老年人急性颅脑损伤早期血浆精氨酸加压素含量变化的研究

目的研究老年人急性颅脑损伤早期血浆中精氨酸加压素（AVP）的变化及临床意义。方法用放射免疫（RIA）法检测32例老年人急性颅脑损伤早期患者,30例非颅脑损伤早期患者和30例健康老年人的血浆AVP,分析和观察其临床变化。结果32例老年人急性颅脑损伤早期组血浆AVP［（48．30±8．28）ng／人］明显高于非颅脑损伤早期组［（25．56±4．64）ng／L］,P＜0.01;非颅脑损伤早期组高于老年健康组［（5.06±4.12）ng／L］,P＜0．01。其中老年人急性颅脑损伤早期组中GCS评分与AVP呈负性相关,P＜0.01;而非颅脑损伤的早期组与GCS评分无明显意义,P＞0．05。结论AVP参与了各种急性损伤早期的病理生理过程,但急性颅脑损伤早期组明显高于非颅脑损伤早期组,尤其颅脑损伤早期组中GCS评分＞8分明显高于＜8分组,颅脑损伤越严重,AVP越高,提示AVP可作为观察老年人,颅脑损伤早期严重程度的标志之一,对临床抢救具有指导意义。     

Copeptin as a marker of relative arginine vasopressin deficiency after pediatric cardiac surgery

Purpose

Relative arginine vasopressin (AVP) deficiency after pediatric cardiac surgery has recently been described. Copeptin, a more stable and easily measured product of pro-AVP processing, may be a means of identifying these patients. We aimed to determine if copeptin was correlated with AVP in these children and whether it can be a surrogate marker of relative AVP deficiency.

Methods

Patients <6?years of age with basic Aristotle scores ≥7 requiring surgery with cardiopulmonary bypass were prospectively enrolled. Plasma AVP and copeptin concentrations were measured pre-cardiopulmonary bypass and 4 and 24?h post-cardiopulmonary bypass. Relative AVP deficiency was defined a priori based on our previous work as AVP <9.2?pg/ml at 4?h post-cardiopulmonary bypass.

Results

Of 41 children enrolled, relative AVP deficiency was present in 13 (32?%). AVP and copeptin concentrations were significantly lower in these 13 children at 4?h post-cardiopulmonary bypass as compared to the other 28 patients. A significant positive association between plasma AVP and copeptin concentrations over time was determined. Based on log-transformed analyses, a 1?% increase in plasma AVP led to a 0.19?% increase in copeptin. Further, copeptin <1.12?ng/ml at 4?h post-cardiopulmonary bypass had a sensitivity of 92?% and a negative predictive value of 95?% for relative AVP deficiency.

Conclusions

Plasma AVP and copeptin are positively associated in children undergoing cardiac surgery. Copeptin may represent a useful means of identifying relative AVP deficiency in these patients.     

精氨酸加压素对感染性休克兔胃肠灌注的影响

目的评价精氨酸加压素(arginine vasopressin,AVP)对感染性休克兔胃黏膜二氧化碳分压与动脉血二氧化碳分压差(P(g-a)CO2)及肠系膜上动脉血流量的影响。方法日本大白兔麻醉后压力控制通气,静脉注入内毒素复制感染性休克模型,达到休克标准后随机分成2组:单纯补液组(对照组)和精氨酸加压素组(AVP组)。对照组按20ml/(kg.h)输注生理盐水,AVP组除按20ml/(kg.h)输注生理盐水外,持续输注AVP0.001IU/(kg.min)。连续监测平均动脉压、心率、心脏指数和肠系膜上动脉血流指数,每10min测定胃黏膜二氧化碳分压一次,每小时测定血红蛋白浓度、动静脉血气分析、动脉血乳酸。结果静脉注射内毒素后,两组平均动脉压、心脏指数及肠系膜血流量指数均明显下降,但P(g-a)CO2和乳酸明显增加。分组治疗2h后,两组平均动脉压、心脏指数及肠系膜上动脉血流流指数均上升,除AVP组平均动脉压升高较对照组明显[(72±4)mmHgvs(65±3)mmHg,t=3.7,P<0.01)外,心脏指数[(181±11)ml/kgvs(187±5)ml/kg,t=1.5,P>0.05]及肠系膜上动脉血流指数[(14.5±1.9)ml/kgvs(16.1±1.4)ml/kg,t=1.9,P>0.05)]的变化两组差异无统计学意义。AVP组的P(g-a)CO2较对照组高,但差异亦无显著性统计学意义[(30±3)mmHgvs(27±4)mmHg,t=1.3,P>0.05)]。结论实验结果显示,感染性休克兔进行容量复苏时,加用小剂量精氨酸加压素有利于恢复平均动脉压,对P(g-a)CO2及肠系膜上动脉血流量无显著影响。     

