renin–angiotensin system

肾素 - 血管紧张素系统
  • 文章类型: Journal Article
    男性不育是一个重大的公共卫生问题。炎症性肠病(IBDs)对男性生殖系统有负面影响。本研究的目的是研究不同摩尔质量的燕麦β-葡聚糖(OBG)是否可以调节TNBS诱导的结肠炎成年Sprague-Dawley大鼠睾丸的抗氧化防御和炎症反应参数,以及OBG干预是否可以调节与RAS系统相关的炎症反应。结果:睾丸超氧化物歧化酶(SOD)较高,谷胱甘肽还原酶(GR)活性和谷胱甘肽(GSH)浓度,和较低的睾酮(T)水平和谷胱甘肽过氧化物酶(GPx)活性,与健康对照组相比,在结肠炎大鼠中观察到。与对照动物相比,TNBS诱导的结肠炎导致饲喂低摩尔质量OBG的大鼠睾丸中血管紧张素1-7(ANG1-7)水平降低。结论:虽然结肠炎引起了性腺的中度促氧化剂变化,似乎合理的是,对燕麦β-葡聚糖质量的不同部分进行饮食干预可能通过刺激局部抗氧化防御系统来支持生殖稳态的维持.
    Male infertility represents a significant public health concern. There is a negative impact of inflammatory bowel diseases (IBDs) on the male reproductive system. The aim of this study was to investigate whether oat beta-glucan (OBG) with different molar mass can modulate parameters of antioxidant defense and inflammatory response in the testes of adult Sprague-Dawley rats with TNBS-induced colitis and whether the OBG intervention can modulate the inflammatory response in association with the RAS system. Results: higher testicular superoxide dismutase (SOD), glutathione reductase (GR) activities and glutathione (GSH) concentration, and lower testosterone (T) level and glutathione peroxidase (GPx) activity, were observed in rats with colitis than in healthy control ones. TNBS-induced colitis resulted in decreased the angiotensin 1-7 (ANG 1-7) level in the testes of rats fed with low-molar mass OBG compared to control animals. Conclusions: although colitis induced moderate pro-oxidant changes in the gonads, it seems plausible that dietary intervention with different fractions of oat beta-glucans mass may support the maintenance of reproductive homeostasis via the stimulation of the local antioxidant defense system.
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  • 文章类型: Journal Article
    这项研究的目的是研究有氧训练对肾功能的影响,氧化应激,肾内肾素-血管紧张素系统,高血压和糖尿病(SHR-STZ)大鼠的死亡率。
    血压,肌酐,尿素水平,尿葡萄糖,尿量,在受过训练的SHR-STZ大鼠中,蛋白质排泄减少。
    有氧训练不仅减轻了SHR-STZ大鼠的氧化应激,而且提高了儿童抗氧化酶的活性。训练可增加肾内血管紧张素转换酶(ACE和ACE2)以及脑啡肽(NEP)活性,随着降低肾内血管紧张素II(AngII)水平。有氧训练能显著提高STZ-SHR大鼠的存活率。
    有氧训练的保护作用与肾脏抗氧化能力的改善有关,尿蛋白排泄减少,肾内AngII减少,NEP活性增加。这些发现可能反映了在联合病理条件下更好的生存,高血压,和糖尿病。
    UNASSIGNED: The purpose of the research was to investigate the effects of aerobic training on renal function, oxidative stress, intrarenal renin-angiotensin system, and mortality of hypertensive and diabetic (SHR-STZ) rats.
    UNASSIGNED: Blood pressure, creatinine, urea levels, urinary glucose, urine volume, and protein excretion were reduced in trained SHR-STZ rats.
    UNASSIGNED: Aerobic training not only attenuated oxidative stress but also elevated the activity of antioxidant enzymes in the kid\'ney of SHR-STZ rats. Training increased intrarenal levels of angiotensin-converting enzymes (ACE and ACE2) as well as the neprilysin (NEP) activity, along with decreased intrarenal angiotensin II (Ang II) levels. Aerobic training significantly improved the survival of STZ-SHR rats.
