苯那普利对高血压病患者肾功能储备的影响

The Effects of Benazepril on Renal Functional Reserve of Patients with Essential Hypertension

目的:研究血管紧张素转化酶抑制剂(ACEI)苯那普利对原发性高血压(EH)患者肾功能储备(RFR)的影响。方法:对27例EH患者采血、留尿后,2h内滴注复方氨基酸500mL。1h后再抽血、留尿,测定氨基酸负荷前后的血肌酐、尿肌酐并计算肌酐清除率(Ccr),测定血、尿中一氧化氮(NO)。给予苯那普利10～30mg/d治疗2月,2个月后再次给予氨基酸负荷,测定氨基酸负荷前后的Ccr,血、尿中NO。结果:(1)在未给苯那普利治疗之前,氨基酸负荷后,Ccr明显增加,血、尿中NO明显增加。(2)苯那普利治疗2月后,血压明显下降,血、尿中NO明显增加。(3)苯那普利治疗2月后,再次给予氨基酸负荷时,Ccr增加不明显,血、尿中NO增加不明显。结论:(1)NO在不影响全身血压变化的情况下,可能参与了氨基酸诱导的超滤作用。(2)苯那普利的降压作用可能与NO有关。(3)苯那普利降低了高血压患者的肾功能储备,推测是由于苯那普利治疗后,使得NO水平增加,肾小动脉舒张,从而使得肾小动脉对随后的氨基酸输注缺乏反应性。

Objective： To study the effects of benazepril（ACEI） on renal functional reserve（RFR） of patients with essential hypertension （EH）. Methods： Twenty-seven patients with EH had blood-drawing and urine specimens then five hundred mL amino acid solution was infused within two hours. The blood and urine samples were collected again one hour after infusing. Serum creatinine （Scr）,urinary creatinine（Ucr）, creatinine clearance rate（Ccr）, serum nitric oxide （NO） and uringary NO were measured before and after amino acid loading. These patients were treated with benazepril, 10-30mg per day for two months. After finishing therapy, amino acid loading was administered again then Ccr and serum NO,urinary NO were measured before and after amino acid loading. Results： （1）Ccr, serum NO,urinary NO increased markedly after amino acid infusion without benazepril therapy. （2）Blood pressure decreased markedly and serum NO,urinary NO increased after two month-treatment of benazepril. （3）Ccr, serum NO,urinary NO had no significant changes after amino acid loading two months post-treatment of benazepril therapy. Conclusion： （1）NO may be involved in ultrafiltration effect induced by amino acid without influencing BP. （2）The role that benazepril decrease BP may be related with NO. （3）Benazepril can decrease renal functional reserve of patients with EH. Presumably, the treatment of benazepril increases NO level and dilates the arterioles at the glomeruli thereby makes it unresponsive to subsequent amino acid infusion. The renal protective effect of angiotensin converting enzyme inhibitors（ACEI） may be attributed to a reduction of glomeruli hyperfiltration induced by protein-rich meals.