原发性高血压患者盐敏感机制的探讨  

Study of the mechanism of "salt-sensitivity" in essential hypertension

作　　者：赵光胜[1] 李迪元[1] 孔德汶[1] 王政[1] 陈贤妙 黄友文[1] 曹素玲 董寿祺[1] ■庆祥 

机构地区：[1]上海第二医科大学上海市高血压研究所

出　　处：《中国病理生理杂志》1990年第6期502-505,共4页Chinese Journal of Pathophysiology

摘　　要：48例原发性高血压(EH)患者于快速静注生理盐水1000ml后及口服速尿40mg后二小时内舒张压分别升、降≥10mmHg的盐敏感患者,探索血压调控激素、红细胞膜结构及离子转运功能机制。发现:(1)约50%患者对负荷盐升压及(或)削减钠(Na)降压敏感。(2)在盐升压组速尿有效的9例血浆类地高辛物质(EDLS)较无效的4例高,(P<0.05);EDLS/心房肽(ANP)也较高(P<0.05);在盐不升压组速尿有效的11例负荷盐水期尿Na排量低于无效的14例(P<0.05),提示速尿有效的存在潴Na、容量扩张倾向。(3)在盐升压的速尿有效组红细胞内向Na“漏”较无效的高(P<0.05);在盐不升压的速尿有效组在盐水负荷前后膜芘I^m/I^e(322nm、272nm时)均较无效的低(P<0.01),血浆醛固酮(PA)也较低(P<0.05)。(4)在速尿有效组盐升压的9例负荷盐水后PA较不升压的11例高(P<0.05),负荷盐水期尿Na排量也偏高(P=0.05),在速尿无效组盐升压的4例内向Na“漏”较盐不升压的14例高(P<0.01)。以上提示红细胞膜功能与结构改变和血压调控激素的平衡失调和盐敏感机制有关。The mechanisms of the blood-pressure (BP)-modulating hormones and erythrocyte membrane structure and cation transport function were studied in 48 cases with essential hypertension(EH), taking an increase of DBP≥10 mmHg to rapid iv infusion of 1000 ml normal saline load or a decrease of DBP≥10 mmHg to 40 mg oral dose of lasix (a loop diuretics) within 2 hours as the standards of the'salt sensitivity'. Results showed:(1) About a half of the patients was sensitive to the salt-loading and (or) depletion of sodium (Na) by lasix. (2) The plasma endogneous digoxin-like substance (EDLS) level and (EDLS)/(atrial natriuretic peptide (ANP)) ratio were higher in saline pressor with lasix effective 9 cases than that in uneffective 4 cases. Urinary Na output in saline non-pressor with lasix effective 11 cases were less than that in unefective 14 cases. (3)Erythrocyte inward Na 'leak' in saline pressor with lasix effective was higher than that in uneffective, P<0.05; the membrane pyrene I^m/I^c (322nm, 272nm)before and after saline-loading in saline non-pressor with lasix effectivive were lower than that in uneffective. (4) PA after saline-loading in lasix effective with saline pressor 9 cases was higher than that in 11 non-pressor cases. Urinary Na output during saline-loading also more. Inward Na'leak' in lasix uneffective with saline pressor 4 cases was higher than that in 14 nonpressor cases. These results indicated that a change of the structure and functions of erthrocyte membrane and an imbalance of BP-modulating hormones might be implicated in the mechanisms of 'salt-sensitivity', and the mechanisms underlying the salt pressor and lasix effective possibly were in the opposite.

关 键 词：高血压 盐类 激素类 生物运输 

分 类 号：R544.1[医药卫生—心血管疾病]