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中国医师杂志 2009年第6期11卷 854-855页

作者：林勇戴福仁应卫星李荣洲林讷浙江省瑞安市温州医学院附属第三医院消化内科浙江瑞安325200

目的探讨普萘洛尔治疗肝硬化腹水疗效及其可能机制。方法选择70例乙肝后肝硬化并腹水患者，在护肝、利尿等治疗基础上，随机分成2组，每组各35例，普萘洛尔组（治疗组）与对照组，对比观察治疗前后2组尿量变化、腹水消退情况及血浆肾素... 详细信息

目的探讨普萘洛尔治疗肝硬化腹水疗效及其可能机制。方法选择70例乙肝后肝硬化并腹水患者，在护肝、利尿等治疗基础上，随机分成2组，每组各35例，普萘洛尔组（治疗组）与对照组，对比观察治疗前后2组尿量变化、腹水消退情况及血浆肾素活性（PRA）、血管紧张素Ⅱ（AⅡ）、醛固酮（ALD）水平。结果治疗组血浆PRA、AⅡ、ALD水平明显下降，与同组治疗前及对照组治疗前后比较，差异有统计学意义（P〈0．05）。治疗组24h尿量较对照组有明显增加（P〈0．05），腹水治疗有效率差异有统计学意义（P〈0．05）。结论在常规治疗基础上加用普萘洛尔治疗肝硬化腹水，能有效促进腹水消退，缩短腹水治疗时间。同时可抑制肾素-血管紧张素-醛固酮系统（RAAS）活性，避免因利尿诱发RAAS过度激活。

关键词：普萘洛尔/治疗应用肝硬化/并发症/药物疗法腹水/并发症/药物疗法肾素-血管紧张素系统/药物作用

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The renin-angiotensin system influences ocular endothelial cell proliferation in diabetes - Transgenic and interventional studies

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AMERICAN JOURNAL OF PATHOLOGY 2003年第1期162卷 151-160页

作者： Moravski, CJ Skinner, SL Stubbs, AJ Sarlos, S Kelly, DJ Cooper, ME Gilbert, RE Wilkinson-Berka, JL Univ Melbourne Dept Physiol Parkville Vic 3010 Australia St Vincents Hosp Dept Med Fitzroy Vic 3065 Australia Austin & Repatriat Med Ctr Dept Med Heidelberg West Australia

Neovascularization in the retina and iris of diabetic patients is a major cause of severe visual loss. However, study of these lesions is compromised by the lack of a comparable diabetic rodent model. Because the vasoactive and angiogenic agent, angiotensin H, is involved in diabetic microvascular disease, we aimed to determine whether endothelial cell proliferation could be induced in the retinae and irides of hypertensive transgenic (mRen-2)27 rats that display an enhanced extra-renal renin-angiotensin system (RAS), including the eye. Six-week-old Ren-2, spontaneously hypertensive, and Sprague-Dawley rats received either streptozotocin or control vehicle and were studied for 36 weeks. Additional nondiabetic and diabetic Ren-2 rats were treated throughout with the angiotensin-converting enzyme inhibitor lisinopril (LIS) (10 mg/kg/day in drinking water). Endothelial cell proliferation was only observed in retinae and irides of diabetic Ren-2 rats and was reduced with LIS. In diabetic Ren-2, vascular endothelial growth factor (VEGF) and VEGFR-2 mRNA were increased in retinae and irides and reduced with US. Diabetes activated ocular renin in Ren-2 but not Sprague-Dawley rats. The diabetic Ren-2 rat is a model of intraocular endothelial cell proliferation that can be attenuated by RAS blockade via VEGF-dependent pathways. RAS blockade is a potential treatment for vision-threatening diabetic microvascular complications.

关键词：血管紧张素转换酶抑制药/药理学动物基因修饰慢性病糖尿病实验性/化学诱导糖尿病实验性/并发症糖尿病实验性/病理学糖尿病视网膜病变/病因学糖尿病视网膜病变/病理学疾病模型动物内皮生长因子/遗传学内皮生长因子/代谢内皮血管/药物作用内皮血管/代谢内皮血管/病理学眼/代谢眼/病理学杂合子原位杂交胞间信号肽类和蛋白质类/遗传学胞间信号肽类和蛋白质类/代谢虹膜/血液供给虹膜/药物作用虹膜/病理学赖诺普利/药理学淋巴因子/遗传学淋巴因子/代谢 RNA 信使/代谢大鼠近交SHR 大鼠 Sprague-Dawley 肾素/遗传学肾素/代谢肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学视网膜/药物作用视网膜/病理学链脲菌素血管内皮生长因子A 血管内皮生长因子受体2/遗传学血管内皮生长因子受体2/代谢血管内皮生长因子类动物女(雌)性大鼠

