Mazouz H, Oprisiu R, Monge M, Andrejak M, Fournier A
Service de néphrologie, Hôpital Sud, 80054 Amiens.
Arch Mal Coeur Vaiss. 2001 Aug;94(8):813-7.
To check wether the deleterious effect of enalaprilat administered before unilateral caroid ligation in the gerbil reported by Fernandez et al. (J Cardiovasc Pharmacol 1994; 24: 937) is not a molecule specific effect but an angiotensin converting enzyme inhibitor class effect.
Survival rate of gerbils (an animal with incomplete Willis hexagona) was measured after unilateral carotid ligation with preadministration (2 hours before by gavage) of saline (0.75 ml) (n = 37); losartan (20 mg/kg) (n = 37), enalaparil (10 mg/kg) (n = 37); a combination of losartan and enalapril at the same dose (n = 37); and of captopril (75 mg/kg) (n = 35).
The survival rate of the gerbils 72 hours after carotid ligation was 65% in control, 62% in losartan, 30% in enalapril, 32% in enalapril + losartan, and 32% in captopril groups. Statistical analysis (log rank test) of the Kaplan-Meier survival curves over 72 hours showed no difference between losartan and controls nor between the various groups treated with ACEI. However survival was significantly lower in the ACEI groups than in the group treated by losartan alone (p < 0.02) or controls (p < 0.02). Intraaortic mean arterial pressure was measured in 6 controls, 6 animals treated with losartan and 6 other treated with enalapril. It was comparable in the losartan and enalapril treated animals (65 +/- 2 mm Hg vs 64 +/- 2) but significantly lower than in the controls (77 +/- 2 mmHg) (p < 0.02).
In contrast to oral preadministration of enalapril and captopril that of losartan does not increase the mortality of the gerbil after unilateral carotid ligation in spite of the same decrease in systemic blood pressure. Although a lower mortality than in controls was not observed with losartan as in the princeps study of Fernandez, these data are consistent with the demonstration by this author that angiotensin II plays a critical protective role in acute ischemia probably by promoting collateral circulation recruitment through non-AT1 receptors stimulation.
检验费尔南德斯等人(《心血管药理学杂志》,1994年;24卷:937页)报道的沙鼠单侧颈动脉结扎前给予依那普利拉的有害作用是否不是分子特异性作用,而是血管紧张素转换酶抑制剂类的作用。
在单侧颈动脉结扎前(通过灌胃在2小时前)给予生理盐水(0.75毫升)(n = 37);氯沙坦(20毫克/千克)(n = 37)、依那普利(10毫克/千克)(n = 37);相同剂量的氯沙坦与依那普利联合使用(n = 37);以及卡托普利(75毫克/千克)(n = 35)后,测量沙鼠(一种具有不完全威利斯六边形的动物)的存活率。
颈动脉结扎72小时后,对照组沙鼠的存活率为65%,氯沙坦组为62%,依那普利组为30%,依那普利 + 氯沙坦组为32%,卡托普利组为32%。对72小时内的Kaplan-Meier生存曲线进行统计分析(对数秩检验)表明,氯沙坦组与对照组之间以及接受血管紧张素转换酶抑制剂治疗的各组之间没有差异。然而,血管紧张素转换酶抑制剂组的存活率显著低于单独使用氯沙坦治疗的组(p < 0.02)或对照组(p < 0.02)。在6只对照组、6只接受氯沙坦治疗的动物和6只接受依那普利治疗的其他动物中测量了主动脉内平均动脉压。氯沙坦和依那普利治疗的动物中的平均动脉压相当(65 ± 2毫米汞柱对64 ± 2),但显著低于对照组(77 ± 2毫米汞柱)(p < 0.02)。
与口服依那普利和卡托普利不同,尽管全身血压有相同程度的下降,但氯沙坦口服给药并不会增加单侧颈动脉结扎后沙鼠的死亡率。虽然在费尔南德斯的主要研究中未观察到氯沙坦组的死亡率低于对照组,但这些数据与该作者的证明一致,即血管紧张素II可能通过刺激非AT1受体促进侧支循环募集,在急性缺血中起关键的保护作用。