Back C, Thiesen K L, Skovgaard K, Edvinsson L, Jensen L T, Larsen V A, Iversen H K
Stroke Unit, Department of Neurology, Copenhagen University Hospital, Glostrup, Denmark; Translational Stroke Center, Copenhagen University Hospital, Glostrup, Denmark.
Acta Neurol Scand. 2015 Feb;131(2):132-9. doi: 10.1111/ane.12298. Epub 2014 Sep 12.
Angiotensin II type 1 receptor blockade has neuroprotective effects in animal stroke models, but no effects in clinical stroke trials. We evaluated cerebral and peripheral changes in the renin angiotensin aldosterone system (RAAS) and stress responses in acute ischemic stroke patients.
Blood from a jugular and cubital vein was collected within 48 h of stroke onset, after 24 and 48 h, and renin, angiotensin I, angiotensin II, aldosterone, norepinephrine, epinephrine, and cortisol were measured. Post-stroke cubital vein samples were collected after 8 (4.7-10) months.
The acute systolic blood pressure was significantly increased, 148 (141-168) vs 140 (130-147) mmHg post-stroke. Angiotensin I, renin and aldosterone levels were significantly lower, angiotensin II was unchanged, and ACE activity was higher in the acute phase compared to post-stroke. No differences in RAAS were detected between jugular and cubital plasma levels. Jugular venous plasma levels of epinephrine and cortisol were elevated in the acute phase compared to cubital levels (P < 0.05).
Increased epinephrine and cortisol levels in the jugular vein blood may reflect a higher peripheral turnover. The observed changes in RAAS in the acute stroke phase are consistent with responses to increased blood pressure.
血管紧张素II 1型受体阻断在动物中风模型中具有神经保护作用，但在临床中风试验中无效。我们评估了急性缺血性中风患者肾素血管紧张素醛固酮系统（RAAS）的脑和外周变化以及应激反应。
在中风发作后48小时内、24小时和48小时后采集颈静脉和肘静脉血，测量肾素、血管紧张素I、血管紧张素II、醛固酮、去甲肾上腺素、肾上腺素和皮质醇。中风后8（4.7 - 10）个月采集肘静脉样本。
急性收缩压显著升高，中风后为148（141 - 168）mmHg，而中风前为140（130 - 147）mmHg。与中风后相比，急性期血管紧张素I、肾素和醛固酮水平显著降低，血管紧张素II不变，ACE活性更高。颈静脉和肘静脉血浆水平的RAAS未检测到差异。与肘静脉水平相比，急性期颈静脉血浆中的肾上腺素和皮质醇水平升高（P < 0.05）。
颈静脉血中肾上腺素和皮质醇水平升高可能反映外周周转率更高。急性中风期观察到的RAAS变化与对血压升高的反应一致。
