ACEI/ARB对糖尿病肺病的影响

近年来,糖尿病肺部病变越来越受到关注。研究发现糖尿病患者存在肺通气功能障碍、弥散功能障碍,易于发生肺纤维化、合并感染等。这主要与糖尿病时炎症介质的参与,ACE基因存在插入多态性,氧化应激损伤和抗氧化失衡等有关。目前研究发现血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）对糖尿病肺炎、慢性阻塞性肺疾病、肺间质纤维化等肺损伤有保护作用,这可能与ACEI具有调节免疫反应、减轻细胞因子水平、抗氧化应激损伤等机制有关。     

波立维联合ARB治疗糖尿病肾病的临床疗效及对患者尿蛋白影响

目的:探讨波立维联合及血管紧张素II受体拮抗剂(AngiotensinⅡreceptor blockers,ARB)治疗糖尿病肾病的临床疗效及对患者尿蛋白水平的影响。方法:选取我院近3年收治的116例糖尿病肾病患者,按照数字随机表法将其分为研究组和对照组,每组各58例。对照组在常规治疗基础上给予ARB治疗,研究组在对照组的基础上给予波立维联合ARB治疗,两组患者均连续治疗4周,检测和比较两组治疗前后血清肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)、白细胞介素-6(Interleukine,IL-6)和转化生长因子-β1 (Transforming growth factor-beta1,TGF-β1)、肌酐(Serum creatinine,SCr)、尿微量蛋白(Urinary microalbumin,U-malb)、24 h尿白蛋白定量(Albumin,Alb)、24 h尿蛋白排泄率(Urinary albumin excretion rate,UAER)、血液流变学指标红细胞刚性指标(Erythrocyte deformation index,TK)、纤维蛋白原(Plasma viscosity,PF)、血浆黏度(Plasma viscosity,PV)的变化情况及治疗期间不良反应的发生情况。结果:治疗后,研究组血清TNF-α、IL-6、TGF-β1、U-malb、Alb、UAER、TK、PF和PV水平均明显低于对照组(P0.05);两组不良反应发生率对比无统计学差异(P0.05)。结论:波立维联合ARB治疗糖尿病肾病有利于减轻炎性反应,改善患者肾脏血流动力学和肾功能,且安全性高。     

血管紧张素转换酶抑制剂和醛固酮受体阻断剂对钙超载大鼠心功能的影响

目的:观察血管紧张素转换酶抑制剂(ACEI)和醛固酮(ALDO)受体阻断剂(spironolactone,安体舒通)对钙超载大鼠心功能的影响,以探讨钙超载引起心功能降低和心肌损伤的机制。方法:维生素D3加尼古丁诱导心肌钙超载,放射免疫法测定心肌组织AngⅡ和ALDO含量,Powerlab仪测定心功能,原子吸收测定心肌和血管钙含量,生化法测定心肌MDA和conjugated diene变化,自动生化分析仪测定血浆LDH和CPK含量。结果:心肌钙超载后,心肌和血管钙含量较对照组分别增加3.2和5.8倍,LVdp/dtmax和LVdp/dtmin分别降低27%和34%,LVESP和LVEDP增加42%和32%;心肌MDA和conjugated diene增加22%和68%;血浆LDH和CPK增加4.5和3.1倍(均P<0.01)。运用ACEI和ALDO受体阻断剂可缓解上述指标变化,与钙超载组相比,心肌钙含量分别低44%和39%,主动脉钙含量也低57%和34%,MDA低20%和30%,conjugated diene低44%和35%,LDH、CPK分别减少28%和34%、20%和27%(均P<0.01)。结论:心肌钙超载可以导致心功能下降和心肌损伤,运用ACEI和ALDO受体阻断剂可以减轻心肌钙超载和改善心功能,心肌损伤程度减轻。     

