对高血压患者静脉注射L-精氨酸的观察

The Change of Endothelical Function in Early Hypertension and its Linkage to L Arginine NO Pathway

目的：探讨内皮细胞（ Ｅ Ｃ）在原发性高血压（ Ｅ Ｈ）发病中的作用，以及 Ｌ精氨酸一氧化氮途径（ Ｌ Ａｒｇ Ｎ Ｏ）与高血压早期 Ｅ Ｃ功能之间的关系。方法：检测比较１１ 例正常血压健康者和１４例 Ｅ Ｈ 患者血浆中血管活性物质水平，并观察比较静脉注射 Ｌ Ａｒｇ（３００ ｍ ｇ／ｋｇ）对平均动脉压、心率及肾脏血流动力学的影响。结果： Ｅ Ｈ 组血浆环磷酸鸟苷（ｃ Ｇ Ｍ Ｐ）及亚硝酸盐（ Ｎ Ｏ２－ ）水平低于正常组（ Ｐ＜ ０．０５）；两组的血浆内皮素（ Ｅ Ｔ）水平无显著性差异。注射 Ｌ Ａｒｇ 后，两组的平均动脉压下降，心率及血浆ｃ Ｇ Ｍ Ｐ水平提高，肾图高峰时间提前。两组的血浆 Ｎ Ｏ２－ 、 Ｅ Ｔ水平，肾小球滤过率在注射前后无显著性差异。结论：提示 Ｅ Ｈ 早期即存在 Ｅ Ｃ功能的改变，且可能以 Ｅ Ｃ依赖性舒张功能的损害为主； Ｌ Ａｒｇ Ｎ Ｏ途径的异常可能是 Ｅ Ｃ依赖性舒张功能损害的重要环节；体内 Ｌ Ａｒｇ 缺乏并非 Ｅ Ｈ Ｌ Ａｒｇ Ｎ

Objective:To probe into the role of endothelium in pathogenesis of hypertension and the relationship between L arginine nitric oxide pathway and endothelial function in early hypertension.Methods:Fourteen patients with mild essential hypertension and 11 age matched normotensive controls were studied by detecting their plasma levels of guanosine 3′、5′ cyclic monophosphate (cGMP),nitrite (NO 2 -) and endothelin (ET) and observing the effect of L arginine hydrochloride (300 mg/kg i.v.) on systemic and renal hemodynamics.Results:Compared with the control subjects,the mild hypertensive patients had reduced plasma levels of cGMP and NO 2 - ( P <0.05),and there was no difference in ET levels between the two groups.After administration of L arginine,mean arterial pressure (MAP) decreased ( P <0.05),peak time of renogram shortened ( P <0.05),heart rate and plasma cGMP level increased ( P <0.05) respectively while glomerular filtration rate,plasma NO 2 - and ET levels had no change in the two groups.Conclusion:The abnormality of L arginine nitric oxide pathway may have potential relevance to the endothelial dysfunction.