Isogai S, Kameyama M, Iso K, Yoshino G
Second Department of Internal Medicine, Toho University School of Medicine, Japan.
J Diabetes Complications. 1998 May-Jun;12(3):170-5. doi: 10.1016/s1056-8727(97)00076-7.
Angiotensin-converting enzyme (ACE) inhibitors have been used in several clinical trials to slow a progressive decline in glomerular function in patients with diabetic nephropathy independent of their effects on blood pressure. The purpose of this study was to clarify the mechanisms(s) through which an ACE inhibitor, captopril, exerts its protective effect on renal function using spontaneously hypertensive rats (SHR) with streptozotocin (STZ)-induced diabetes. Male SHRs were made diabetic by intravenous injection of STZ (45 mg/kg). One hundred or 25 mg/kg of captopril was administered daily for 4 weeks to them. Urine albumin excretion (UAE) rate was markedly increased in diabetic SHRs, while captopril treatment resulted in a significant suppression of UAE in diabetic SHRs, independent of both its daily dose and effects on blood pressure as well as glycemic control. Examination by electron microscope revealed that the number of anionic sites (AS) in the lamina rara externa per 1000 nm of glomerular basement membrane (GBM) was significantly decreased (22.9+/-0.2 to 16.1+/-0.3, p < 0.001), after induction of diabetes, whereas, significant recovery (18.2+/-0.1, p < 0.001) could be obtained even by the smaller dose (25 mg/kg) of captopril which did not exert either antihypertensive or antidiabetic effect on diabetic SHRs. Thus, we demonstrate here the direct evidence that captopril, an ACE inhibitor, can protect against damage on GBM of diabetic SHR without controlling blood pressure as well as blood glucose level.
血管紧张素转换酶(ACE)抑制剂已在多项临床试验中用于减缓糖尿病肾病患者肾小球功能的渐进性下降,这一作用独立于其对血压的影响。本研究的目的是使用链脲佐菌素(STZ)诱导糖尿病的自发性高血压大鼠(SHR),阐明ACE抑制剂卡托普利对肾功能发挥保护作用的机制。雄性SHR通过静脉注射STZ(45mg/kg)诱导糖尿病。分别给予它们100mg/kg或25mg/kg的卡托普利,每日一次,持续4周。糖尿病SHR的尿白蛋白排泄(UAE)率显著增加,而卡托普利治疗可使糖尿病SHR的UAE显著降低,且这一作用与其每日剂量、对血压的影响以及血糖控制均无关。电子显微镜检查显示,糖尿病诱导后,每1000nm肾小球基底膜(GBM)的外疏松层中阴离子位点(AS)的数量显著减少(从22.9±0.2降至16.1±0.3,p<0.001),而即使是对糖尿病SHR未产生降压或降糖作用的较小剂量(25mg/kg)卡托普利,也能使其显著恢复(18.2±0.1,p<0.001)。因此,我们在此证明了直接证据,即ACE抑制剂卡托普利可在不控制血压和血糖水平的情况下,保护糖尿病SHR的GBM免受损伤。