原发性高血压患者血浆肾上腺髓质素水平变化意义的研究

目的探讨肾上腺髓质素(ADM)在原发性高血压(EH)的病理生理作用.方法在大鼠离体主动脉血管条上观察ADM与血管紧张素Ⅱ(ATⅡ)释放的相互影响.同时观察EH患者治疗前、后ADM的变化.结果大鼠离体主动脉血管组织中ADM、ATⅡ释放存在着相互影响;ATⅡ增加大鼠离体主动脉血管条ADM的分泌,ADM则抑制ATⅡ的释放.EH患者血浆ADM水平较正常对照组升高,有显著性差异(P<0.05);且与血浆ATⅡ水平、平均动脉压、动脉舒张压呈显著正相关.药物治疗后,伴随平均动脉压和血浆ATⅡ降低,ADM水平亦有不同程度的下降,尤以服用巯甲丙脯酸治疗后ADM改变更为明显,有显著性差异(P<0.05).结论血压和ATⅡ可能与ADM的分泌及(或)合成有关,EH患者血浆ADM水平升高可能是机体的代偿反应.药物治疗后的不同反应与药物的特性有关.

Significance of Adrenomedullin in Essential Hypertension

Objective: To investigate pathophysiological function of adrenomedullin (ADM)in patients with essential hypertension (EH). Methods: The relationship between ADM and angiotensin II (AT H )was investigated in isolated aortic tissue in Wistar rats.The plasma level of ADM in the patients with EH was measured before and after treatment. Results: The release of ADM and AT II influenced each other. AT II increased the secretion of ADM and ADM inhibited the release of AT II in the aortic tissue of the rats.The plasma level of ADM in the patients was significantly higher than that of the controls (p < 0.05). It was positively correlated with the plasma level of AT II , mean blood pressure and diastolic blood pressure (r = 0.4701, p<0.01,0.4357,p<0.05 and 0.5508, p< 0.01) respectively. After treatment with captopril and nifedipine the decrease of plasma level of ADM was ac-companied by the decrease of AT II and MBP in various degree, espe- cially in patients with captopril treatment (p<0.05). Conclusion: Blood pressure and ATII may be associated with the secretion and/or synthesis of ADM.The increased plas- ma ADM in EH patients may be a compensating reaction.The different effects of treatment may result from the nature of the drugs.