螺内酯的降血压作用与血浆醛固酮肾素比值的关系探讨  被引量:5

Study of the relationship between the depressurization of aldosterone antagonists and plasma aldosterone renin activity ratio(ARR) in refractoriness hypertension patients

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作  者:吴小庆[1] 薄小萍[1] 高运来[1] 顾向红[1] 王强[1] 邓燕芳[1] 

机构地区:[1]无锡市人民医院心内科,江苏无锡214023

出  处:《临床心血管病杂志》2010年第9期686-689,共4页Journal of Clinical Cardiology

基  金:2007年江苏省卫生厅课题资助项目(No:H200765)

摘  要:目的:研究在治疗顽固性高血压患者中醛固酮拮抗剂螺内酯的降压疗效与血浆醛固酮/肾素比值(ARR)的关系,及对原发性醛固酮增多症(原醛)的诊断及鉴别诊断价值。方法:10例血压正常人与55例顽固性高血压患者入选,在清晨平卧时抽取空腹血后静脉快速注射速尿40mg,注射后10min,30min,各抽血1次查血浆醛固酮(ALD)及肾素(PRA)水平,并计算出ARR。后患者口服非洛地平缓释片10mgqd2周,效果不理想加服贝那普利10mgqd2周,如效果仍不理想,再加上螺内酯20mgbid4周,观察血压下降的程度与ARR的关系。结果:正常血压组的ARR为8.18,静脉注射速尿后,PRA迅速上升,P<0.01,而ALD上升不明显,致ARR下降。在按治疗反应分组观察中发现,加螺内酯组的空腹ARR较不加螺内酯组为高(15.1±2.16:7.7±2.1),但2组比较无明显差异,P>0.05。在应用速尿静脉注射后2组ARR的差别进一步增大,10min时为(25.2±5.23:5.5±1.13),30min时为(27.3±6.46:6.53±1.8),差异有统计学意义,P<0.01。结论:正常人和原发性高血压患者静脉注射速尿可快速激发PRA和ALD的增加,PRA以10min时最为明显,ALD以30min为明显,ARR有所下降。顽固性高血压患者经一般降压治疗疗效不佳而加用醛固酮拮抗剂螺内酯后血压下降明显,应考虑有原醛可能,静脉注射速尿激发试验测定ARR对原醛的诊断有一定的帮助。Objective:To study the relationship between the depressurization of aldosterone antagonists and plasma aldosterone renin activity ratio(ARR)before and after furosemide intravenous injection in refractoriness hypertension patients.And to study the value of diagnosis and differential diagnosis of primary aldosteronism by the plasma aldosterone renin ratio(ARR).Method:The 10normotension and 55refractoriness hypertension cases were examined the change of ALD,PRA and ARR before and after10min,30min by furosimide 40mg intravenous injection supine in the early morning hours.After that these cases took orally Felodipine Sustaind-released Tablets 10mg qd for 2w,if the blood pressure was still high,added Benazepril 10mg qd for another 2w,if the blood pressure was still high,superadded spironolactone 20mg bid for 4weeks,observed the relationship between the ARR and the change of the blood pressure.Result:In normotension persons the ARR is 8.18,after furosemide 40mg iv,the PRA rose quickly,P0.01.But the ALD did not rose obviously,so the ARR descended.According to groups by therapeutic reaction to spironolactone we found that the ARR was higher in plus spironolactone group than no spironolactone group before furosemide 40mg iv,(15.1±2.16:7.7±2.1),but there was no obvious difference between the two groups.After furosemide 40mg iv,ARR in 10min was 25.2±5.23:5.5±1.13,in 30min was 27.3±6.46:6.53±1.8,the difference between two groups increased further,P0.01.Conclusion:Injecting furosemide 40mg by vein in both groups(normotension and hypertension)can stimulate the increase of ALD and PRA quickly,the peak in PRA is 10min,in ALD is 30min,but ARR decrease on the contrary.In refractoriness hypertension cases if the effect of treatment is not ideal by common medicine but obviously descend after using aldosterone antagonists,we should think over it maybe primary aldosteronism aldosteronism.The provocation testing of furosemide injecting by vein is helpful to diagnosis the primary aldosteronism by the c

关 键 词:高血压 醛固酮拮抗剂 螺内酯 血浆醛固酮/肾素活性比值 速尿静脉注射激发试验 原发性醛固酮增多症 

分 类 号:R544.1[医药卫生—心血管疾病]

 

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