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Systemic and renal effects of atrial natriuretic peptide in patients with heart failure treated with angiotensin-converting enzyme inhibitor or in acute saline solution loading

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AMERICAN HEART JOURNAL 2001年第3期141卷 422-427页

作者： Tomiyama, H Watanabe, G Abe, M Okazaki, R Yoshida, H Doba, N Teikyo Univ Div Cardiol Ichihara Hosp Chiba 2990111 Japan Teikyo Univ Div Endocrinol Ichihara Hosp Dept Internal Med 3 Chiba 2990111 Japan

Background Our purpose was to study the effects of atrial natriuretic peptide (ANP) on cardiorenal functions when it is used to manage patients with heart failure who are receiving an angiotensin-converting enzyme inhibitor (ACEI) or in acute saline solution loading. Methods seventeen patients with mild to moderate heart failure were entered into protocol 1 or 2. Protocol 1 was ANP (30 ng/kg/min) infused before and after treatment with ACEi (n = 9). Protocol 2 was acute saline loading with or without coadministration of ANP (n = 8). In both protocols cardiorenal hemodynamics and urinary sodium excretion were assessed before and after each intervention. Results Protocol 1: Although ANP infusion significantly increased urinary sodium excretion to a similar extent before and after ACEI treatment, the infusion increased the glomerular filtration rate (75 +/- 16 --> 82 +/- 15 mL/min, P < .05) and renal blood flow (390 +/- 123 --> 438 +/- 140 mL/min, P < .05) only before ACEI treatment. Protocol 2: Acute saline solution loading decreased plasma renin activity (P<.05) but did not affect ANP level. Coadministration of ANP with saline solution load enhanced the increase of urinary sodium excretion (75% +/- 34% increase) compared with the acute saline solution load alone (49% +/- 33% increase) (P.05) but had no affect on renal hemodynamics. Conclusions When ANP is used in patients with mild to moderate heart failure who are on combined ACEi treatment or in acute saline solution loading, the vasodilatory effect of ANP is blunted while the natriuretic effect of ANP is preserved. The renin-angiotensin system seems to modulate the vasodilatory effect of ANP.

关键词：血管紧张素转换酶抑制药/治疗应用心钠素/药理学交叉研究肾小球滤过率/药物作用心脏/药物作用输注静脉内肾/药物作用微循环肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学钠/尿血管舒张/药物作用成年人老年人女(雌)性人类男(雄)性中年人

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Blockade of the renin angiotensin system in heart failure: the potential place of angiotensin II receptor blockers

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EUROPEAN HEART JOURNAL 2000年第1期21卷 14-16页

作者： Van Veldhuisen, DJ Voors, AA Univ Groningen Hosp Thoraxctr Dept Cardiol Utrecht Netherlands Diakonessehuis Utrecht Netherlands

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High dose angiotensin-converting enzyme inhibition prevents fluid volume expansion in heart transplant recipients

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第2期36卷 487-+页

作者： Braith, RW Mills, RM Wilcox, CS Mitchell, MJ Hill, JA Wood, CE Univ Florida Ctr Exercise Sci Coll Hlth & Human Performance Gainesville FL 32611 USA Univ Florida Dept Med Gainesville FL 32611 USA Univ Florida Dept Physiol Gainesville FL 32611 USA Cleveland Clin Cleveland OH 44106 USA Georgetown Univ Med Ctr Dept Med Washington DC 20007 USA

OBJECTIVES We sought to test the hypothesis that plasma Volume (PV) expansion in heart transplant recipients (HTRs) is caused by failure to reflexively suppress the renin-angiotensin-aldosterone (RAA) axis. BACKGROUND Extracellular fluid volume expansion occurs in clinically stable HTRs who become hypertensive. We have previously demonstrated that the RAA axis is not reflexively suppressed by a hypervolemic stimulus in HTRs. METHODS Plasma volume and fluid regulatory hormones were measured in eight HTRs (57 +/- 6 years old) both before and after treatment with captopril (225 mg/day). Antihypertensive and diuretic agents were discontinued 10 days before. The HTRs were admitted to the Clinical Research Center (CRC), and, after three days of a constant diet containing 87 mEq/day of Na+, PV was measured by using the modified Evans blue dye dilution technique. After approximately four months (16 +/- 5 weeks), the same HTRs again discontinued all antihypertensive and diuretic agents;they were progressed to a captopril dose of 75 mg three times per day over 14 days, and the CRC protocol was repeated. RESULTS Captopril pharmacologically suppressed (p < 0.05) supine rest levels of angiotensin II (-65%) and aldosterone (-75%). The reductions in vasopressin and atrial natriuretic peptide levels after captopril did not reach statistical significance. The PV, normalized for body weight (ml/kg), was significantly reduced by 12% when the HTRs received captopril. CONCLUSIONS Extracellular fluid volume is expanded (12%) in clinically stable HTRs who become hypertensive. Pharmacologic suppression of the RAA axis with high-dose captopril (225 mg/day) returned HTRs to a normovolemic state. These findings indicate that fluid retention is partly engendered by a failure to reflexively suppress the RAA axis when HTRs become hypervolemic. (C) 2000 by the American College of Cardiology.