Stimulation of arginine vasopressin secretion by a small increase in blood ionized calcium in normal men

Evidence has been provided for an increase in baseline serum corticotrophin (ACTH) levels in response to a rise in circulating ionized calcium (Ca_i) levels within the physiological range. In order to establish whether small Ca_i increments are also able to modify the basal secretion of arginine vasopressin (AVP), we infused calcium gluconate through an intravenous infusion pump in eight healthy male subjects (25–31 years old). Serum Ca_i, ACTH and AVP concentrations were measured every 10 min over an infusion period lasting 90 min. A significant progressive rise in serum Ca_i (baseline: 42 ± 0.9 mg dL⁻¹; 90 min: 47.2 ± 0.9 mg dL⁻¹, P  < 0.001), ACTH (baseline: 30.7 ± 1.3 pg mL⁻¹; mean peak at 80 min: 37.4 ± 2.4 pg mL⁻¹, P  < 0.01) and AVP levels (baseline: 2.1 ± 0.6 pg mL⁻¹; mean peak at 80 min: 3.2 ± 0.5 pg mL⁻¹, P  < 0.01) was observed during calcium infusion. Furthermore, a significant positive correlation ( r  = 0.71; P  < 0.001) was observed between ACTH and AVP responses to calcium infusion at 60, 70, 80 and 90 min. These data demonstrate that AVP secretion is stimulated by a slight rapid increase in serum Ca_i levels even though absolute serum Ca_i levels remain within the normal range. In addition, the positive correlation between Ca_i-induced ACTH and AVP increments suggests that AVP plays a releasing role on ACTH secretion during calcium infusion.     

急性颅脑损伤后血管内皮细胞钙黏蛋白和精氨酸加压素的动态变化

目的 研究急性颅脑损伤后血中血管内皮细胞钙黏蛋白(VE-cadherin)和精氨酸加压素(arginine vasopressin,AVP)的动态变化及其与继发性脑水肿的关系.方法 采用酶联免疫吸附法(ELISA)检测VE-cadherin含量,采用放射免疫法检测AVP含量,回顾性分析110例急性颅脑损伤住院患者伤后12 h、伤后3,5 d血中VE-cadherin和AVP含量,并结合临床表现、影像学检查及格拉斯哥预后评分(COS)进行比较分析.结果 本组110例急性颅脑损伤患者伤后早期(12 h内)血VE-cadherin和AVP含最随着格拉斯哥昏迷评分(GCS)下降均有不同程度的升高.颅脑损伤越严重,VE-eadherin和AVP升高越明显,脑水肿程度越重,脑水肿高峰持续时间越长(P<0.01).颅脑损伤早期血VE-cadherin和AVP含量与脑水肿严重程度(r=0.69,0.65,P<0.01)和脑水肿高峰持续时间(r=0.70,0.64,P<0.01)呈正相关.此外,不同GOS组之间VE-cadherin和AVP差异亦有统计学意义,其中预后不良组血VE-eadherin和AVP水平在伤后5 d持续升高,而且显著高于预后良好组和正常对照组(P<0.05或P<0.01).同时急性颅脑损伤后血VE-cadherin和AVP的含量呈正相关(r=0.72,P相似文献   

