激素(ACTH)和皮质醇含量的变化以及下丘脑中AVP、促肾上腺皮质激素释放因子(CRF)含量的变化,进而探讨酒精对机体应激水平的影响以及AVP在酒精依赖过程中的作用。方法:以6%(V/V)的酒精作为大鼠饮水的唯一来源,分别饮酒1、3、7、14、21、28d,以及饮酒28d后撤除酒精2h,取不同处理大鼠的血浆和下丘脑标本,采用放射性免疫测定法分别测定CRF、AVP、ACTH和皮质醇水平;气相色谱法测定大鼠在饮酒过程中不同时段血中酒精浓度。结果:大鼠饮酒3d后,血浆中的AVP和皮质醇水平显著增高,并持续至饮酒结束,而血浆ACTH水平无明显变化。使用AVP受体拮抗剂后,血液中ACTH和皮质醇含量显著下降。动物血中酒精浓度在摄入酒精的不同时段无明显差异。结论:长时程的低浓度酒精刺激使机体应激水平升高,同时下丘脑-腺垂体-肾上腺皮质轴功能紊乱,这可能是动物产生酒精依赖的重要原因之一。