静滴L-精氨酸对原发性高血压影响的研究

The Effect of L Arg Administration on Essential Hypertension

从血流动力学及神经内分泌学两方面探讨左旋精氨酸（Ｌ－Ａｒｇ）－一氧化氮（ｎｉｔｒｉｃｏｘｉｄｅ，ＮＯ）通路对原发性高血压的影响。方法２６例高血压病人分为两组，一组静滴Ｌ－Ａｒｇ，一组静滴生理盐水，观察其血压、心率及心功能的变化，同时检测血中ＮＯ、ｃＧＭＰ、肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）以探讨其降压机理。结果在Ｌ－Ａｒｇ静注期间，病人血压下降，心率增快，心输出量（ＣＯ）、每搏输出量（ＳＶ）、射血分数（ＥＦ）增加，总外周阻力（ＴＰＲ）降低，ＮＯ的标志物ｃＧＭＰ升高。而在滴注６０＇时，随着ｃＧＭＰ浓度的降低，ＣＯ、ＳＶ、ＥＦ也随之降低，而ＴＰＲ复又回升。Ｅ、ＮＥ、Ｎｉｔｒｉｔｅ及Ｎｉｔｒａｔｅ在静滴前后无显著性改变。结论Ｌ－Ａｒｇ通过使ｃＧＭＰ浓度升高，引起明显的血流动力学改变；Ｌ－Ａｒｇ可能抑制血压过低所致的反应性Ｅ及ＮＥ的升高作用。

Aim\ To investigate the effect of L arginine administration on patients with essential hypertension.\ Methods\ Hemodynamic parameters,neuroendocrine hormones and indicators of nitric oxide(NO) were measured.Twenty six essential hypertensive patients(EH) were studied. Of which,13 received L arg administration. The remaining 13 received normal saline as placebo.\ Results\ In the L arg administration group arterial pressure decreased,heart rate increased,cardial output(CO)、systolic volume(SV) and eject fraction(EF) increased,total peripheral resistance(TPR) decreased.The cGMP as indicator of NO release increased simultaneously during administration.But at 60 min after, with the decreasing of cGMP concentration,SBP、DBP increased, HR decreased. CO、SV and EF decreased,TPR increased.\ E and NE,rather than increase in response to L arginine induced hypotension as expected,showed no significant changement.\ Nitrite and nitrate showed no significant changement also.\ Conclusion\ (1) Exogenous L-arginine produces a vasodilatory effect by increasing NO production,causing the fall of blood pressure,increase in CO and other hemodynamic function;(2)It suppressed the hypotension induced increasing of E and NE.