充血性心衰患者肾素—血管紧张素—醛固酮系统的活性

Activity of Renin Angiotensin Aldosterone System in Heart Failure Patients with Different Levels of Blood Pressure

目的 为探讨不同血压水平的充血性心力衰竭 (CHF)患者体内肾素—血管紧张素—醛固酮系统(RAAS)的活性为临床应用提供依据。方法 运用放免法测定血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )及醛固酮 (ALD)水平 :①A组 (n =2 2 )收缩压 (SP)小于 10 0mmHg的患者 ;②B组 ,(n =2 5 )sp >10 0mmHg的CHF患者。③健康人 (对照组健康人 (n =18) 90mmHg <SP <140mmHg。结果 A组及B组血浆PRA、AngⅡ和ALD均明显高于对照组(P小于 0 0 5～ 0 0 1) ,A组血清钠、SP及脉压 收缩压显著低于B组 (P小于 0 0 5～ 0 0 1) ;CHF患者脉压 收缩压与血浆AngⅡ及ALD呈显著负相关 (r =- 0 .5 0 1p <0 .0 1;r =- 0 .439p <0 .0 1)。结论 提示CHF患者体内RAAS活性增高 ,且sp <10 0mmHg者较sp >10 0mmHg者更高。

Objective To investigate the activity of renin angiotensin aldosterone system(RAAS) in the congestive heart failure (CHF) patients with different levels of systolic blood pressure so to provide the basis for clinical treatment of such patients.Methods The plasma renin activity(PRA).angiotensin Ⅱ(AngⅡ) and aldosterone (ALD) levels were quantitatively determined by radioimmunoassay in CHF patients with systolic pressure(SP)<100mmHg before treatment (group A, n=22),also in those with SP>100mmHg before treatment (group B, n=25) and in healthy individuals (control group,n=18) with 90mmHg<SP<140mmHg.Results The PRA.plasma AngⅡ and ALD levels were significantly increased both in group A and B patients than those in control group.(P<0.05～0.01).The serum Na +,SP and Pulse pressure/SP ratio in group A were apparently lower than those in control group (P<0.05～0.01).While PRA,plasma Ang.Ⅱ and ALD level in group A were remarkedly higher than those in group B(P<0.05～0.01),and the serum Na +,SP and pulse pressure/SP ratio in group A were remarkedly lower than those in group B (P<0.05～0.01).The pulse pressure/SP ratio was correlated negatively with plasma Ang Ⅱ and ALD with r=-0.501 (p<0.01) and -0.439(p<0.01) respectively in patients with CHF.Conclusion It revealed that the RAAS activity in patients with CHF was significantly increased and the activity in patients with SP<100mmHg was increased more than patients with SP>100mmHg.The clinical application of ACEI and anti ALD agents for treatment of CHF patients with different levels of SP was discussed.