    UNASSIGNED: The protective role of aerobic training was associated with improvements in the renal antioxidative capacity, reduced urinary protein excretion along with reduced intrarenal Ang II and increased NEP activity. These findings might reflect a better survival under the combined pathological conditions, hypertension, and diabetes.
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  • 文章类型: Journal Article
    已知肾素-血管紧张素系统(RAS)会影响多种生理过程,从而影响许多关键器官的功能。血管紧张素转换酶(ACE)调节多种与疼痛相关的生物活性肽。ACE抑制剂(ACEis)已在心血管疾病的治疗中找到应用,肾,神经和代谢紊乱。然而,ACEis也倾向于显示不良效果,导致疼痛敏化和机械性异常性疼痛增加。在这次审查中,我们全面讨论了临床前和临床研究,涉及各种临床批准的ACEis的评估.随着对RAS信号传导中涉及的其他因素的认识和ACE底物在疼痛中的不明确的药理学作用,仍然需要广泛的研究来阐明ACE在疼痛感知中的机制作用。
    The renin-angiotensin system (RAS) is known to affect diverse physiological processes that affect the functioning of many key organs. Angiotensin-converting enzyme (ACE) modulates a variety of bioactive peptides associated with pain. ACE inhibitors (ACEis) have found applications in the treatment of cardiovascular, kidney, neurological and metabolic disorders. However, ACEis also tend to display undesirable effects, resulting in increased pain sensitization and mechanical allodynia. In this review, we provide comprehensive discussion of preclinical and clinical studies involving the evaluation of various clinically approved ACEis. With the emerging knowledge of additional factors involved in RAS signaling and the indistinct pharmacological role of ACE substrates in pain, extensive studies are still required to elucidate the mechanistic role of ACE in pain perception.
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  • 文章类型: Journal Article
    肾素-血管紧张素系统(RAS)越来越被认为在肿瘤微环境中发挥作用,促进肿瘤生长。阻断部分RAS的研究显示出不同的结果,可能是由于RAS中存在不同的旁路途径和冗余。因此,已经开发了RAS的多峰阻断以更完全地抑制RAS。本研究的目的是评估多峰RAS阻断在狗中的安全性。五只狗(四只阑尾骨肉瘤,一个患有口腔恶性黑色素瘤)用阿替洛尔治疗,贝那普利,姜黄素,美洛昔康,还有二甲双胍.这些狗接受了临床检查,血压测量,在0、1、3、6、9和12周进行血液学和血清生物化学测试,此后每三个月。最后的决定是由业主做出的。没有一只狗出现低血压。一只狗在试验的64周内出现间歇性呕吐。一只狗的血清SDMA(对称二甲基精氨酸)浓度一次性增加。狗在第3周安乐死(骨肉瘤),10(骨肉瘤),17(骨肉瘤),和26(口腔恶性黑色素瘤),在64周的试验结束时,一只狗仍然活着(骨肉瘤)。这是对狗的RAS的多模态封锁的首次评估,结果表明,它只会对某些动物造成轻微的不良反应。由于狗的数量少,没有评估治疗的功效。这项初步研究允许未来更大的研究评估多模式RAS阻断治疗犬癌。
    The renin-angiotensin system (RAS) is increasingly being recognized to play a role in the tumor microenvironment, promoting tumor growth. Studies blocking a single part of the RAS have shown mixed results, possibly due to the existence of different bypass pathways and redundancy within the RAS. As such, multimodal blockade of the RAS has been developed to exert more complete inhibition of the RAS. The aim of the present study was to assess the safety of multimodal RAS blockade in dogs. Five dogs (four with appendicular osteosarcoma, one with oral malignant melanoma) were treated with atenolol, benazepril, curcumin, meloxicam, and metformin. The dogs underwent clinical examination, blood pressure measurement, and hematology and serum biochemistry tests performed at 0, 1, 3, 6, 9, and 12 weeks, then every 3 months thereafter. End-of-life decisions were made by the owners. None of the dogs developed hypotension. One dog had intermittent vomiting during the 64 weeks it was on the trial. One dog had a one-off increase in serum SDMA(symmetrical dimethylarginine) concentration. Dogs were euthanized at weeks 3 (osteosarcoma), 10 (osteosarcoma), 17 (osteosarcoma), and 26 (oral malignant melanoma), and one dog was still alive at the end of the trial at 64 weeks (osteosarcoma). This is the first assessment of multimodal blockade of the RAS in dogs, and the results suggest it causes only mild adverse effects in some animals. The efficacy of the treatment was not assessed due to the small number of dogs. This pilot study allows for future larger studies assessing multimodal RAS blockade for the treatment of canine cancer.