急性颅脑损伤后抵抗素和精氨酸加压素动态变化的临床研究

目的研究急性颅脑损伤后血中抵抗素和精氨酸加压素（AVP）的动态变化,探讨抵抗素和AVP与急性颅脑损伤后继发性脑水肿及其预后的关系。方法采用酶联免疫吸附法（ELISA）检测抵抗素含量,采用放射免疫法检测AVP含量,分别测定110例急性颅脑损伤住院患者伤后12h,伤后第3、5d血中抵抗素和AVP含量,并结合临床表现、影像学检查及格拉斯哥预后评分（GOS）进行比较分析。结果本组110例急性颅脑损伤患者伤后早期（12h内）,血抵抗素和AVP含量随着格拉斯哥昏迷评分（GCS）下降,均有不同程度的升高。颅脑损伤越严重,抵抗素和AVP升高越明显,脑水肿程度越重,脑水肿高峰持续时间越长（P均〈0．01）。颅脑损伤早期,血抵抗素和AVP含量与脑水肿严重程度（r=0．68,0．65,P均〈0．01）和脑水肿高峰持续时间（r=0．69,0．64,P均〈0．01）呈正相关。此外,不同GOS组之间抵抗素和AVP差异亦有统计学意义,其中预后不良组血抵抗素和AVP水平在伤后5d仍持续在较高水平,而且显著高于预后良好组和正常对照组（P〈0．05或P〈0．01）。同时急性颅脑损伤后血抵抗素和AVP的含量呈正相关（r=0．72,P〈0．01）。结论急性颅脑损伤后血抵抗素和AVP的动态变化与急性颅脑损伤预后密切相关,抵抗素和AVP参与了颅脑损伤后继发性脑水肿形成的病理生理过程。     

Does the stress of admission to an intensive care unit influence arginine vasopressin secretion and renal diluting ability?

The pathogenesis of excessive arginine vasopressin (AVP) release and hyponatraemia in euvolaemic intensive care unit (ICU) patients is poorly understood. Stress has frequently been proposed as a possible determinant, but its actual responsibility has not been adequately assessed. Therefore, water-load tests were prospectively performed in 11 patients admitted to the ICU for severe or potentially severe diseases, but who had no other condition which could result in excessive AVP release or impairment of renal diluting ability. Renal diluting ability was normal in 9 patients. Two patients exhibited very slight defects, which might be the consequence of subclinical haemodynamic alterations, since one had a pulmonary embolism and the other manifested a gastrointestinal haemorrhage just after the completion of the water load. Nevertheless, plasma AVP levels decreased in response to the water load in all the patients, resulting in a significant decrease in mean values. Plasma norepinephrine values were found to be elevated both before and after water loading. A highly significant correlation existed between the levels of norepinephrine and those of AVP measured before the load, but was lost after it. In addition, norepinephrine values were markedly elevated in two patients who exhibited strictly normal renal diluting abilities, and no correlation was found between plasma norepinephrine values and any parameter of renal water excretion. Our study shows that the stress of a serious illness and of admission to an ICU does not seem to interfere, by itself, with osmotic regulation of AVP secretion and renal diluting ability, and that sympathetic activation is not, under such circumstances, a predominant stimulus for AVP release. Caution is advisable before attributing to medical stress alone the responsibility for hyponatraemia in ICU patients.Presented in part at the 4th European Congress on Intensive Care Medicine, Baveno-Stresa, Italy, June 14–18 1988     

Influence of residual C-peptide secretion on the arginine vasopressin response to hypoglycaemia and metoclopramide in insulin-dependent diabetes

Abstract. Arginine vasopressin (AVP) hypersecretion in response to metoclopramide or to insulin-induced hypoglycaemia has been described in type I diabetes mellitus. In the present study, we examined whether residual endogenous insulin secretion may play a role in the control of this abnormal AVP secretory pattern. For this purpose, 21 insulin-dependent diabetic men and 10 age- and weight-matched normal men were tested with MCP (20 mg in an i.v. bolus). On a different occasion, subjects were tested with insulin (0.15IU kg^-1). The diabetic patients were subdivided into C-peptide negative patients (CpN, 11 patients without detectable endogenous pancreatic β cell activity) (group I) and C-peptide positive patients (CpP, 10 patients with residual endogenous insulin secretion) (group II). Experiments started after optimization of the metabolic status of the diabetic men by 3 days of treatment with continuous subcutaneous insulin infusion. The basal concentrations of AVP were similar in all groups. The administration of MCP induced a striking elevation in plasma AVP levels in the normal controls and in the diabetic subjects of groups I and II. However, the AVP rise was significantly higher in group I and group II than in normal controls. Furthermore, group I diabetics showed higher AVP increments than group II. Insulin induced a similar hypoglycaemic nadir in all subjects at 30 min, even though the diabetic subjects of groups I and II had a delayed recovery in blood glucose levels. The hypoglycaemic pattern was similar in group I and II. Hypoglycaemia induced a striking AVP increase in the normal controls. However, significantly higher AVP responses to hypoglycaemia were observed in the diabetic men of group I and group II than in the normal controls. Furthermore, group I diabetics showed higher AVP increments than group II. These data indicate that the hypothalamic-pituitary disorder affecting the AVP response to MCP and insulin-induced hypoglycaemia in well controlled type I diabetic men is inversely related to residual β-cell activity.     

