AⅡ受体拮抗剂与ACEI对慢性肾衰患者血浆ANF及RAS的影响

The Effects of ACE Inhibitor and Angiotensin II Receptor Antagonist on Atrial Natriuretic Factor and Renin-angiotensin System in Patients' Plasma with Chronic Renal Failure

目的 了解血管紧张素Ⅱ受体拮抗剂 (ATRA)和转换酶抑制剂 (ACEI)对慢性肾衰 (CRF)高血压患者血浆心钠素 (ANF)和肾素 血管紧张素系统 (RAS)的影响。方法 受试者口服氯沙坦 (Los组 )或福辛普利 (Fos组 )连续 12周 ,于治疗前和治疗后第 4、8及 12周测定坐位舒张压 (SiDBP)、血清尿素氮 (BUN)、血清肌酐 (SCr)、ANF、血管紧张素Ⅰ (AⅠ )和血管紧张素Ⅱ (AⅡ )。用SPSS 7.0软件作统计分析。结果 经 12周治疗 ,两组患者SiDBP均降至目标值。Fos组 :与治疗前比较 ,AⅡ下降 ,ANF和Scr升高 (P <0 .0 1)。Los组 :AⅡ明显升高 (P<0 .0 1) ,ANF在短暂升高后降至治疗前水平 ,Scr无变化。结论 ACEI可能对CRF高血压患者肾内灌注压有影响 ,ANF动态改变可作为肾内灌注压变化的指标之一。ATRA对肾内灌注压影响小于ACEI。

Objective To investigate the effects of angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor antagonist (ATRA) on atrial natriuretic factor (ANF) and renin angiotensin system (RAS) in patients with chronic renal failure (CRF). Methods The plasma angiotensin Ⅰ (AI), angiotensin Ⅱ (AII) and ANF levels were determined in 30 healthy volunteers and 40 patients with CRF after administration of losartan (Los) 50 mg once daily or fosinopril (Fos) 10 mg once daily in 0?4?8 and 12 weeks. Sit diastolic blood pressure (SiDBP) and blood urea nitrogen (BUN) and serum creatinine (SCr) were also measured at the same time. The data were analyzed by statistical software SPSS 7.0 . Results After 12 weeks, the levels of SiDBP were significantly decreased in both Los and Fos groups. In Fos group, aII was significantly inhibited, ANF and Scr were significantly increased ( P <0.01). In Los group, aII was significantly increased ( P <0.01), ANF reduced to normal level after it was increased at fourth week. SCr didn't increase. Conclusion There are significant effects of ACEI on intrarenal perfusion pressure. The change in ANF level may be used as a parameter for the effects. There are less effects of ATRA on intrarenal perfusion pressure than ACEI.