高血压患者血管活性物质水平变化及雷米普利干预的影响

目的 :本研究主要了解原发性高血压 (EH)不同时期血浆肾上腺髓质素N端 2 0肽 (PAMP)、内皮素 (ET)、血管紧张素Ⅱ (AⅡ )、肾上腺素 (E)和去甲肾上腺素 (NE)浓度变化及雷米普利对其影响。方法 :40例EH患者应用雷米普利治疗前后和 2 0例正常对照组检测上述血管活性物质水平 ,血浆PAMP、ET和AⅡ的放免活性用放射免疫法测定 ,血浆E和NE浓度用高压液相法测定。结果 :EH患者不同时期血浆PAMP、ET、AⅡ、E和NE水平均明显高于对照组 (P <0 0 5～ <0 0 1) ;并随病期进展而增加(P均 <0 0 5 ) ;与平均动脉压 (MAP)均呈正相关 (r =0 431、0 82 1、0 76 2、0 46 7、0 473,P <0 0 5～ <0 0 0 1) ;PAMP与ET、AⅡ、E、NE水平亦有良好的相关性 (r =0 5 31、0 5 2 4、0 40 1、0 42 5 ,P <0 0 5～ <0 0 1) ;雷米普利治疗 4周 ,血压下降同时伴血浆血管活性物质浓度改变。结论 :高血压的发生和发展与上述缩血管活性物质水平变化有关 ;舒血管肽PAMP浓度升高是维持机体内环境稳定的一种代偿性保护机制 ;雷米普利在降压同时能改变其血管活性物质浓度水平

Changes of plasma vasoactive substances in hypertensive patients and its effects on ramipril treatment

Objective:This study is to measure the levels of plasma proadrenomedullin N-terminal 20 peptide(PAMP),endothelin(ET),angiotensin Ⅱ(AⅡ),epinephrine(E) and norepinephrine(NE) in essential hypertension(EH) and to investigate the changes of these vasoactive substances after ramipril treatment.Method:The levels of plasma vasoactive substances were determined in 40 EH patients and 20 normal subjects before and after ramipril treatment.The plasma concentrations of PAMP,ET and AⅡ were measured by radioimmunoassay,E and NE were measured by high performance liquid choromagraphy (HPLC).Results:The levels of PAMP,ET,AⅡ,E and NE in patients with mild and moderate hypertension were significantly higher than that in control groups (P<0.05～<0.01) and was increased with the clinical stages or severity of the disease (P<0.05).The levels of PAMP,ET,AⅡ,E and NE were positively correlated with mean artery pressure (MAP) (r=0.431、0.821、0.762、0.467、0.473，P<0.05～<0.001);the plasma levels of PAMP were also positively correlated with ET,AⅡ,E and NE(r=0.531、0.524、0.401、0.425，P<0.05～<0.01).Ramipril decreased hypertension and changed levels of these vasoactive substances.Conclusion:The data suggest vasoconstrictive substance is the main factor causing hypertensive;PAMP is a vasodilator peptide.The change of PAMP may be the compensatory mechanism by which maintains the stability of the internal environment in the organism.Ramipril can control hypertension and changes the levels of PAMP,ET,AⅡ,E and NE.