精氨酸加压素在应激性体温过高中的作用

目的：探讨精氨酸加压素（AVP）是否具有降低应激性体温过高的作用。方法：用无线遥测技术测量大鼠的体温变化,观察腹腔注射AVP和精氨酸加压素V1受体阻断剂（AVP V1阻断剂）对大鼠应激性体温过高的影响。结果：腹腔注射AVP能明显降低大鼠应激性体温过高,而注射AVP V1阻断剂则能提高应激性体温过高的反应。结论：AVP不仅有降低大鼠应激性体温过高的作用,而且证明内源性AVP在应激性体温过高中有负调节作用。     

Role of arginine vasopressin and terlipressin as first-line vasopressor agents in fulminant ovine septic shock

Purpose  To compare the effects of first-line therapy with low-dose arginine vasopressin (AVP) or terlipressin (TP) on mesenteric blood flow, plasma AVP levels, organ function and mortality in ovine septic shock. Methods  Twenty-four adult ewes were anesthetized and instrumented for chronic hemodynamic monitoring. A flow-probe was placed around the superior mesenteric artery, and feces were extracted from the cecum. Following baseline measurements, feces were injected into the peritoneal cavity. When mean arterial pressure (MAP) decreased to less than 60 mmHg, animals were randomly assigned to receive AVP (0.5 mU kg⁻¹ min⁻¹), TP (1 μg kg⁻¹ h⁻¹) or saline (n = 8 each). A norepinephrine infusion was titrated to maintain MAP at 70 ± 5 mmHg in all groups. Results  Cardiovascular pressures, cardiac output, mesenteric blood flow, and lung tissue concentrations of 3-nitrotyrosine and hemoxygenase-1 were similar among groups throughout the study period. TP infusion resulted in lower plasma AVP concentrations, reduced positive net fluid balance, increased central venous oxygen saturation and slightly prolonged survival compared to control and AVP-treated animals. However, TP treatment was associated with higher liver transaminases and lactate dehydrogenase versus control animals after 12 h. Conclusions  This study provides evidence that the effects of low-dose TP differ from those of AVP, not only as TP has a longer half life, but also because of different mechanisms of action. Although low-dose TP infusion may be superior to sole norepinephrine or AVP therapy in septic shock, the safety of this therapeutic approach should be determined in more detail. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

血管加压素对心肺转流术后血管麻痹综合征患者血流动力学的影响

目的评价血管加压素对心肺转流术(CPB)后血管麻痹综合征患者血流动力学的影响。方法选取CPB下心脏手术后发生血管麻痹综合征患者14例,分为去甲肾上腺素(NE)组(NE组)和血管加压素(AVP)组(AVP组)。NE组患者输注NE维持平均动脉血压>65 mmHg,当NE输注速率>0.4μg/(kg.min)则加用AVP 0.01～0.04 U/min;AVP组患者输注AVP0.01～0.04 U/min,必要时使用NE维持患者平均动脉血压>65 mmHg。于血管麻痹综合征诊断时(T1,基础值)、注药后24 h(T2)、48 h(T3)、72 h(T4)分别记录两组患者心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、心排血量(CO)、肺毛细血管楔压(PCWP)、中心静脉压(CVP)及尿量,计算体循环血管阻力(SVR)及肺循环血管阻力(PVR)。并记录儿茶酚胺药物使用量及不良反应。结果两组患者年龄、体重、性别构成比,术前EF、术前治疗用药情况、CPB时间、主动脉阻断时间比较差异无统计学意义(P>0.05)。两组患者血压维持稳定。与NE组比较,AVP组SVR T2时增加;HR T2～3时显著降低(P<0.05);NE需要量T2～4明显降低(P<0.05);尿量明显增加(P<0.05)。结论 AVP可以改善CPB术后血管麻痹综合征患者的血流动力学。     

