贵州医科大学学报

1982, (02) 119-139

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原发性高血压血管紧张素Ⅱ、儿茶酚胺、血液流变学的研究(多因子逐步回归分析)
STUDY OF ANGIOTENSIN Ⅱ, CATECHOLAMINE AND HEMORHEOLOOY IN ESSENTIAL HYPERTENSION (STEPWISE REGRESSION ANALYSIS)

陈炳忠;张美祥;
Postgraduate of Medicine: Chen Bingzhong Advisor: Professor Zhang Meixiang

摘要(Abstract):

<正> 前言原发性高血压的病因、发病机理和病理生理极为错综复杂,涉及许多方面,其中肾素—血管紧张素系统(Renin—Angiotensin—system,RAS)是探索较多的因素之一,但分歧也不少,故仍需进一步探讨。自从Brunner等1972年提出肾素是高血压病心血管损害的一个危险因子以来,至今也仍有争论。这些研究大多是单因子的,而与儿茶酚胺、醛固酮等多因子作同步测定和逐步回归分析则很少报道。儿茶酚胺在高血压病的分泌状况至今各家研究结果不一,血液流变性在高血压病不同时期的变化以及影响全血粘度的多因子的逐步回归分析也研究甚少。我们为了探讨高血压病发生发展中多因子的影
The etiology, pathogenesis and physiopathology of essential hypertension are very complex and related to a number of factors. Most of them are still being to research. The purpose of present study was to research the changes of an- giotensin Ⅱ (AT Ⅱ), catecholamine (CA) and hemorheology in essential hyper-- tension and the correlation between these factors and cardiovascular complicat-- ions was also analysed. Material and methods: plasma AT Ⅱ, 24 -- hour urine CA, aldosterone and sodium of 31 normal subjects and 55 essential hypertensive cases were detected synchronously. The hemorheological detections were done in 190 normal adults and 55 patients at the same period. The comparison of these indices between the normal and patients group was made. The correlation amongplasma AT Ⅱ, urine CA, aldosterone, sodium, blood pressure and age as well as the influence factors to blood viscosity were studied not only by single factor regression but also stepwise regression analysis with DJS-21 model computer. The effect of AT Ⅱ, CA, blood vistcosity and mean arterial pressure to the deve- lopment and progress of cardiovascular damage in hypertension were analysed in its divided stages and groups. AT Ⅱ was detected by the method of radioim- munoassay. The repeated tube and non-specific combined tube were set in every determination. The specific radioactivity of ~(125)I. AT Ⅱ were all beyond 7000 CPM, 50% inhibition of 25 standard curves was 52±2.8 PG (M±SE) and the precision was 1.24±0.17%, all of these data are satisfactory. The CA in urine was detected by means of trihydroxylindol fluorometry that the withdrawn rate, the repeated test, the stability of the fluorescence and the standard curve are all appropriately to standard demand. The indices of hemorheology were detected separately by SDZ--3 model viscosity machine, SDZ--1 model cell electropho-- resis apparatus and FM--3 model ice-point osmometer etc. Results and discussion: AT Ⅱ basal values, stimulated values and increased va- lues after stimulation in the peripheral venous plasma of normak subiects were 15±12, 62±39, 47±34 pG/ml, respectively. The normal values of CA in urine was 62±38 μg/24 hours. The blood specific viscosity of normal male and fe- male were 4.359±0.65 and 4.028±0.61, respectively; the plasma specific viscosity was 1.64±0.2; the RBC electrophoresis time was 18±2.2 seconds. The hematocrit of normal male and female were 51.4±4.6% and 39.3±4.3% respectively. In the normal subjects, negative correlation between AT Ⅱ stimula- ted value and 24-hour urine aldosterone was found in stepwise regression analysis, it suggests that aldosterone may inhibit secretion of renin by means of foodback directly or indirectly. The negative correlation between the age and the logarithm of AT Ⅱ increased value following provocation suggests that the reactivity of RAS is decresing as the age advanced. The AT Ⅱ basal value of the patients wis similar to the normal control (P>0. 05), but, according to the normal regulation of renin excretion, the value is still abnormally excessive. The reactivity of RAS in the patients was much lower than that in normal group and there was a tendericy that the reactivity was getting lower and lower with the progress of the disease. Because of the incidence of cardiovascular damage in high AT Ⅱ hypertensive group was not higher than that in low AT Ⅱ and normal AT Ⅱ hypertension, furthermore, the AT Ⅱ basal value and increased value following provocation of the group with complication was not higher than those in simple hypertensive group, it was failed to confirm that RAS may result in hypertensive cardiovascular lesion. In patients group the negative cor- relation between AT Ⅱ and aldosterone which existed in normal group was not found and this suggests that the regulation mechanism between AT Ⅱ and aldosterone is abnormal in essential hypertension. CA in 24-hour urine of patients group was similar to that of normal group (P>0.05) but in ordinary condition the sympathetic activity should be inhibited by depressor reflex when the blood pressure had raised, thus the "normal" uine CA is actually more excessive. The positive correlation between CA and aldosterone in urine was found but it did not occur in control group. The urine CA of complicated group wes less than that in simple hypertensive group, however, there are a number of factors to be influence in urine CA, it has not been confirmed that cardiovascular damage does not depend upon the existence of catecholamine. The mean arterial pressure of the complicated group was much higher than that of the simple hypertensive group (P<0.002), therefore, the degree of elevated blood pressure iS possibly an important factor to cardiovascular damage in essential hypertension. RBC electrophoresis time was prolonged in all stages of essential hypertension, but the specific viscosity of plasma and blood were increased only in Ⅱ and Ⅲ stages. This abnormality of blood viscosity may play a part for the mainte- nance of hypertension in the latter stages of patients. The blood specific viscosity of complicated group was higher than that of the simple hypertension group, it suggests that the hemorheological abnormality is possibly a deteriorated factor for the development of cardiovascular lesions. Following the comparison between linear regression and stepwise regression analysis, we had discovered that the latter was much more reasonable than the former. The classification of essential hypertension on the basis of RAS was discus- sed, a design was presented by the basal AT Ⅱ value into low, normol and high-AT Ⅱ groups and furthermore subdivided into low, normal and high- reactivity according to the increased value following stimulation. Whether the design is beneficial to direct therapy or not should be further investigated.

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作者(Author): 陈炳忠;张美祥;
Postgraduate of Medicine: Chen Bingzhong Advisor: Professor Zhang Meixiang

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