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  • 文章类型: Journal Article
    背景:二肽基肽酶3(DPP3)是一种普遍存在的细胞溶质酶,在组织损伤后释放到血流中,能降解血管紧张素II.高浓度的循环DPP3(cDPP3)与脓毒症期间更差的结果相关。这项研究的目的是评估Procizumab(PCZ)的效果,在感染性休克的实验模型中,一种中和cDPP3的单克隆抗体。
    方法:在本随机分组中,开放标签,对照研究,当平均动脉压(MAP)降至50mmHg以下时,将16只患有腹膜炎的麻醉和机械通气猪随机接受PCZ或标准治疗。用液体复苏,抗菌治疗,腹腔灌洗,一小时后开始去甲肾上腺素,以将MAP维持在65-75mmHg之间12小时。血液动力学变量,组织氧合指数,并收集器官衰竭和心肌损伤的测量值。使用同位素评估(99mtech白蛋白)评估器官血流。cDPP3活性,对肾素-血管紧张素系统和循环儿茶酚胺进行平衡分析.在血管和心肌样本上评估了白细胞介素6的组织mRNA表达以及肾上腺素能和血管紧张素受体的下调。
    结果:PCZ治疗的动物的cDPP3水平降低,需要的去甲肾上腺素和液体比败血症对照动物少,器官灌注和局部血流量相似。PCZ处理的动物心肌损伤较少,和更高的PaO2/FiO2比率。PCZ与较低的循环儿茶酚胺水平相关;较高的循环血管紧张素II和较高的血管紧张素II受体1型心肌蛋白表达,心肌和桡动脉白细胞介素-6mRNA表达较低。
    结论:在感染性休克的实验模型中,PCZ给药与液体和儿茶酚胺需求减少有关,减少心肌损伤和心血管炎症,以及保留的血管紧张素II信号。
    BACKGROUND: Dipeptidyl peptidase 3 (DPP3) is a ubiquitous cytosolic enzyme released into the bloodstream after tissue injury, that can degrade angiotensin II. High concentrations of circulating DPP3 (cDPP3) have been associated with worse outcomes during sepsis. The aim of this study was to assess the effect of Procizumab (PCZ), a monoclonal antibody that neutralizes cDPP3, in an experimental model of septic shock.
    METHODS: In this randomized, open-label, controlled study, 16 anesthetized and mechanically ventilated pigs with peritonitis were randomized to receive PCZ or standard treatment when the mean arterial pressure (MAP) dropped below 50 mmHg. Resuscitation with fluids, antimicrobial therapy, peritoneal lavage, and norepinephrine was initiated one hour later to maintain MAP between 65-75 mmHg for 12 h. Hemodynamic variables, tissue oxygenation indices, and measures of organ failure and myocardial injury were collected. Organ blood flow was assessed using isotopic assessment (99mtechnetium albumin). cDPP3 activity, equilibrium analysis of the renin-angiotensin system and circulating catecholamines were measured. Tissue mRNA expression of interleukin-6 and downregulation of adrenergic and angiotensin receptors were assessed on vascular and myocardial samples.