关键词：血管紧张素转换酶抑制药/药理学卡托普利/药理学交叉研究心脏移植/副作用心脏移植/生理学血流动力学/药物作用肾/药物作用血浆容量/药物作用肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学心室功能左/药物作用人类男(雄)性中年人

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Effect of cortisol on blood pressure and the renin-angiotensin system in fetal sheep during late gestation

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JOURNAL OF PHYSIOLOGY-LONDON 2000年第1期526卷 167-176页

作者： Forhead, AJ Pipkin, FB Fowden, AL Univ Cambridge Dept Physiol Cambridge CB2 3EG England Univ Nottingham Queens Med Ctr Dept Obstet & Gynaecol Nottingham NG7 2UH England

1. The effects of cortisol on blood pressure and the circulating components of the renin-angiotensin system (RAS) were investigated in sheep fetuses during late gestation and after exogenous cortisol infusion. 2. Plasma cortisol concentration was greater in fetuses at 140 +/- 1 days of gestation (term 145 +/- 2 days) compared to those studied earlier in gestation (128 +/- 1. days), although, because of wide inter-animal variation, no differences were observed in Mood pressure or plasma angiotensin II (AII), renin or angiotensinogen (Ao) concentrations. 3. At 129 +/- 1 days of gestation, an infusion of cortisol for 5 days (2-3 mg kg(-1) day(-1) I.V) increased plasma cortisol concentration to a value normally seen close to term. This rise in plasma cortisol was accompanied by increases in blood pressure and plasma concentrations of AII, renin and Ao. 4. When observations from all fetuses were considered, plasma cortisol concentration cor related with plasma AII and renin, and blood pressure correlated with plasma cortisol and AII concentrations. 5. Intravenous administration of an AII type 1 (AT(1))-specific receptor antagonist (3 mg kg(-1) GR138950) caused a reduction in blood pressure in all fetuses;the hypotensive response was greatest in fetuses studied near term and in the cortisol-treated fetuses. Overall, the magnitude of the hypotension induced by GR138950, and the concomitant rise in plasma renin, both correlated with the plasma cortisol concentration before GR138950 treatment. 6. These findings show that, in the sheep fetus during late gestation, the RAS becomes more important in the maintenance of resting blood pressure when plasma cortisol concentration is elevated, whether endogenously or exogenously.

关键词：血管紧张素Ⅱ/血液血管紧张素受体拮抗剂抗高血压药/投药和剂量苯呋喃类/投药和剂量血压/药物作用血压/生理学用药计划表胎儿/代谢孕龄氢化可的松/投药和剂量氢化可的松/血液输注静脉内受体血管紧张素 1型受体血管紧张素 2型肾素/血液肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学绵羊/胚胎学绵羊/代谢动物

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Vasopeptidase inhibitors:: clinical implications of a new class of drugs

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DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT 2000年第16期125卷 499-503页

作者： Quaschning, T Corti, R Ruschitzka, FT Noll, C Lüscher, TF Univ Zurich Hosp Abt Kardiol & Kardiovaskulare Forsch CH-8091 Zurich Switzerland Univ Zurich Irchel Inst Physiol CH-8057 Zurich Switzerland

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Fibrinolytic actions of ACE inhibitors:: a significant plus beyond antihypertensive therapeutic effects

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CARDIOVASCULAR RESEARCH 2000年第4期47卷 642-644页

作者： Dézsi, L Gedeon Richter Chem Works Ltd Dept Vasc Pharmacol Pharmacol & Drug Safety Res H-1475 Budapest 10 Hungary

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Angiotensin II receptor blockers: Review of the binding characteristics

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第10A期84卷 3S-8S页

作者： Siragy, H Univ Virginia Hlth Syst Dept Med Div Endocrinol & Metab Charlottesville VA 22908 USA

