Hirakata H, Onoyama K, Hori K, Fujishima M
Clin Nephrol. 1986 Jul;26(1):27-32.
The study was aimed to show whether the renin-angiotensin system acts on erythropoiesis in chronic renal failure patients with hemodialysis, since captopril leads to the worsening of anemia in such patients. The average dose of captopril in 13 cases studied was 19.3 mg per day and duration of the administration was 48 days. Blood-pressure fall by captopril was accompanied with the worsening of anemia. There were significant decreases in hemoglobin (8.3%), hematocrit (7.3%), red blood cell count (7.6%) and reticulocyte count (43.7%). Angiotensin II was significantly decreased (15.7%) with significant reductions of plasma aldosterone concentration (15.2%) and angiotensin-I converting enzyme (45.7%), and with significant increases in plasma renin activity (158.6%) and in angiotensin I (238.3%). However, plasma erythropoietin concentration remained unchanged. Serum iron concentration was slightly but significantly increased after captopril. Reticulocyte count was significantly correlated with AII either before (r = 0.716, p less than 0.01) or after captopril (r = 0.658, p less than 0.05). There was significant correlation between angiotensin II and red blood cell count before captopril (r = 0.710, p less than 0.01). It is concluded from the present study that the reduction of angiotensin II by captopril might contribute to the worsening of anemia seen in chronic hemodialysis patients.
本研究旨在表明肾素 - 血管紧张素系统是否对接受血液透析的慢性肾衰竭患者的红细胞生成有作用，因为卡托普利会导致此类患者贫血加重。在研究的13例患者中，卡托普利的平均剂量为每日19.3毫克，给药持续时间为48天。卡托普利导致血压下降的同时伴有贫血加重。血红蛋白（下降8.3%）、血细胞比容（下降7.3%）、红细胞计数（下降7.6%）和网织红细胞计数（下降43.7%）均显著降低。血管紧张素II显著降低（15.7%），血浆醛固酮浓度（15.2%）和血管紧张素I转换酶（45.7%）显著降低，而血浆肾素活性（158.6%）和血管紧张素I（238.3%）显著升高。然而，血浆促红细胞生成素浓度保持不变。卡托普利治疗后血清铁浓度略有但显著升高。网织红细胞计数与血管紧张素II在卡托普利治疗前（r = 0.716，p < 0.01）或治疗后（r = 0.658，p < 0.05）均显著相关。卡托普利治疗前血管紧张素II与红细胞计数之间存在显著相关性（r = 0.710，p < 0.01）。本研究得出结论，卡托普利降低血管紧张素II可能是导致慢性血液透析患者贫血加重的原因。