活血化瘀方对糖尿病模型大鼠糖脂代谢、血管内皮生长因子和血管紧张素II1型受体表达的影响

目的:探讨活血化瘀方对糖尿病模型大鼠糖脂代谢、血管内皮生长因子(VEGF)和血管紧张素Ⅱ1型受体(AT1R)表达的影响。方法:选取健康雄性SD大鼠50只,适应性喂养7 d后以随机数字表法分成对照组10只、模型组13只、中药组14只、西药组13只。其中模型组与对照组予以纯净水灌胃,中药组予以活血化瘀通络中药配方颗粒灌胃,西药组则予以厄贝沙坦灌胃,1次/d,连续灌胃16周。分别比较各组大鼠的糖脂代谢指标水平及24 h尿蛋白定量、糖化血红蛋白、血清肌酐水平,并检测肾组织VEGF和AT1R表达情况。结果:模型组、中药组、西药组大鼠空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平均高于对照组,中药组、西药组大鼠LDL-C水平低于模型组,中药组大鼠FBG水平低于模型组与西药组(P0.05)。模型组、中药组、西药组大鼠24 h尿蛋白定量与糖化血红蛋白均高于对照组,中药组、西药组大鼠24 h尿蛋白定量低于模型组(P0.05)。模型组、中药组、西药组大鼠VEGF、AT1R水平均高于对照组,中药组、西药组大鼠VEGF、AT1R水平低于模型组,中药组大鼠AT1R水平低于西药组(P0.05)。结论:活血化瘀方可有效改善糖尿病大鼠糖脂代谢状态,通过抑制VEGF与AT1R的表达水平,延缓糖尿病的发生与发展。     

卡托普利对急性缺血心肌早期室性心律失常的影响

目的:观察卡托普利对急性心肌缺血早期在体电生理指标的改变,探讨卡托普利对急性心肌梗塞(AMI)早期心律失常的影响。方法:采用S1-S2程控电刺激方法同时测定无心肌缺血对照组(假手术对照组)、AMI早期缺血组(AMI组)和用卡托普利(浓度0.1mg·kg-1·min-1)灌流AMI早期缺血的卡托普利组对家兔心室易损期(VVP)、室颤阈(VFT)、舒张阈(DT)、有效不应期(ERP)、T波顶点与VVP外缘处的时间关系(TT-VVP)等电生理指标。结果:VVP、VFT、DT、ERP和TT-VVP在假手术对照组与AMI组和卡托普利组比较均有显著差异(P<0.01),AMI组与卡托普利组比较亦有显著差异(P<0.01),相对于假手术对照组,AMI组VVP延长,VFT和DT降低,ERP缩短,心室易损期外缘向T波方向延伸增加;相对于AMI组,卡托普利组早期VVP缩短,VFT相对升高,ERP相对延长,心室易损期外缘向T波方向延伸相对减少。结论:卡托普利对急性心肌梗塞早期室性心动过速和/或心室颤动的产生有抑制作用。     

吗啡和血管紧张素II对大鼠脑突触小体Ca^2＋摄取的拮抗效应

Behavioral observations have repeatedly shown that the analgesic effect of morphine can be antagonized by intracerebroventricular injection of angiotensin I (A I), although mechanisms underlying the action were obscure. Since a prevention of Ca2+ uptake into the nerve terminals was considered as one of the mechanisms for morphine analgesia, we examined the effect of A I and morphine on the 45Ca uptake by rat brain synaptosomal preparations. Morphine of 10(-8)-10(-6) mol/L produced a dose-related suppression on synaptosomal 45Ca uptake, which was completely reversed by the opioid antagonist naloxone of 10(-6) mol/L. A I of 10(-8)-10(-6) mol/L, on the contrary, enhanced 45Ca uptake. This effect was totally abolished by saralasin, a A I antagonist, at 10(-6) mol/L. When synaptosomal preparations were incubated in a mixture of morphine (10(-6) mol/L) and A I (10(-8)-10(-6) mol/L), the effect of morphine was almost completely reversed. The results suggest that the distinct effect of A I may account for, at least in part, the antagonistic effect of A I on morphine analgesia.     

