糖尿病患者血浆心钠素浓度变化的研究

作者应用放射免疫法测定了50名正常人53例糖尿病患者血浆心钠素,肾素、血管紧张素Ⅱ水平。结果表明无并发症糖尿病病人和有慢性并发症糖尿病病人血浆心钠素均低于正常人。有慢性并发症糖尿病病人血浆心钠素低于无并发症者。糖尿病患者血浆心钠素浓度测定对预测糖尿病并发症及估计并发症预后有一定临床意义。     

甲状腺机能亢进症患者血浆心钠素水平的动态变化

本文应用放射免疫法测定了50例甲亢患者及50例正常人血浆心钠素浓度,对其中25例甲亢患者测定了治疗前后血浆心钠素、肾素、血管紧张素Ⅱ浓度。结果表明甲亢患者血浆心钠素、肾素、血管紧张素Ⅱ明显升高,治疗后明显降低。甲状腺激素可能有促进心房肌细胞释放心钠素作用。     

不稳定性心绞痛患者血浆心钠素与肾素系统的变化及其影响

应用放射免疫方法和彩色多普勒超声心动图对５９例不稳定性心绞痛（ＵＡＰ）患者和３４例正常人分别测定血浆心钠素（ＡＮＰ）、肾素（ＰＲＡ）、血管紧张素ＩＩ（Ａｎ）、醛固酮（Ａｌｄ）水平及各房、室腔内径。结果显示ＵＡＰ患者血浆ＡＮＰ、ＰＲＡ、Ａｎ含量均明显增高（Ｐ〈０．００５），Ａｌｄ含量无明显变化（Ｐ〉０．０５），且ＡＮＰ含量与心房内径呈正相关，表明ＵＡＰ患者肾素－血管紧张素－醛固酮系统（ＲＡＡＳ）活性     

硬膜外阻滞下剖宫产血浆肾素,血管紧张素Ⅱ及心钠素浓度的变化

本文观察了１０例正常产妇硬膜外阻滞下剖宫产血浆肾素活性，血管紧张素Ⅱ及心钠素的浓度变化，结果显示硬膜外阻滞后１５ｍｉｎ，血浆ＰＲＡ，ＡＴⅡ均无明显变化，胎儿娩出后５ｍｉｎ，ＰＲ５，ＡＴⅡ均明显增高。     

急性心肌梗塞患者血浆心钠素与肾素系统的变化及作用

检测３４例正常人及７１例急性心肌梗塞（ＡＭＩ）患者血浆心钠素（ＡＮＰ）、肾素（ＰＲＡ）、血管紧张素ＩＩ（ＡＩＩ）、醛固酮（Ａｌｄ）的含量。其中发病４８小时内入院者４２例，４８小时至１周入院者２９例。结果显示：ＡＭＩ患者血浆ＡＮＰ、ＰＲＡ及ＡＩＩ均较正常组为高（Ｐ〈０．００１），Ａｌｄ无明显变化（Ｐ〉０．０５）；发病４８小时前后比较仅ＡＩＩ有明显差异（Ｐ〈０．０５），提示在急性心肌梗塞早期，血浆中Ａ     

原发性闭角型青光眼患者眼压和血浆心钠素、肾素及血管紧张素Ⅱ相关研究

用放射免疫法测定59例原发性闭角型青光眼（PACG）患者和34例健康人血浆心钠索（ANP）、肾素（RE）和血管紧张素Ⅱ（AT2）水平。结果显示PACG患者ANP水平明显高于健康人，与患者眼压水平呈正相关；患者AT2明显低于健康人，与患者眼压水平呈负相关；患者RE和健康人无差异，与患者眼压水平不相关。     

心钠素对肝硬化患者血浆内皮素血管紧张素Ⅱ的影响

目的：应用外源性心钠素（ANP），观察其对直硬化患者血浆内皮素（ET）、血管紧张素Ⅱ（ATⅡ）等缩血管物质的影响。方法：应用心血通注射液（心钠素）治疗41例肝硬化患者，用放免法分别检测治疗前后血浆ANP、ET、ATⅡ的水平，同时检测20例健康人，结果：肝硬化组比正常组血浆ANP、ET、ATⅡ水平明显升高（P＜0．05），肝硬化患者血浆ANP与ET呈负相关，与ATⅡ无显著相关。外源性心钠素能降低childA级和／或B级ET、ATⅡ的水平（P＜0．05，P＜0．01），对childC级无抑制作用。结论：肝硬化患者血管扩张因子与血管收缩因子之间失衡，促进腹水及门脉高压的形成，外源性心钠素能部分调节它们之间的紊乱关系，对肝硬化失代偿期的治疗有重要价值。     

