de Châtel R, Weidmann P, Flammer J, Ziegler W H, Beretta-Piccoli C, Vetter W, Reubi F C
Kidney Int. 1977 Dec;12(6):412-21. doi: 10.1038/ki.1977.132.
Interrelations among plasma renin activity (PRA), aldosterone and cortisole levels, 0lood volume, exchangeable sodium, urinary catecholamines, and blood pressure were studied in 35 normal subjects and 60 age-matched non-azotemic patients with diabetes mellitus (60% with hypertension, 15% with orthostatic hypotension). Basal PRA, plasma aldosterone, cortisol, blood volume, plasma potassium, and urinary electrolytes were comparable in diabetic and normal subjects. Diabetic patients, however, had a 10% increase in body sodium (P less than 0.01), and 8% of them showed normal postural PRA responses and subnormal aldosterone responses; 22% had subnormal PRA and normal aldosterone responses, and 17% had subnormal responses of PRA and aldosterone. Non-PRA-related aldosterone responses could not be explained by ACTH or electrolytes. Orthostatic decreases in blood pressure correlated (P less than 0.01) with both catecholamine excretion and basal PRA. This suggests that in diabetes mellitus, body sodium is increased. Basal PRA and plasma aldosterone are usually normal, but their postural responses are frequently impaired. Absent aldosterone responses, despite normal PRA responsiveness, may reflect an adrenal abnormality or an ineffective form of renin. Marked postural aldosterone stimulation, unrelated to PRA, ACTH, or electrolytes, points to a potent unknown factor in aldosterone control. Low levels of free peripheral catecholamines and PRA may be complementary factors contributing to postural hypotension.
在35名正常受试者和60名年龄匹配的非氮质血症糖尿病患者（60%患有高血压，15%患有体位性低血压）中，研究了血浆肾素活性（PRA）、醛固酮和皮质醇水平、血容量、可交换钠、尿儿茶酚胺和血压之间的相互关系。糖尿病患者和正常受试者的基础PRA、血浆醛固酮、皮质醇、血容量、血浆钾和尿电解质水平相当。然而，糖尿病患者的体内钠含量增加了10%（P<0.01），其中8%的患者体位性PRA反应正常而醛固酮反应低于正常水平；22%的患者PRA低于正常水平而醛固酮反应正常，17%的患者PRA和醛固酮反应均低于正常水平。与PRA无关的醛固酮反应无法用促肾上腺皮质激素（ACTH）或电解质来解释。体位性血压下降与儿茶酚胺排泄及基础PRA均相关（P<0.01）。这表明糖尿病患者体内钠含量增加。基础PRA和血浆醛固酮通常正常，但其体位反应常受损。尽管PRA反应正常但醛固酮反应缺失，可能反映肾上腺异常或肾素的一种无效形式。与PRA、ACTH或电解质无关的明显体位性醛固酮刺激，提示醛固酮调控中存在一个强大的未知因素。外周游离儿茶酚胺和PRA水平较低可能是导致体位性低血压的互补因素。