高血压患者严重急性呼吸综合征冠状病毒2型的易感性和血管紧张素转换酶抑制剂用药探讨

严重急性呼吸综合征冠状病毒2型(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)引起的2019冠状病毒病(coronavirus disease 2019,COVID-19)呈现出两个高比例态势,一是病毒感染者合并高血压比例较高;二是合并高血压的病毒感染者发展为重症和危重病例的比例高。这提示病毒感染与高血压之间存在密切联系,因此对高血压患者这一特殊群体的合理用药提出了需求。本文通过分析血管紧张素转换酶 2(angiotensin converting enzyme 2,ACE2),即SARS-CoV-2的功能性受体与ACE之间的平衡关系,探讨高血压与病毒易感性之间的联系,以及高血压人群罹患COVID-19可能的发病规律。由于高血压群体中,血管紧张素转换酶抑制剂(angiotensin converting enzyme inhibitors, ACEI)的应用占有重要地位,本文从药理学和病原学角度进行分析,对该人群病毒感染前后的高血压用药给出指导建议,以供临床参考。     

AT2R载体可调控表达对大鼠颈动脉损伤后骨桥蛋白及新生内膜增生的影响

目的:血管紧张素Ⅱ 2型受体(AT2R)基因转染的骨髓间充质干细胞(MSC)在四环素可调控系统下作为载体,利用计算机图像分析系统研究新生内膜增生的情况,并探讨AT2R在体可调控表达对大鼠颈动脉损伤后骨桥蛋白(OPN)表达影响。方法:利用球囊损伤60只SD大鼠颈动脉,并随机将SD大鼠分为5组,分别为正常组(未行球囊扩张术)、对照组(球囊扩张术后注入PBS)、MSC组(球囊扩张术后注入常规MSC)、MSC转染组(球囊扩张术注入转染AT2R的MSC)、强力霉素(Dox)组(球囊扩张术后注入转染AT2R的MSC,术后当天至处死前三天通过尾静脉注射Dox 100μg/kg/d)。术后14及28天分别处死大鼠取材,光镜下观察血管内膜增生情况,Image pro plus 6.0计算机图像分析系统测量新生内膜面积(I/M),逆转录-多聚酶链反应(RT-PCR)检测AT2R及OPN在大鼠血管标本中的表达变化。结果:大鼠颈动脉AT2R在Dox组的表达显著增高,新的增生内膜面积较其它各损伤组显著降低(P≤0.01),并且OPN的表达显著低于其他各手术组。结论:AT2R基因在体可调控表达受到Dox的有效控制,AT2R基因可能抑制血管损伤后OPN的表达及新生内膜的过度增生。     

血管紧张素II 1型受体相关蛋白研究进展

血管紧张素Ⅱ(angiotensin Ⅱ,AngⅡ)作为肾素-血管紧张素系统(renin-angiotensin system,RAS)的关键效应因子,与血管紧张素Ⅱ1型受体(angiotensin Ⅱ type 1 receptor,AT1R)结合后,在体内发挥维持体液及电解质平衡、收缩血管、调节血压,促进心肌、肾近端小管以及血管平滑肌细胞增殖,参与肿瘤的发生发展、血管形成和转移等重要作用。最新研究发现,AT1R相关蛋白特异性作用于AT1R蛋白的碳末端,通过调节受体的内化、细胞膜的再通和受体的敏感性对其表达进行控制,发挥相应的生物学作用。本文的重点在于对AT1R相关蛋白的研究进展进行综述,阐述不同AT1R相关蛋白在RAS系统中所起的作用,为RAS系统的进一步研究提供依据。     