Congenital nephrogenic diabetes insipidus arginine vasopressin receptor 2 gene mutation at new site: A case report

BACKGROUNDCongenital nephrogenic diabetes insipidus (CNDI) is a rare hereditary disorder. It is associated with mutations in the arginine vasopressin receptor 2 (AVPR2) gene and aquaporin 2 (AQP2) gene, and approximately 270 different mutation sites have been reported for AVPR2. Therefore, new mutations and new manifestations are crucial to complement the clinical deficiencies in the diagnosis of this disease. We report a case of a novel AVPR2 gene mutation locus and a new clinical mani-festation.CASE SUMMARYWe describe the case of a 48-d-old boy who presented with recurrent fever and diarrhea 5 d after birth. Laboratory tests showed electrolyte disturbances and low urine specific gravity, and imaging tests showed no abnormalities. Genetic testing revealed a novel X-linked recessive missense mutation, c.283 (exon 2) C>T (p.P95S). This mutation results in the substitution of a proline residue with a serine residue in the AVPR2 protein sequence. The diagnosis of CNDI was confirmed based on the AVPR2 gene mutation. The treatment strategy for this patient was divided into two stages, including physical cooling supplemented with appropriate amounts of water in the early stage and oral hydrochlorothia-zide (1-2 mg/kg) after a clear diagnosis. After follow-up of one and a half years, the patient gradually improved.CONCLUSIONAVPR2 gene mutations in new loci and new clinical symptoms help clinicians understand this disease and shorten the diagnosis cycle.     

Arginine vasopressin dissociates the diuresis and natriuresis due to atrial natriuretic factor in man

The possible interaction between arginine vasopressin (AVP) and atrial natriuretic factor (ANF) in the control of urinary sodium and water excretion was investigated in man. Nine healthy male volunteers undergoing stable maximal water diuresis were studied on four separate occasions. Atrial natriuretic factor 15 pmol kg-1 min-1 or placebo (P) was concomitantly administered against a background infusion of either AVP 0.003 pmol kg-1 min-1 or P; thus the combinations P + P, AVP + P, P + ANF and AVP + ANF were studied. Atrial natriuretic factor caused a significant increase in sodium excretion (UNaV) [+56%], urinary flow rate (V) [+17%] and free water clearance (CH2O) [+23%]; creatinine clearance (Ccr) did not change. Arginine vasopressin reduced V (-58%) and CH2O (-68%) but did not alter UNaV or Ccr. On the AVP + ANF study day, UNaV increased (+64%) as with P + ANF, but V (-44%) and CH2O (-52%) continued to decrease below baseline levels; analysis of variance showed this antidiuresis reflected the prevalent effect of AVP rather than any specific interaction. These results show that AVP is able to dissociate the natriuretic and diuretic effects of ANF.     

Metabolic clearance rate of immunoreactive vasopressin in man

Abstract. Metabolic clearance of synthetic arginine vasopressin (AVP) has been measured in sixteen healthy subjects and ten uraemic patients on maintenance haemodialysis. Plasma AVP was measured using a specific radioimmunoassay at different intervals after a single injection of 2 μg AVP. The theoretical curve which fitted best with the disappearance curve was the sum of two exponentials in twenty-two subjects and of three exponentials in the other four. Metabolic clearance rate and the volume of fast initial distribution were 287·1 ml min^-1 (m²)^-1 and 219·3 ml/kg b.w., respectively, in normal subjects. Metabolic clearance rate was considerably lower in the uraemic group. This emphasizes the role of kidneys in the degradation of AVP and may account, at least in part, for the higher basal plasma value of this hormone observed in uraemic patients.     