    RESULTS: PCZ-treated animals had reduced cDPP3 levels and required less norepinephrine and fluid than septic control animals for similar organ perfusion and regional blood flow. PCZ-treated animals had less myocardial injury, and higher PaO2/FiO2 ratios. PCZ was associated with lower circulating catecholamine levels; higher circulating angiotensin II and higher angiotensin II receptor type 1 myocardial protein expression, and with lower myocardial and radial artery mRNA interleukin-6 expression.
    CONCLUSIONS: In an experimental model of septic shock, PCZ administration was associated with reduced fluid and catecholamine requirements, less myocardial injury and cardiovascular inflammation, along with preserved angiotensin II signaling.
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  • 文章类型: Journal Article
    丙氨酰羧肽酶(PRCP,PCP,溶酶体前-X-羧肽酶,血管紧张素酶C)控制血管紧张素和激肽诱导的细胞信号传导。在慢性炎症性疾病[心血管疾病(CVD)中,PRCP的升高似乎被激活,糖尿病]与严重程度成正比。血管内皮细胞衰老和线粒体功能障碍一直在CVD模型中显示。细胞衰老,与年龄有关的功能障碍的驱动者,由于溶酶体膜通透性,可以差异改变溶酶体酶的表达。缺乏数据证明年龄相关的功能障碍对PRCP的表达和功能的影响。为了探索PRCP的变化,PRCP依赖性的前激肽释放酶(PK)途径在早期和晚期传代人肺动脉内皮细胞(HPAECs)中得到表征.用高分子量激肽原(HK)处理的细胞的详细动力学分析,缓激肽(BK)的前体,和PK揭示了衰老的HPAECs在HPAECs上组装HK-PK复合物时激活激肽释放酶的产生,同时上调PRCP和内皮一氧化氮(NO)合酶(eNOS)和NO形成的机制。PRCP和eNOS的NO产生和表达在早期传代HPAECs中增加,在晚期传代HPAECs中减少。晚期传代HPAECs中PRCP的低活性与端粒酶逆转录酶mRNA水平的快速降低有关。我们还发现,随着HPAECs通过数量的增加,减少的PRCP改变了呼吸速率。这些结果表明,衰老失调PRCP蛋白表达,进一步的研究将揭示衰老过程中PRCP依赖性信号通路的复杂性。
    Prolylcarboxypeptidase (PRCP, PCP, Lysosomal Pro-X-carboxypeptidase, Angiotensinase C) controls angiotensin- and kinin-induced cell signaling. Elevation of PRCP appears to be activated in chronic inflammatory diseases [cardiovascular disease (CVD), diabetes] in proportion to severity. Vascular endothelial cell senescence and mitochondrial dysfunction have consistently been shown in models of CVD in aging. Cellular senescence, a driver of age-related dysfunction, can differentially alter the expression of lysosomal enzymes due to lysosomal membrane permeability. There is a lack of data demonstrating the effect of age-related dysfunction on the expression and function of PRCP. To explore the changes in PRCP, the PRCP-dependent prekallikrein (PK) pathway was characterized in early- and late-passage human pulmonary artery endothelial cells (HPAECs). Detailed kinetic analysis of cells treated with high molecular weight kininogen (HK), a precursor of bradykinin (BK), and PK revealed a mechanism by which senescent HPAECs activate the generation of kallikrein upon the assembly of the HK-PK complex on HPAECs in parallel with an upregulation of PRCP and endothelial nitric oxide (NO) synthase (eNOS) and NO formation. The NO production and expression of both PRCP and eNOS increased in early-passage HPAECs and decreased in late-passage HPAECs. Low activity of PRCP in late-passage HPAECs was associated with rapid decreased telomerase reverse transcriptase mRNA levels. We also found that, with an increase in the passage number of HPAECs, reduced PRCP altered the respiration rate. These results indicated that aging dysregulates PRCP protein expression, and further studies will shed light into the complexity of the PRCP-dependent signaling pathway in aging.