血管紧张素转换酶2-血管紧张素1-7-Mas轴对血管作用的研究进展

血管紧张素转换酶2（ACE2）和Mas受体的发现使人们对肾素-血管紧张素（RAS）有了更全面的认识。ACE2可水解血管紧张素Ⅰ和血管紧张素Ⅱ直接或间接生成血管紧张素1-7（Ang 1-7）,并与高血压的形成密切相关。Ang 1-7主要通过Mas受体引起血管舒张、抑制细胞增殖。ACE2-Ang1-7-Mas轴的发现为RAS的研究、高血压等心血管疾病的防治和新药开发提供了新的思路和方向。     

In vivo imaging of oxidative stress in the kidney of diabetic mice and its normalization by angiotensin II type 1 receptor blocker

This study was undertaken to evaluate oxidative stress in the kidney of diabetic mice by electron spin resonance (ESR) imaging technique. Oxidative stress in the kidney was evaluated as organ-specific reducing activity with the signal decay rates of carbamoyl-PROXYL probe using ESR imaging. The signal decay rates were significantly faster in corresponding image pixels of the kidneys of streptozotocin-induced diabetic mice than in those of controls. This technique further demonstrated that administration of angiotensin II type 1 receptor blocker (ARB), olmesartan (5 mg/kg), completely restored the signal decay rates in the diabetic kidneys to control values. In conclusion, this study provided for the first time the in vivo evidence for increased oxidative stress in the kidneys of diabetic mice and its normalization by ARB as evaluated by ESR imaging. This technique would be useful as a means of further elucidating the role of oxidative stress in diabetic nephropathy.     

七氟烷对糖尿病心肌缺血/再灌注损伤的影响

糖尿病是一种常见病、多发病,严重威胁着人类的健康。现已明确,糖尿病是冠心病发病的一个重要因素。心肌缺血/再灌注(ischemia/reperfusion,I/R)损伤是临床常见的病理过程,同时是冠心病发病及心肌血运重建治疗过程中的核心环节,如何减轻I/R损伤一直是国际研究热点之一。糖尿病与I/R损伤对心肌都有损害作用,相关研究证明糖尿病能够进一步恶化I/R损伤对心肌的损伤作用。研究表明,缺血预处理(ischemia preconditioning,IPC)可以延缓或减轻心肌I/R损伤,同时,麻醉药预处理(anesthetic induced preconditioning,APC)也具有IPC样的心肌保护作用。其中,七氟烷作为现阶段临床较常用的吸入麻醉药,同样对心肌I/R损伤具有保护作用。本文就七氟烷对糖尿病心肌I/R损伤的影响及其机制做一综述。     

汉族人群中血管紧张素转换酶抑制剂所致咳嗽与血管紧张素转换酶基因及缓激肽β2受体基因多态性的关系冰

目的：探讨汉族人群中血管紧张素转换酶抑制剂（ACEI）所致咳嗽与血管紧张素转换酶（ACE）基因及缓激肽β2受体（BDK-RB2）基因多态性的关系。方法：应用聚合酶链反应（PCR）方法。检测汉族人群中151例由于服用ACEI引起的咳嗽患者及151例未发生咳嗽的患者的ACEI／D及BDKRB2C／T的多态性,并采用紫外法检测ACE活性。结果：发现ACE基因分布在咳嗽组中II型为47．0％,ID型为42．4％,DD型为10．6％;无咳嗽组分别为39．7％、47．0％、13.3％,两组相比其差异具有统计学意义（P〈0．01）;BDKRB2基因分布在咳嗽组中CC型为21．3％,CT型为50．0％,TT型为28．7％,无咳嗽组分别为22．5％、47．7％、29．8％。两组相比其差异无统计学意义（P〉0．05）;咳嗽组ACE活性水平为[（28．3±10．1）U／L]明显低于无咳嗽组[（40．2±9．4）U／L],两组相比其差异具有统计学意义（P〈0．01）。结论：汉族人群中ACEI所致咳嗽与ACE基因多态性及血清ACE水平有关,BDKRB2C／T与咳嗽间未发现有统计学意义的关联。     

