原发性高血压病人醛固酮逃逸现象及螺内酯的干预研究

The Aldosterone Escape in Essential Hypertension and the Interference with Spirolactone

目的探讨原发性高血压病人使用血管紧张素抑制剂(ACEI)依那普利治疗后所并发的醛固酮(Ald)逃逸现象,并观察联合使用醛固酮受体拮抗剂螺内酯后的效果。方法65例原发性高血压病人使用依那普利治疗,分别于治疗前及治疗后1个月、3个月、6个月采血检测血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)浓度,根据治疗3个月时的Ald浓度,判断有无并发Ald逃逸,对有Ald逃逸者,联合使用螺内酯3个月,观察其治疗效果。结果依那普利治疗后1个月AngⅡ、Ald与治疗前相比均下降,但3个月时,AngⅡ有所升高,Ald明显增高,65例中有28例并发Ald逃逸,发生率约43%,并发Ald逃逸的28例病人使用螺内酯3个月后,AngⅡ、Ald均有所下降,但并未达到有统计学意义。结论原发性高血压病人长期(3个月以上)使用ACEI后部分病人会出现Ald逃逸现象,ACEI联合使用螺内酯可能会改善Ald逃逸现象。

Objective To investigate aldosterone escape during angiotensin - converting enzyme inhibitor （ACEI） therapy in patients （pts） with essential hypertension （EH）, and to observe the effects of aldosterone antagonist- spirolactone combined with ACEI on aldosterone escape. Methods Sixty - five pts with EH were treated with ACEI - enalapril. Plasma angiotensin Ⅱ（Ang Ⅱ ） and aldosterone （Aid） concentrations were measured by radioimmunoassay following the therapy at 1, 3, 6 months respectively, Aidosterone escape was estimated by the plasma Aid level after 3 months treatment. Spirolactone was given for 3 months to pts with aldosterone escape. Results Following the treatment of enalapril for 1 month, the plasma Ang Ⅱ and Aid concentrations decreased. But following the treatment for 3 months, the plasma Ang Ⅱ levels increased slightly, the plasma Aid levels increased significantly. Aidosterone escape was observed in 28 pts after 3 months treatment of enalapril. The incidence of aldosterone escape was 43 %. Following the treatment with spironlactone for 3 months, the plasma Ang Ⅱ and Aid concentrations decreased in 28 pts with aldosterone escape, but there were no difference. Conclusion Aidosterone escape may occur during ACEI therapy in some of EH patients. Aidosterone antagonist - spirolactone combined with ACEI may be useful for aldosterone escape in pts with EH.