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  • 文章类型: Journal Article
    球旁体(JGA)介导的稳态机制与钠-葡萄糖协同转运蛋白2抑制剂(SGLT2is)如何减缓慢性肾脏疾病(CKD)的进展有关,并且可能与托伐普坦如何减缓常染色体显性多囊肾疾病(ADPKD)的肾功能下降有关。
    基于对肾小管肾小球反馈和肾素-血管紧张素系统的研究,假设了JGA介导的稳态机制。我们回顾了SGLT2is和托伐普坦的临床试验,以评估该机制与这些药物之间的关系。
    当钠对黄斑(MD)的负荷增加时,MD增加了腺苷的产生,收缩传入小动脉(Af-art)并保护肾小球。同时,MD信号抑制肾素分泌,增加尿钠排泄,和平衡减少钠过滤。然而,当每个肾单位的钠负荷明显增加时,与先进的CKD一样,MD腺苷产量增加,放松Af-art并以肾小球为代价维持钠稳态。托伐普坦对ADPKD中肾功能的有益作用也可能取决于JGA介导的稳态机制,因为托伐普坦抑制粗大的上行肢体中钠的重吸收。JGA介导的稳态机制调节Af-arts,根据体内平衡的需要收缩到放松。了解这种机制可能有助于药物治疗化合物的开发以及对CKD患者的更好护理。
    UNASSIGNED: Juxtaglomerular apparatus (JGA)-mediated homeostatic mechanism links to how sodium-glucose cotransporter 2 inhibitors (SGLT2is) slow progression of chronic kidney disease (CKD) and may link to how tolvaptan slows renal function decline in autosomal dominant polycystic kidney disease (ADPKD).
    UNASSIGNED: JGA-mediated homeostatic mechanism has been hypothesized based on investigations of tubuloglomerular feedback and renin-angiotensin system. We reviewed clinical trials of SGLT2is and tolvaptan to assess the relationship between this mechanism and these drugs.
    UNASSIGNED: When sodium load to macula densa (MD) increases, MD increases adenosine production, constricting afferent arteriole (Af-art) and protecting glomeruli. Concurrently, MD signaling suppresses renin secretion, increases urinary sodium excretion, and counterbalances reduced sodium filtration. However, when there is marked increase in sodium load per-nephron, as in advanced CKD, MD adenosine production increases, relaxing Af-art and maintaining sodium homeostasis at the expense of glomeruli. The beneficial effects of tolvaptan on renal function in ADPKD may also depend on the JGA-mediated homeostatic mechanisms since tolvaptan inhibits sodium reabsorption in the thick ascending limb.The JGA-mediated homeostatic mechanism regulates Af-arts, constricting to relaxing according to homeostatic needs. Understanding this mechanism may contribute to the development of pharmacotherapeutic compounds and better care for patients with CKD.
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  • 文章类型: Journal Article
    化疗在提高胰腺导管腺癌(PDAC)生存率方面的疗效有限,因此需要探索克服治疗耐药性的新策略。
    本研究旨在探讨肾素-血管紧张素系统(RAS)阻滞剂联合化疗对PDAC患者生存结局的影响。
    PDAC患者纳入回顾性研究。
    我们分析了2014年至2021年在我们机构接受PDAC(n=384)的患者。生存结果,包括无事件生存率(EFS)和总生存率(OS),根据RAS阻断剂的伴随使用情况进行分析。
    在研究的384名患者中,70(18.2%)同时接受了血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)。ACEI/ARB组患者,特点是年龄较大,合并症较多,显示出显著优于12个月的EFS率(22.86%对13.69%,p=0.008)与非ACEI/ARB组相比,而组间OS保持相似。在多变量分析中,使用ACEI/ARB与更好的12个月EFS相关(风险比=0.71,95%置信区间:0.52-0.96;p=0.024).性能差,晚期疾病状态,较高的CA19-9水平与较差的生存结局相关。
    在胰腺癌患者中同时使用ACEI/ARB可显著改善12个月EFS。年龄,性能状态,疾病状态,和较高的CA19-9水平是生存的独立预测因子。组合策略可能为PDAC患者提供更好的治疗结果。
    UNASSIGNED: The limited efficacy of chemotherapy in improving survival in pancreatic ductal adenocarcinoma (PDAC) necessitates the exploration of novel strategies to overcome treatment resistance.