孤立性心房颤动患者血浆心钠素及血管紧张素Ⅱ浓度的测定及其意义

目的通过测定孤立性房颤患者血浆心钠素(ANP)、血管紧张素Ⅱ(ANGⅡ)的浓度,探讨这两种物质与房颤发生的关系。方法入选病例84例,通过使用放射免疫学方法,测定入选病例外周静脉血浆ANP、ANGⅡ,包括32例孤立性阵发性房颤患者于房颤发作时、终止后7 d及32例孤立性持续性房颤患者,并与20例健康对照组相比较。结果孤立性阵发性房颤患者房颤发作时及终止后7 d、持续性房颤患者血浆ANP、ANGⅡ浓度较正常对照组明显增高(P<0.01);阵发性房颤发作时与终止后1周比较均明显升高,持续性房颤患者血浆ANP及ANGⅡ水平低于阵发性房颤患者房颤发作时(P<0.01)。结论孤立性房颤患者ANP及ANGⅡ水平与房颤发生和持续可能相关。     

心功能不全患儿血浆心钠素与血管紧张素Ⅱ水平的比较及临床意义

了解心脏舒张，收缩功能不全患儿血浆心钠素、血管肾张素Ⅱ、水平有否差异。方法对１２例扩张型心肌病患儿，１０例肥厚型心肌病患儿及２０例健康检检儿检测其血浆ＡＮＰ、ＡｎｇⅡ水平。     

卡维地洛治疗慢性心衰对外周血浆肾素及利钠肽的影响

目的:探讨β-受体阻滞剂卡维地洛治疗慢性心力衰竭时对外周血中血浆肾素活性(PRA)、心钠肽(ANP)及脑钠肽(NBNP)水平的影响.方法:60例慢性心衰患者随机分为常规治疗组(血管紧张素转换酶抑制 利尿剂 地高辛)和卡维地洛组(常规治疗药物 卡维地洛),随访12周,采用放射免疫法测定二组治疗前后和30例健康体检者(正常对照组)外周血中PRA、ANP及N-BNP水平.同时使用核素心室显像测定心衰患者左心室射血分数(LVEF).结果:心衰患者外周血中PRA、ANP及N-BNP水平较正常对照组显著升高,其中ANP及N-BNP水平在卡维地洛治疗前与LVEF负相关,在卡维地洛治疗后与LVEF密切相关,但PRA水平与LVEF无关.治疗后卡维地洛组外周血中PRA、ANP及N-BNP水平较常规治疗组下降更明显.结论:外周血中ANP及N-BNP水平在慢性心衰的病理生理机制中起着重要作用,甚至在β-受体阻滞剂治疗后仍可用于指导心衰患者的治疗.β-受体阻滞剂能抑制心衰患者神经内分泌的过度激活.     

Lack of correlation between the acute haemodynamic response to intravenous captopril and plasma concentrations of angiotensin II in patients with chronic cardiac failure

Summary We have given a series of incremental intravenous injections of captopril to ten patients with chronic cardiac failure.Small doses of captopril produced significant changes in pulmonary artery end-diastolic pressure and right atrial pressure, up to a total cumulative dose of captopril of 2.5 mg, after which further injections had no significant effect. There were large changes in systemic vascular resistance and blood pressure up to a cumulative dose of captopril of 5.0 mg, after which the injection of larger doses caused no further significant changes.Small doses of intravenous captopril produced large increases in plasma renin activity and plasma angiotensin I concentrations up to a total cumulative dose of captopril of 1.25 mg, after which there were no significant further changes in either plasma renin activity or plasma angiotensin I concentration. However the plasma concentration of angiotensin II fell more slowly, no further change being recorded after a total cumulative dose of captopril of 10 mg.These results suggest that plasma renin activity is not the only determinant of plasma angiotensin II concentrations.     

Sequential changes in plasma renin activity and plasma catecholamines in mildly hypertensive patients during acute,furosemide-induced body-fluid loss

Summary To evaluate the role of adrenergic mechanisms in the acute response of renin to furosemide, plasma renin activity (PRA) and plasma catecholamine concentrations were measured for 3 h after i.v. administration of furosemide 1 mg/kg to 8 patients with mild essential hypertension. Furosemide induced a prompt and long-lasting increase in renin, with PRA more than doubled at all times. The increase in PRA within the first 30 min paralleled the peak increases in urinary water and sodium flow rates, and significant decreases in plasma volume and central venous pressure. There was no change in plasma catecholamine concentrations. Plasma noradrenaline was increased significantly at 60 min and adrenaline at 90 min, once furosemide had induced a marked loss of body-fluid and 65% decrease in central venous pressure. Both catecholamines remained elevated until the end of the study, whereas urinary water and sodium flow rates had returned to their pre-treatment values by 150 min. Mean blood pressure was essentially unchanged throughout the study, whereas heart rate increased significantly after 90 min. The findings suggest that in mildly hypertensive patients adrenergic mechanisms are not involved in the initial renin response to furosemide, but they come into play later, probably as a result of reflex sympathetic activation triggered by marked volume depletion.     