颅脑创伤患者血浆和脑脊液血管升压素的动态变化及意义

目的 探讨颅脑创伤患者血浆和脑脊液血管升压素(AVP)的动态变化及其临床意义。方法 将36例中重度颅脑创伤患者按GCS和GOS评分分组，采用放射免疫RIA方法和渗透压测定仪对患者血浆和脑脊液中AVP、血浆和脑脊液渗透压和电解质进行动态检测，同时选择30例外科手术患者作为对照。结果 颅脑创伤组血浆和脑脊液AVP明显高于对照组并与GCS评分有关。对照组血浆AVP术前与术后有显著性差异，GOS各分组间脑脊液AVP有显著性差异，AVP水平与脑脊液渗透压和颅内压相关；血浆AVP与血浆渗透压相关；Spearman相关性检验提示，相对低钠血症，血浆AVP变化较脑脊液AVP敏感；相对颅内压变化血浆渗透压较脑脊液渗透压敏感。结论 血浆和脑脊液中AVP可以通过不同环节和不同因素参与继发性脑损害的过程。脑脊液或血浆中的AVP可以通过不同环节和不同因素参与继发性脑损害的过程，脑脊液或血浆中的AVP与颅脑创伤损伤严重程度密切相关，可以作为判断伤情程度的客观指标；创伤患者预后越差，脑脊液中AVP浓度越高，测定颅脑创伤患者CSF中AVP水平比血浆中AVP更合适作为预后的判断指标，用来评估脑水肿严重程度和颅内压也较血浆中AVP敏感、准确。     

局部亚低温对急性重症脑出血血管活性物质及自由基的影响及临床疗效的研究

目的　研究局部亚低温治疗急性重症脑出血患者临床疗效及其对血管活性物质NO、ET、神经肽AVP及自由基的影响。方法　随机将 78例脑出血患者分为局部亚低温组 38例和常规治疗组 (对照组 ) 4 0例 ,治疗组在药物综合治疗基础上加用局部亚低温治疗 ,对照组为单纯药物综合治疗 ,动态观察两组血浆NO、ET、AVP、MDA的变化及治疗 2 1d脑水肿带的变化和治疗 30d后临床神经功能评分。结果　治疗 15d ,局部亚低温组ET、AVP较对照组明显下降 (P <0 0 1) ,NO含量较对照组明显升高 (P <0 0 5 ) ,血浆MDA与健康对照组比较明显下降 (P <0 0 5 ) ;治疗 2 1d ,局部亚低温组脑水肿体积较对照组明显减小 (P <0 0 5 ) ;治疗 30d后局部亚低温组临床神经功能评分明显低于对照组 (P <0 0 1)。结论　局部亚低温治疗能明显抑制血管活性物质ET、AVP、MDA的过高分泌 ,调节NO分泌的减少 ,减轻脑出血患者脑水肿 ,促进患者神经功能恢复 ,提高临床疗效。     

Role of the adrenal cortex in the natriuresis associated with vasopressin infusion

We have compared the effects of a 48-h continuous infusion of arginine vasopressin (AVP) given to four subjects (one subject studied twice) with that given to four patients lacking adrenocortical function and maintained on fixed doses of mineralocorticoid and glucocorticoid replacement therapy. Both patients and normal subjects were subjected to dietary salt and water restriction during the period of the infusion, and all participants were in balance on a low sodium diet at the start of the infusion period. Infusion of vasopressin in normal subjects was associated with an increase in fractional excretion of sodium by the kidney, which continued during the day after the infusion was stopped. The infusion was also associated with a fall in plasma aldosterone as well as falls in whole blood packed cell volume, plasma renin activity and plasma noradrenaline. Infusion of vasopressin in patients lacking adrenocortical function was associated with a smaller increase in fractional excretion of sodium by the kidney in comparison with that seen in normal subjects, and the increase in sodium excretion was confined to the period of the infusion. Mineralocorticoid activity was maintained constant during the infusion, although a fall in whole blood packed cell volume, plasma renin activity and plasma noradrenaline were noted, in similarity to the study made in normal subjects. We conclude that changes in mineralocorticoid activity are the main factors contributing to the increase in renal sodium excretion seen during, and after, the continuous infusion of vasopressin in salt- and water-restricted man.     

急性脑血管病患者血浆一氧化氮、垂体加压素、泌乳素的变化

目的探讨不同时期、病情、梗死面积和出血量的急性脑血管病患者(ACVD)血浆中一氧化氮(NO)、垂体加压素(AVP)、泌乳素(PRL)的变化及临床意义。方法脑梗死(C I)、脑出血(CH)患者,分别按意识障碍和肌力状况分为轻、重组。C I按梗死面积分为大梗死组、多发梗死组及单发性小梗死组;CH按出血量多少分为小于20 m l组;20~40 m l组;大于40 m l组;据不同病程分为急性期(发病后1小时至3天),恢复期(住院3周后)。对照组:30例同期健康体检者,测定对照组及患者入院时和3周后血浆中NO、AVP、PRL的水平。结果C I、CH患者NO、PRL、AVP均高于正常人,且病情越急,病情越重,脑梗死面积和出血量程度越大者,升高越明显,升高程度与患者愈后密切相关。至恢复期C I、CH患者NO、PRL、AVP已恢复正常。结论急性脑血管疾病患者急性期AVP、NO、PRL升高,可作为判断ACVD的严重程度和愈后的参考指标。     