    UNASSIGNED: This study aimed to investigate the impact of combining renin-angiotensin system (RAS) blockers with chemotherapy on survival outcomes in patients with PDAC.
    UNASSIGNED: Patients with PDAC were enrolled in the retrospective study.
    UNASSIGNED: We analyzed patients with PDAC (n = 384) at our institution between 2014 and 2021. Survival outcomes, including event-free survival (EFS) and overall survival (OS), were analyzed according to the concomitant use of RAS blockers.
    UNASSIGNED: Among the 384 patients in the study, 70 (18.2%) concomitantly received angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Patients in the ACEI/ARB group, characterized by older age and more comorbidities, displayed a significantly superior 12-month EFS rate (22.86% versus 13.69%, p = 0.008) compared to the non-ACEI/ARB group, while OS remained similar between the groups. In the multivariate analysis, the use of ACEI/ARB was associated with better 12-month EFS (hazards ratio = 0.71, 95% confidence interval: 0.52-0.96; p = 0.024). Poor performance, advanced disease status, and higher CA19-9 levels were associated with poor survival outcomes.
    UNASSIGNED: Concomitant use of ACEIs/ARBs in patients with pancreatic cancer resulted in significantly better 12-month EFS. Age, performance status, disease status, and higher CA19-9 levels were independent predictors of survival. The combination strategy might provide better treatment outcomes in patients with PDAC.
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  • 文章类型: Journal Article
    肥胖过度激活肾素-血管紧张素系统(RAS)的经典臂,损害骨骼肌重塑。我们旨在比较运动训练和依那普利的效果,血管紧张素转换酶抑制剂,关于肥胖动物骨骼肌中RAS调制的研究。因此,我们将C57BL/6小鼠分为两组:标准食物(SC)和高脂肪(HF)饮食,持续16周。在第八周,喂食HF的动物分为四个亚组-久坐(HF),用依那普利(HF-E)治疗,运动训练方案(HF-T),和联合干预措施(HF-ET)。治疗8周后,我们评估了体重和指数(BMI),身体成分,锻炼能力,肌肉形态学,和骨骼肌分子标记。所有干预措施均导致经典手臂的BMI降低和过度激活的减弱,同时有利于缓激肽受体中的B2R。这与肥胖骨骼肌中凋亡标志物的减少有关。HF-T组显示出肌肉质量和生物合成标记表达的增加,以及由于肥胖引起的降解标记表达和肌肉纤维萎缩的减少。这些发现表明,联合干预对肥胖诱导的肌肉重塑没有协同作用。此外,采用依那普利对受损肌肉的生理适应进行运动训练。
    Obesity over-activates the classical arm of the renin-angiotensin system (RAS), impairing skeletal muscle remodeling. We aimed to compare the effect of exercise training and enalapril, an angiotensin-converting enzyme inhibitor, on RAS modulation in the skeletal muscle of obese animals. Thus, we divided C57BL/6 mice into two groups: standard chow (SC) and high-fat (HF) diet for 16 weeks. At the eighth week, the HF-fed animals were divided into four subgroups-sedentary (HF), treated with enalapril (HF-E), exercise training protocol (HF-T), and combined interventions (HF-ET). After 8 weeks of treatment, we evaluated body mass and index (BMI), body composition, exercise capacity, muscle morphology, and skeletal muscle molecular markers. All interventions resulted in lower BMI and attenuation of overactivation in the classical arm, while favoring the B2R in the bradykinin receptors profile. This was associated with reduced apoptosis markers in obese skeletal muscles. The HF-T group showed an increase in muscle mass and expression of biosynthesis markers and a reduction in expression of degradation markers and muscle fiber atrophy due to obesity. These findings suggest that the combination intervention did not have a synergistic effect against obesity-induced muscle remodeling. Additionally, the use of enalapril impaired muscle\'s physiological adaptations to exercise training.