Several angiotensin II receptor blockers (ARBs), including candesartan cilexetil, irbesartan, losartan, telmisartan, and valsartan, are currently approved by the US Food and Drug Administration (FDA) for the treatment of patients with hypertension. These agents share a common mechanism of action-antogonism of the angiotensin type 1 (AT(1)) receptor-and as a result, they block a number of angiotensin II effects that are relevant to the pathophysiology of cardiovascular disease, including vasoconstriction, renal sodium reabsorption, aldosterone and vasopressin secretion, sympathetic activation, and vascular and cardiac hyperplasia and hypertrophy. Unlike the angiotensin converting enzyme (ACE) inhibitors, these new drugs block the effects of angiotensin II regardless of whether it is produced systemically in the circulation or locally via ACE- or non-ACE-dependent pathways in tissues. ARBs also block the angiotensin II-induced feedback regulation of renin release, resulting in an increase in angiotensin II levels. With the AT(1) receptor blocked, angiotensin II is available to activate the angiotensin type 2 (AT(2)) receptor, which mediates several potentially beneficial effects in the cardiovascular system, including vasodilation, antiproliferation, and apoptosis. Thus, ARBs provide a highly selective approach for regulating the effects of angiotensin II.. (C) 1999 by Excerpta Medico, Inc.

关键词：血管紧张素Ⅱ/拮抗剂和抑制剂抗高血压药/治疗应用高血压/药物疗法蛋白质结合/药物作用受体血管紧张素 1型受体血管紧张素 2型受体血管紧张素/拮抗剂和抑制剂肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学信号传导/药物作用人类

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Adenosine causes the release of active renin and angiotensin II in the coronary circulation of patients with essential hypertension

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1677-1684页

作者： Virdis, A Ghiadoni, L Marzilli, M Orsini, E Favilla, S Duranti, P Taddei, S Marraccini, P Salvetti, A Univ Pisa Dept Internal Med I-56100 Pisa Italy CNR Inst Clin Physiol I-56100 Pisa Italy

OBJECTIVES The aim of the study was to evaluate whether adenosine infusion can induce production of active renin and angiotensin II in human coronary circulation. BACKGROUND Adenosine can activate angiotensin production in the forearm vessels of essential hypertensive patients METHODS In six normotensive subjects and 12 essential hypertensive patients adenosine was infused into the left anterior descending coronary artery (1, 10, 100 and 1,000 mu g/min x 5 min each) while active renin (radioimmunometric assay) and angiotensin II (radioimmunoassay after high performance liquid chromatography purification) were measured in venous (great cardiac vein) and coronary arterial blood samples. In five out of 12 hypertensive patients adenosine infusion and plasma samples were repeated during intracoronary angiotensin-converting enzyme inhibitor benazeprilat (25 mu g/min) administration. Finally, in adjunctive hypertensive patients, the same procedure was applied during intracoronary sodium nitroprusside (n = 4) or acetylcholine (n = 4) RESULTS In hypertensive patients, but not in control subjects, despite a similar increment in coronary blood flow, a significant (p < 0.05) transient increase of venous active renin (from 10.7 +/- 1.4 [95% confidence interval 9.4 to 11.8] to a maximum of 13.8 +/- 2.1 [12.2 to 15.5] with a consequent drop to 10.9 +/- 1.8 [9.7 to 12.1] pg/ml), and angiotensin II (from 14.6 +/- 2.0 [12.7 to 16.5] to a maximum of 20.4 +/- 2.7 [18.7 to 22.2] with a consequent drop to 16.3 +/- 1.8 [13.9 to 18.7] pg/ml) was observed under adenosine infusion, whereas arterial values did not change. Calculated venous-arterial active renin and angiotensin II release showed a strong correlation (r = 0.78 and r = 0.71, respectively;p < 0.001) with circulating active renin. This adenosine-induced venous angiotensin II increase was significantly blunted by benazeprilat. Finally, both sodium nitroprusside and acetylcholine did not affect arterial and venous values of active r

关键词：乙酰胆碱/药理学腺苷/药理学血管紧张素Ⅱ/血液血管紧张素转换酶抑制药/药理学苯丙氮|艹卓|类/药理学冠状动脉循环/药物作用冠状动脉循环/生理学剂量效应关系药物前臂/血液供给血流动力学/药物作用高血压/病理生理学输注动脉内激光多普勒流量测定硝普钠/药理学肾素/血液肾素-血管紧张素系统/药物作用肾素-血管紧张素系统/生理学成年人女(雌)性人类男(雄)性中年人

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