老年危重病人血管紧张素Ⅱ与醛固酮的分离现象及其临床意义

Clinical significance and dissociation of angiotensin Ⅱ and aldosterone in the aged critical patients

目的 探讨老年危重病人中血管紧张素Ⅱ (AⅡ )与醛固酮 (ALD)的分离现象及其临床意义。方法 以放射免疫法测定老年和非老年危重病人 (A组和B组 )、老年及非老年健康人 (C组及D组 )血中皮质醇 (COR)、AⅡ和ALD的浓度。结果 ①A、B组的COR、AⅡ均显著高于对照组 (C、D组 ,P <0 0 1) ;而A组ALD的浓度 (195 44± 5 2 83pmol/L)显著低于C、D组 (P <0 0 1)和B组 (2 30 5 4± 44 44pmol/L ,P <0 0 5 )。②A组发生低ALD率为 5 0 % (15 / 30 ) ,高于B组的 2 4% (6 / 2 5 ) (P <0 0 5 ) ;高ALD率两组差异不显著 (P >0 0 5 )。③在 2 1例低ALD患者中 ,老年危重病人ALD浓度显著低于非老年危重病人 (P <0 0 1)。④老年低ALD患者合并休克 (86 6 7% )、MODS (73 33% )和病死率 (6 6 6 7% )均分别高于非老年低ALD的 33 33%、 16 6 7%和 16 6 7% (P <0 0 5或P <0 0 1)。结论 老年危重病人中AⅡ -ALD分离现象并非少见 ,且病情严重 ,预后差 。

Objective To research clinical significance and dissociation of angiotensin Ⅱ(AⅡ) and aldosterone(ALD) in the aged critical patients.Methods Plasma levels of cortisol (COR)、AⅡ and ALD were measured by radioimmunoassay in aged and non-aged critical patients group A and group B, in aged and non-aged healthy persons group C and group D.Results ①The COR and A Ⅱ concentrations of group A、B in critical patients were significantly higher than those of group C and group D in normal subjects (all P <0 01).The COR and AⅡ were not significantly difference among group A、B(all P >0 05) The plasma ALD in group A(195.44±52.83 pmol/L)was obviously lower than that in group C and group D (234 50±36 63 pmol/L )( P <0 01) and lower than that in group B(230 54±44 44 pmol/L( P <0 05).②The lower ALD rate in group A(50%,15/30) was obviously higher than that in group B(24%,6/25)( P <0 05).The higher ALD rate in group A(10%,3/30) was not significantly difference than that in group B(32%,8/25) ( P >0 05).③Among 21 cases of lower ALD,the ALD in aged critical patients were 154 82±36 77 pmol/L,it was significantly lower than that under 60 years old critical patients (194 11±32 60 pmol/L) ( P <0 01). ④The shock rate (86 67%)、MODS rate (73 33%) and death rate (66 67%) in lower ALD of the aged critical patients were obviously higher than those (33 33%、16 67%、16 67%)in lower ALD under 60 years critical patients ( P <0 05 or P <0 01). Conclusions It is not a little that dissociation of AⅡ and ALD in the aged critical patients.There were the severity of disease,severe prognosis,higher complications and higher death rate in dissociation of AⅡ and ALD in the aged critical patients.The mechanism and clinical significance of dissociation of AⅡ and ALD in the aged critical patients were briefly discussed.