肾上腺素与血管加压素对窒息性心脏骤停大鼠早期心肺复苏的影响

目的：比较肾上腺素与血管加压素对室息性心脏骤停大鼠早期心肺复苏的影响。方法：健康SI）夫鼠48只,体重200～250g,雌雄产拘,将大鼠随机分成4组（n=12）：正常对照组（C组）、模型组（M组）、肾上腺素组（E组）和血管加雎素组（V组）。M组、E组及V绀大鼠均经气管夹闭1min,建立窒息性心脏骤停模型。肖窒息时间达1min时,分别在常规心肺复苏前：c组和M组大鼠经股静脉注射生理盐水1m1。E组及V纰大鼠经股静脉分别注射肾上腺素0．04mg／kg及血管加压素0．4u／kg,H时开始胸外心脏按压及机械通气,观察自主循环恢复情况,5min无效则放弃复苏。自主循环恢复的大鼠连续监测心电和血压30min。记录在CPR30min内自主循环恢复情况及血流动力学;记录CPR30rain后,采用免疫组织化学法检测各组实验大鼠血清中肿瘤坏死因子-水平、白细胞介素6及白细胞介素10水平。结果：E、V组大鼠自主循环恢复率均显著高于M组（分别为73．4％．74．6％,和15．3％,P〈0．05）．E组大鼠自主循环恢复牢与V组比较差异无统计学意义（P〉0．05）;E、V组大鼠平均动脉压明显高于M绀大鼠（P〈0．05）,V组大鼠MAP高于E组大鼠。差异有统计学意义（P〈0．05）。M组大鼠血清中自细胞介素6及肿瘤坏死因子-水平与E、V组差异有统计学意义（P〈0．05）;E组大鼠m清中肿瘤坏死阔子-及白细胞介素-6水平高于V组（P〈0．05）。E组大鼠血清中白细胞介素-10水平低于V组（P〈0．05）。结论：肾卜腺素与血管加压素在窒息性心脏骤停大鼠早期心肺复苏过程中复苏成功牢无明显差异,但血管加乐素町维持大鼠复苏后平均动脉搓在相对较高水平;同时血管加压素可提高复苏后大鼠血清中抗炎因子水平。     

Angiotensin II, aldosterone and arginine vasopressin in plasma in congestive heart failure

Angiotensin II (AII), aldosterone (Aldo) and arginine vasopressin (AVP) in plasma were determined during basal conditions in seventeen patients with congestive heart failure and in seventeen control subjects. The same parameters were measured before and 1, 2 and 3 h after an oral water load of 20 ml (kg body weight)-1 together with urine volume (V) and free water clearance (CH2O) in seven patients with congestive heart failure and in seven control subjects. AII, Aldo and AVP were significantly higher in heart failure than in control subjects (AII:81 and 12 pmol l(-1) (medians), P less than 0.01; Aldo: 411 and 103 pmol l(-1), P less than 0.01; AVP: 5.3 and 2.0 pmol l)-1), P less than 0.01). AVP was positively correlated to Aldo in both heart failure (p = 0.593, n = 17, P less than 0.02) and control subjects (p = 0.511, n = 17, P less than 0.05), but in neither of the groups to AII. V and CH2O were significantly lower in heart failure when compared to control subjects (maximum increase in CH2O 3.55 and 5.86 ml min-1, P less than 0.02), but did not correlate directly with either A II, Aldo or AVP. Creatinine clearance was reduced in heart failure. It is concluded that the activity of both the renin-angiotensin-aldosterone system and the osmoregulatory system is enhanced in congestive heart failure, presumably as a compensatory phenomenon in order to maintain arterial blood pressure. It is suggested that the decrease in free water clearance may be attributed to both an elevated level of vasopressin and a reduced glomerular filtration rate.