Pedersen E B, Danielsen H, Jensen T, Madsen M, Sørensen S S, Thomsen O O
Eur J Clin Invest. 1986 Feb;16(1):56-60. doi: 10.1111/j.1365-2362.1986.tb01308.x.
Angiotensin II (AII), aldosterone (Aldo) and arginine vasopressin (AVP) in plasma were determined during basal conditions in seventeen patients with congestive heart failure and in seventeen control subjects. The same parameters were measured before and 1, 2 and 3 h after an oral water load of 20 ml (kg body weight)-1 together with urine volume (V) and free water clearance (CH2O) in seven patients with congestive heart failure and in seven control subjects. AII, Aldo and AVP were significantly higher in heart failure than in control subjects (AII:81 and 12 pmol l(-1) (medians), P less than 0.01; Aldo: 411 and 103 pmol l(-1), P less than 0.01; AVP: 5.3 and 2.0 pmol l)-1), P less than 0.01). AVP was positively correlated to Aldo in both heart failure (p = 0.593, n = 17, P less than 0.02) and control subjects (p = 0.511, n = 17, P less than 0.05), but in neither of the groups to AII. V and CH2O were significantly lower in heart failure when compared to control subjects (maximum increase in CH2O 3.55 and 5.86 ml min-1, P less than 0.02), but did not correlate directly with either A II, Aldo or AVP. Creatinine clearance was reduced in heart failure. It is concluded that the activity of both the renin-angiotensin-aldosterone system and the osmoregulatory system is enhanced in congestive heart failure, presumably as a compensatory phenomenon in order to maintain arterial blood pressure. It is suggested that the decrease in free water clearance may be attributed to both an elevated level of vasopressin and a reduced glomerular filtration rate.
在基础状态下，对17例充血性心力衰竭患者和17例对照者的血浆血管紧张素II（AII）、醛固酮（Aldo）和精氨酸加压素（AVP）进行了测定。在7例充血性心力衰竭患者和7例对照者中，口服20 ml/（kg体重）的水负荷前及负荷后1、2和3小时，测量了相同参数，同时记录尿量（V）和自由水清除率（CH2O）。心力衰竭患者的AII、Aldo和AVP显著高于对照者（AII：中位数分别为81和12 pmol/L，P<0.01；Aldo：411和103 pmol/L，P<0.01；AVP：5.3和2.0 pmol/L，P<0.01）。在心力衰竭患者（p = 0.593，n = 17，P<0.02）和对照者（p = 0.511，n = 17，P<0.05）中，AVP与Aldo呈正相关，但在两组中AVP与AII均无相关性。与对照者相比，心力衰竭患者的V和CH2O显著降低（CH2O的最大增加值分别为3.55和5.86 ml/min，P<0.02），但与AII、Aldo或AVP均无直接相关性。心力衰竭患者的肌酐清除率降低。结论是，充血性心力衰竭时肾素-血管紧张素-醛固酮系统和渗透调节系统的活性均增强，推测这是为维持动脉血压的一种代偿现象。提示自由水清除率降低可能归因于血管加压素水平升高和肾小球滤过率降低。
