Kubo S H, Clark M, Laragh J H, Borer J S, Cody R J
Department of Medicine, New York Hospital-Cornell University Medical College, New York 10021.
Am J Cardiol. 1987 Dec 1;60(16):1322-8. doi: 10.1016/0002-9149(87)90615-1.
To characterize further the pathophysiology of the neurohormonal vasoconstrictor pathways in congestive heart failure (CHF), plasma renin activity, plasma norepinephrine, blood pressure, blood volume and renal hemodynamics were measured in 12 patients with mild to moderate CHF. In addition, the response to the gravitational stress of head-up tilt and the influence of 3 weeks of furosemide treatment as stimuli of neurohormonal activity were assessed. Supine plasma renin activity before diuretics was relatively normal at 1.94 +/- 1.6 ng/ml/hr and was significantly increased to 3.9 +/- 2.7 ng/ml/hr after diuretics. During tilt, there was a significant reflex increase in plasma renin activity both before and after diuretics. Plasma norepinephrine was also relatively normal before diuretics (325 +/- 211 pg/ml), did not increase after diuretics, but showed significant increases during tilt both before and after diuretics. Diuretic administration led to decreases in both systolic and diastolic blood pressures, but there was no change in body weight or total blood volume. In addition, diuretic administration did not result in any significant changes of renal blood flow (546 +/- 119 to 634 +/- 204 ml/min/1.73m2), glomerular filtration rate (81 +/- 22 to 90 +/- 27 ml/min/1.73m2) or filtration fraction (0.26 to 0.25). The present study demonstrates that the renin-angiotensin system and the sympathetic nervous system were not activated in the early symptomatic stages of CHF and that baroreceptor stimulation of these pathways during head-up tilt was relatively preserved. Renin secretion increased during diuretic administration, suggesting that the macula densa signal for renin release was also preserved in patients with relatively mild CHF.
为了进一步阐明充血性心力衰竭（CHF）中神经激素血管收缩途径的病理生理学，对12例轻至中度CHF患者测定了血浆肾素活性、血浆去甲肾上腺素、血压、血容量和肾血流动力学。此外，评估了头高位倾斜的重力应激反应以及3周呋塞米治疗作为神经激素活性刺激因素的影响。利尿前仰卧位血浆肾素活性相对正常，为1.94±1.6 ng/ml/hr，利尿后显著升高至3.9±2.7 ng/ml/hr。倾斜过程中，利尿前后血浆肾素活性均有显著的反射性升高。利尿前血浆去甲肾上腺素也相对正常（325±211 pg/ml），利尿后未升高，但利尿前后倾斜过程中均显著升高。使用利尿剂导致收缩压和舒张压均下降，但体重和总血容量无变化。此外，使用利尿剂未导致肾血流量（546±119至634±204 ml/min/1.73m2）、肾小球滤过率（81±22至90±27 ml/min/1.73m2）或滤过分数（0.26至0.25）发生任何显著变化。本研究表明，在CHF的早期症状阶段，肾素-血管紧张素系统和交感神经系统未被激活，并且头高位倾斜期间这些途径的压力感受器刺激相对保留。利尿期间肾素分泌增加，提示相对轻度CHF患者中肾素释放的致密斑信号也保留。
