2型糖尿病患者卡托普利试验后的肾内血流动力学变化：一项双功多普勒超声研究

Intrarenal hemodynamic changes after captopril test in patients with type 2 diabetes: a duplex Doppler sonography study.

作者信息

Taniwaki Hiromichi, Ishimura Eiji, Kawagishi Takahiko, Matsumoto Naoki, Hosoi Masayuki, Emoto Masanori, Shoji Tetsuo, Shoji Shigeichi, Nakatani Tatsuya, Inaba Masaaki, Nishizawa Yoshiki

机构信息

Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

Diabetes Care. 2003 Jan;26(1):132-7. doi: 10.2337/diacare.26.1.132.

DOI:10.2337/diacare.26.1.132

PMID:12502669

Abstract

OBJECTIVE

ACE inhibitors are known to be effective in preventing the progression of diabetic nephropathy. Activation of the renin-angiotensin system (RAS) is reported to contribute to intrarenal hemodynamic abnormality in diabetic patients. We examined whether RAS blockade by captopril induces intrarenal hemodynamic changes in normotensive patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

The patients ranged in age from 40 to 65 years (20 men and 20 women). A total of 15 age- and sex-matched healthy individuals served as control subjects. Resistive index (RI) of interlobar arteries was examined by duplex Doppler sonography before and after the oral captopril (25 mg) test.

RESULTS

At baseline, no significant differences in RI values or plasma renin activity (PRA) were seen between the patients and healthy subjects. In healthy subjects, the RI values after the captopril test were significantly higher than baseline values (P < 0.01). However, in patients with type 2 diabetes, both with normoalbuminuria and microalbuminuria, RI values after the test were significantly lower than baseline values (P < 0.001). There were significant negative correlations between DeltaRI value and HbA1c (r = -0.458, P < 0.005) and between DeltaRI value and baseline PRA in diabetic patients (r = -0.339, P < 0.05). Multiple regression analysis showed that HbA1c and baseline PRA significantly and independently affected the magnitude of decrease in RI values after captopril administration in diabetic patients (R2 = 0.391, P < 0.0001).

CONCLUSIONS

These results indicate that the intrarenal RAS may be activated in diabetic patients, that such activation may be affected by poor glycemic control, and that blockade of RAS activation by ACE inhibitor reduces intrarenal vascular resistance in diabetic patients. The results emphasize the beneficial effects of ACE inhibition in improving intrarenal hemodynamics in diabetic patients.

摘要

目的

已知血管紧张素转换酶（ACE）抑制剂可有效预防糖尿病肾病的进展。据报道，肾素 - 血管紧张素系统（RAS）的激活会导致糖尿病患者肾内血流动力学异常。我们研究了卡托普利对RAS的阻断是否会在2型糖尿病血压正常的患者中引起肾内血流动力学变化。

研究设计与方法

患者年龄在40至65岁之间（男性20例，女性20例）。共有15名年龄和性别匹配的健康个体作为对照。在口服卡托普利（25毫克）试验前后，通过双功多普勒超声检查叶间动脉的阻力指数（RI）。

结果

基线时，患者与健康受试者之间的RI值或血浆肾素活性（PRA）无显著差异。在健康受试者中，卡托普利试验后的RI值显著高于基线值（P < 0.01）。然而，在2型糖尿病患者中，无论是正常白蛋白尿还是微量白蛋白尿患者，试验后的RI值均显著低于基线值（P < 0.001）。糖尿病患者中，ΔRI值与糖化血红蛋白（HbA1c）之间存在显著负相关（r = -0.458, P < 0.005），且ΔRI值与基线PRA之间也存在显著负相关（r = -0.339, P < 0.05）。多元回归分析表明，HbA1c和基线PRA在糖尿病患者中对卡托普利给药后RI值降低的幅度有显著且独立的影响（R2 = 0.391, P < 0.0001）。