卡托普利对高血压病及非胰岛素依赖型糖尿病患者运动血压及微蛋白尿的短期作用

Acute effect of captopril on microalbuminuria and blood pressure after exercise in normotensive NIDDM and essential hypertensive patients

对血压正常的非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者１４例（ＮＩＤＤＭ组）、高血压病（ＥＨ）患者１２例（ＥＨ组）、ＥＨ合并ＮＩＤＤＭ患者１２例（ＥＨ并ＮＩＤＤＭ组）给予卡托普利口服２５ｍｇｂｉｄ，在１ｄ半内共服３次，服药前后做踏车运动试验测定血压、心率、尿白蛋白排泄率（ｕＡＥＲ）及尿转铁蛋白排泄率（ｕＴＥＲ），并以１０例正常人作对照（对照组）。结果：①服卡托普利后ＥＨ组血压明显下降，ｕＡＥＲ及ｕＴＥＲ无明显改变，而ＥＨ并ＮＩＤＤＭ组却相反；②运动状态下，三组患者服卡托普利后尿白蛋白均明显下降，但与血压互不相关；③ＥＨ组服药后，运动血压有所下降，但血压变化的绝对值服药前后相似；④血压正常的ＮＩＤＤＭ组运动后血压明显升高，服药后这种异常消失。提示：①运动状态下，早期ＥＨ和ＮＩＤＤＭ有不同的病理生理机理，似乎糖尿病更依赖于肾素－血管紧张素系统，卡托普利有较好的疗效。②对于正常血压、尿白蛋白（－）的ＮＩＤＤＭ患者，运动激发是观察尿白蛋白及血压改变的灵敏方法，若被运动激发，应当考虑给予卡托普利治疗。

The effects of captopril on blood pressure(BP),urinary excretion of microalbumin (uAER and uTER) after exercise were determined in 12 patients with essential hypertension(EH group).14 with normotensive NIDDM(NIDDM group)、12 with hypertensive NIDDM (EH and NIDDM group)and 10 normal subjects. Bicycle ergometer test was performed before and after receiving captopril(three doses of 25mg in 24 hours). The results showed:(1) After receiving captopril,the reduction on BP was significant(P<0.05), but the 24 hour urinary albumin excretion was not reduced significantly in EH group. In contrast,no change of BP occurred,but microalbuminurea decreased significantly in NIDDM group(P<0. 05). (2)Although captopril decreased microalbuminurea significantly in all the three groups compared with normal subjects,these changes occurrd,indenpendently of the changes in BP. (3) In EH group,captopril seemed to reduce maximal BP during exercise,but the exercise-induced absolute changes were similar as before captopril administration. Howerer,these changes were decreased significantly in both NIDDM group and EH and NIDDM group.(4)Obvious increase in BP was found during exercise in NIDDM group. But these changes were not significant after captopril administration compared with nomal subjects. The above results suggest:(1)The patho-physiological mechanism involved in EH or NLDDM may be different.The NIDDM patient seems related more with renin-angiotensin system.(2) The induction of microalbuminuxia and rising of BP in nomotensive NIDDM patient may be indicated for captopril therapy.