Favre L, Glasson P, Flory E D, Dray F, Vallotton M B
Schweiz Med Wochenschr. 1979 Feb 3;109(5):142-7.
Two adults with Bartter's syndrome were treated first with propranolol and a potassium-sparing diuretic and then with indomethacin for 22 months. Inhibition of prostaglandin synthesis by indomethacin, confirmed by a fall in urinary excretion rate of prostaglandins E2 and F2 alpha, induced a marked decrease in plasma renin activity and aldosterone excretion rate and an increase in plasma potassium. While the first patient was well controlled by this therapy, the second had elevation of prostaglandin excretion after 8 months associated with a relapse of symptomatic hypokalemia. Reintroduction of propranolol in addition to indomethacin led to renormalization of plasma potassium. A therapeutic trial with another prostaglandin synthesis inhibitor, meclofenamate, also produced partial correction of hyperreninemia and hypokalemia but only for a short time. From these observations it is concluded that (1) inhibition of renal prostaglandins by indomethacin or meclofenamate represents an effective but transient therapy for Bartter's syndrome, and (2) while prostaglandin secretion may elude pharmacological inhibition, the addition of propranolol restores complete inhibition and the therapeutic benefits of the previous treatment.
两名巴特综合征成年患者首先接受普萘洛尔和保钾利尿剂治疗，随后接受吲哚美辛治疗22个月。吲哚美辛抑制前列腺素合成，这通过前列腺素E2和F2α尿排泄率下降得到证实，它使血浆肾素活性和醛固酮排泄率显著降低，并使血浆钾升高。虽然第一名患者通过这种治疗得到良好控制，但第二名患者在8个月后前列腺素排泄增加，伴有症状性低钾血症复发。除吲哚美辛外重新使用普萘洛尔使血浆钾恢复正常。用另一种前列腺素合成抑制剂甲氯芬那酸进行的治疗试验也使高肾素血症和低钾血症得到部分纠正，但仅持续较短时间。从这些观察结果得出结论：（1）吲哚美辛或甲氯芬那酸抑制肾前列腺素是治疗巴特综合征的一种有效但短暂的疗法；（2）虽然前列腺素分泌可能逃避药物抑制，但加用普萘洛尔可恢复完全抑制并恢复先前治疗的益处。