Disruption of the kinin B1 receptor gene affects potentiating effect of captopril on BK-induced contraction in mice stomach fundus

A transgenic mouse model, deficient in kinin B₁ receptor (B₁^−/−) was used to evaluate the role of B₂ receptor in the smooth muscle stomach fundus. The results showed that the potency of bradykinin (BK) to induce contraction in the gastric tissue was maintained whereas the efficacy was markedly reduced. The angiotensin converting enzyme (ACE) inhibitor captopril potentiated BK-induced effect in wild type (WT) but not in B₁^−/− fundus. However, ACE activity detected by the convertion of Ang I to Ang II was inhibited by captopril in both types of gastric tissues. Taking into account the hypothesis that captopril and ACE bind to the B₂ receptor, we suggest that this complex was not formed in the stomach deficient in B₁ receptor. Therefore, our finding strongly support the hypothesis that in smooth muscles that constitutively express the kinin B₁ and B₂ receptors, an interaction between captopril and ACE, B₁ and B₂ receptors should occur forming a complex protein interaction for the potentiating effect of ACE on kinin receptors.     

糖尿病与肺功能的关系及相互影响机制

糖尿病是一种影响多器官的疾病,其并发症包括糖尿病肾病、糖尿病神经病变、糖尿病视网膜病变以及心血管病变等.由于吸入性胰岛素的使用,越来越多的人开始关注糖尿病和肺功能之间的关系以及糖尿病与肺功能损害相互影响的机制.糖尿病患者普遍存在肺功能降低,肺功能降低或可导致易患糖尿病,其相互影响机制可能与低氧血症、系统性炎症反应、胰岛素抵抗相关.长期有效的血糖控制、低氧运动和高压氧疗对改善糖尿病患者胰岛素抵抗和肺功能均有良好的作用,但更多的机制和干预方法尚待进一步研究.本文拟对糖尿病与肺功能的关系及相互影响的机制做一综述.     

The levels of renin-angiotensin related components are modified in the hippocampus of rats submitted to pilocarpine model of epilepsy

We previously showed that patients with temporal lobe epilepsy (TLE) present an increased expression of angiotensin II (AngII) AT1 and AT2 receptors in the hippocampus, supporting the idea of an upregulation of renin-angiotensin system (RAS) in this disease. This study aimed to verify the relationship between the RAS and TLE during epileptogenesis. Levels of the peptides angiotensin I (AngI), angiotensin II (AngII) and angiotensin 1-7 (Ang 1-7), were detected by HPLC assay. Angiotensin AT1 and AT2 receptors, Mas mRNA receptors and angiotensin converting enzyme (ACE), tonin and neutral endopeptidase (NEP) mRNA were also quantified at the hippocampus of Wistar rats by real time PCR, during acute (n=10), silent (n=10) and chronic (n=10) phases of pilocarpine-induced epilepsy. We observed an increased peptide level of Ang1-7 into acute and silent phases, decreasing importantly (p≤0.05) in the chronic phase, suggesting that AngI may be converted into Ang 1-7 by NEP, which is present in high levels in these periods. Our results also showed increased peptide level of AngII in the chronic phase of this model. In contraposition, the ACE expression is reduced in all periods. These data suggest that angiotensinogen or AngI may be cleaved to AngII by tonin, which showed increased expression in all phases. We found changes in AT1, AT2 and Mas mRNA receptors levels suggesting that Ang1-7 could act at Mas receptor during the silent period. Herein, we demonstrated for the first time, changes in angiotensin-related peptides, their receptors as well as the releasing enzymes in the hippocampus of rats during pilocarpine-induced epilepsy.     

