Shand B I, Bailey R R, Lynn K L, Robson R A
Department of Nephrology, Christchurch Hospital, New Zealand.
Blood Press. 1995 Jul;4(4):238-40. doi: 10.3109/08037059509077601.
Treatment of hypertension with an angiotensin converting enzyme inhibitor (ACEI) may be associated with a decrease in haemoglobin concentration especially in patients with renal insufficiency. This open study in 19 patients with a variety of renal diseases with complicating hypertension investigated the effects of the ACEI, enalapril, on haemoglobin and plasma erythropoietin (EPO) concentrations. Blood samples were obtained at baseline and 2, 60 and 120 days after starting treatment with enalapril. By day 60 there was a significant decrease in mean haemoglobin concentration (mean decrease 7.4 g/l) that was sustained until day 120. Apart from a small, but significant, reduction by day 2, mean plasma EPO concentration remained constant throughout the study. The magnitude of the decrease in haemoglobin concentration was, however, significantly correlated with the baseline plasma creatinine concentration and creatinine clearance. These results suggested that the degree of renal insufficiency was important in determining the haematological response to ACE inhibition. While the mechanism of these changes remains unclear, our findings suggest that inhibition of the renin-angiotensin system, rather than decreasing EPO production, may reduce the erythropoietic activity of the hormone.
使用血管紧张素转换酶抑制剂（ACEI）治疗高血压可能会导致血红蛋白浓度降低，尤其是在肾功能不全的患者中。这项针对19例患有各种肾病并伴有高血压并发症的患者的开放性研究，调查了ACEI依那普利对血红蛋白和血浆促红细胞生成素（EPO）浓度的影响。在开始依那普利治疗的基线、2天、60天和120天后采集血样。到第60天时，平均血红蛋白浓度显著下降（平均下降7.4 g/l），并持续到第120天。除了在第2天有一个小但显著的下降外，整个研究期间平均血浆EPO浓度保持不变。然而，血红蛋白浓度下降的幅度与基线血浆肌酐浓度和肌酐清除率显著相关。这些结果表明，肾功能不全的程度在决定血液学对ACE抑制的反应中很重要。虽然这些变化的机制尚不清楚，但我们的研究结果表明，抑制肾素-血管紧张素系统可能会降低该激素的促红细胞生成活性，而不是减少EPO的产生。