Sublingual and oral isoxsuprine in patients with Raynaud's phenomenon

Summary Plasma propranolol steady-state concentrations (Css) were measured in 24 hyperthyroid and 6 hypothyroid patients before and after correction of the thyroid disorder. Following treatment of hyperthyroidism by surgery, antithyroid drugs or radioiodine, there was a significant rise in the plasma propranolol Css in patients receiving propranolol either 160 mg/day, 240 mg/day, or 480 mg/day. In addition, in five patients the area under the plasma propranolol concentration versus time curve during a dosing interval increased significantly from 405 ng/ml/h when hyperthyroid to 778 ng/ml/h when euthyroid. In the hypothyroid patients given propranolol 160 mg/day concomitantly with 1-thyroxine therapy the plasma propranolol Css fell significantly when euthyroid. There was a small but significant increase in the degree of plasma protein binding of propranolol, following treatment of hyperthyroidism and a significant decrease following correction of hypothyroidism. It is concluded that thyroid disorders markedly influence propranolol handling.     

Plasma atrial natriuretic peptide and the renin-aldosterone system during long-term administration of the diuretic xipamide in man

Summary We have studied the effect of xipamide on plasma α-atrial natriuretic peptide and the reninaldosterone-kallikrein system in twelve healthy men, using a double-blind cross-over design. After a run-in period on placebo for 1 week the subjects were treated with either placebo (n=6) or xipamide 20 mg once daily (n=6) for 16 weeks and were then switched to the alternative medication for another 16 weeks. The plasma concentration of α-atrial natriuretic peptide fell after 1 week of xipamide administration and increased during prolonged xipamide administration but remained suppressed. The changes in plasma α-ANP observed after 1 week of xipamide were negatively correlated with the changes in haematocrit and haemoglobin. Plasma renin activity (PRA), aldosterone concentration (PAC), and urinary excretion of aldosterone and kallikrein increased after 1 week of xipamide administration, levelled off during the second and fourth weeks, but remained elevated during further prolonged xipamide administration for 16 weeks. The xipamide-induced changes in PRA and PAC were positively correlated with the changes in the haematocrit and haemoglobin. Our data suggest that the changes in plasma renin, aldosterone, and α-atrial natriuretic peptide during xipamide administration may be related to diuretic-induced volume contraction.     

Aliskiren as a novel therapeutic agent for hypertension and cardio-renal diseases

Objectives High blood pressure (BP) is a major risk factor for cardiovascular and renal complications. A majority of treated hypertensive patients still complain of high BP. The renin‐angiotensin aldosterone system (RAAS) has been a centre‐stage target for all the cardiovascular and cardio‐renal complications. Aliskiren, is the first direct renin inhibitor (DRI) to be approved by the US FDA. Renin controls the rate‐limiting step in the RAAS cascade and hence is the most favorable target for RAAS suppression. Key findings This review article strives to summarize the pharmacokinetic, preclinical and clinical studies done so far pertaining to the efficacy of aliskiren. Further, the pharmacology of aliskiren has been comprehensively dealt with to enhance understanding so as to further research in this unfathomed area in the multitude of cardiovascular disorders and renal diseases. Summary Aliskiren has been shown to have comparable BP‐lowering effects to other RAAS inhibitors. Recent clinical trials have indicated that it might contribute significantly in combination with other agents for the protection of end‐organ diseases.     

Pharmacokinetics of theophylline in hyperthyroid and hypothyroid patients with chronic obstructive pulmonary disease

Summary The pharmacokinetics of theophylline was investigated in five hyperthyroid, five hypothyroid, and five euthyroid patients, all with chronic obstructive pulmonary disease. Wide individual variability was found in theophylline kinetics, but the rate of elimination of theophylline was significantly higher in hyperthyroid, and lower in hypothyroid patients than in the euthyroid patients (k_el=0.155, 0.060 and 0.107 h^–1, respectively). The values for clearance and volume of distribution were not consistently changed compared with those in the euthyroid group, although all the parameters except AUC were significantly different in hyperthyroid and hypothyroid patients. There was a positive correlation between both thyroxine and triiodothyronine serum concentrations and total body clearance of theophylline (r=0.795 and r=0.791, respectively). It is concluded that in spite of the wide interindividual variability and the relatively small differences in the pharmacokinetics of theophylline in thyroid dysfunction compared with the euthyroid status, these differences have to be considered in certain clinical situations, as they may require changes in the therapeutic regimen for administration of theophylline in hyperthyroid or hypothyroid patients.