The study of renin–angiotensin–aldosterone in experimental diabetes mellitus

It is generally accepted that hypertension and other vascular pathologies increase in diabetes mellitus (DM) patients as a result of the renin–angiotensin–aldosterone (RAA) system. In this study, changes in the renin‐angiotensin‐aldosterone (RAA) system level was determined in Streptozotocin (STZ)‐injected rats. A total of 46 female Wistar albino rats (180–220 g body weight) was utilized in these experiments. STZ was given intraperitoneally to induce diabetes in rats. Streptozotocin (60 mg kg⁻¹ body weight) was dissolved in 0·1 m citrate–‐phosphate buffer (pH 4–5). The non‐diabetic rats were injected with sterilized buffer alone to act as a control group. Blood glucose levels were 398±8·2 mg dl⁻¹, 488±11·75 mg dl⁻¹ and 658±29·6 mg dl⁻¹ at days 3, 12 and 30 respectively. The level of plasma renin activity (PRA) was measured as 7·69±1·07 ng ml⁻¹ h⁻¹; 1·82±0·22 ng ml⁻¹ h⁻¹ and 0·67±0·12 ng ml⁻¹ h⁻¹ at days 3, 12 and 30, respectively. These values showed that the PRA levels are decreased with increased time period. Serum angiotensin converting enzyme (ACE, E.C. 3.4.15.1) levels were increased at days 12 and 30 (p<0·05 and p<0·005), whereas serum aldosterone levels were increased at days 3 and 12 (p<0·05). The level of urea and creatinine increased at days 12 and 30 (p<0·05 and p<0·005, respectively) when compared to the control group. The data from these experiments indicate that the PRA level decreased whereas ACE activity level increased in diabetic rats compared with the control. Aldosterone levels increased at the first stage of the experiment, but then decreased by the end of the experiment as a result of changes in renin and ACE levels. Copyright © 1999 John Wiley & Sons, Ltd.     

Angiotensin II type 1 (AT1)-receptor blocker prevents impairment of endothelium-dependent cerebral vasodilation by acute cigarette smoking in rats

Our aim was to test for smoking-induced endothelial dysfunction in rat cerebral vessels, then to evaluate the effect of valsartan [angiotensin II type I (AT1)-receptor blocker] on that impairment. In pentobarbital-anesthetized, mechanically ventilated Sprague-Dawley rats, we used a cranial window preparation to measure changes in pial vessel diameters following topical applications of acetylcholine (Ach) (before and after smoking or intravenous nicotine infusion; n = 6 in each group), and adenosine (n = 6 for before and after smoking). Then, after intravenous valsartan pretreatment we reexamined the pial vasodilator response to topical Ach (before and after cigarette smoking). Under control conditions, cerebral arterioles were dilated by 6.9 +/- 4.2% and 13.6 +/- 4.8% by topical Ach (10(-6) M and 10(-5) M, respectively) and by 6.4 +/- 2.5% and 12.2 +/- 3.1% by topical adenosine (10(-5) M and 10(-4) M, respectively). One hour after a 1-min inhalation of mainstream smoke (1-mg nicotine cigarette), 10(-5) M Ach constricted cerebral arterioles (-4.4 +/- 4.1%), while 10(-4) M adenosine dilated them by 13.4 +/- 3.4%. One hour after a 1-min nicotine infusion (0.05 mg), 10(-5) M Ach dilated cerebral arterioles by 9.9 +/- 2.4%. Thus, vasodilator response to topical Ach was impaired after smoking, whereas that to adenosine was unaffected. However, the vasodilator response to Ach was unaffected by intravenous nicotine. Valsartan prevented smoking from impairing Ach-induced vasodilation. In conclusion, acute single-cigarette smoking causes a dysfunction of endothelium-dependent, but not endothelium-independent, vasodilation of rat cerebral vessels in vivo, and the effect was not mimicked by intravenous nicotine. AT1-receptor blockade prevented the above smoking-induced impairment of endothelium-dependent vasodilation.