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  • 文章类型: Randomized Controlled Trial
    背景:血管紧张素转换酶抑制剂(ACEi)和血管紧张素受体阻滞剂(ARB)药物被广泛使用。我们试图评估在血管舒张性休克期间入院前使用这些药物可能如何影响对血管紧张素II治疗的反应。
    方法:在随机分组的事后亚组分析中,安慰剂对照,血管紧张素治疗高输出休克(ATHOS-3)试验,我们比较了使用慢性血管紧张素转换酶抑制剂(ACEi)的患者,和使用血管紧张素受体阻滞剂(ARB)的患者,不接触ACEi或ARB的患者。主要结果是治疗1小时后的平均动脉压。其他临床结果包括随着时间的推移平均动脉压和去甲肾上腺素等效剂量要求,随着时间的推移和研究药物剂量。生物学结果包括基线RAS生物标志物(肾素,血管紧张素-I,血管紧张素II,和血管紧张素-I/血管紧张素-II比率),以及肾素从0到3小时的变化。
    结果:我们包括n=321名患者,谁,270名ACEi和ARB未暴露,29例暴露于ACEi,22例暴露于ARB。在ACEi/ARB未暴露的患者中,血管紧张素治疗的患者,与安慰剂相比,1小时平均动脉压较高(9.1mmHg[95%CI7.6-10.1],p<0.0001),在48小时内降低去甲肾上腺素等效剂量(p=0.0037),和较低的研究药物剂量超过48小时(p<0.0001)。与未暴露的ACEi/ARB相比,接受血管紧张素II治疗的ACEi暴露患者的1小时平均动脉压相似(治疗效果差异:-2.2mmHg[95%CI-7.0-2.6],pinteraction=0.38),但在48小时内,去甲肾上腺素等效剂量(p相互作用=0.0031)和研究药物剂量(p相互作用<0.0001)的减少更大。相比之下,与未暴露的ACEi/ARB相比,暴露于ARB的患者对1小时平均动脉压的血管紧张素II的作用减弱(治疗效果差异:-6.0mmHg[95%CI-11.5至-0.6],pinteraction=0.0299),去甲肾上腺素等效剂量(pinteraction<0.0001),和研究药物剂量(p相互作用=0.0008)。ACEi暴露患者的基线肾素水平和血管紧张素-I/血管紧张素-II比率最高。最后,在ACEi/ARB未暴露和ACEi暴露的患者中,血管紧张素II治疗降低了h-3肾素,但在ARB暴露的患者中没有降低.
    结论:在血管舒张性休克患者中,对血管紧张素-II的心血管和生物学RAS反应因之前服用ACEi和ARB药物而有所不同.ACEi暴露与血管紧张素II反应性增加有关,而ARB暴露与反应性降低相关。这些发现对血管舒张性休克患者的选择和血管紧张素II的剂量具有临床意义。试验注册临床试验。政府标识符:NCT02338843(2015年1月14日注册)。
    Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blockers (ARB) medications are widely prescribed. We sought to assess how pre-admission use of these medications might impact the response to angiotensin-II treatment during vasodilatory shock.
    In a post-hoc subgroup analysis of the randomized, placebo-controlled, Angiotensin Therapy for High Output Shock (ATHOS-3) trial, we compared patients with chronic angiotensin-converting enzyme inhibitor (ACEi) use, and patients with angiotensin receptor blocker (ARB) use, to patients without exposure to either ACEi or ARB. The primary outcome was mean arterial pressure after 1-h of treatment. Additional clinical outcomes included mean arterial pressure and norepinephrine equivalent dose requirements over time, and study-drug dose over time. Biological outcomes included baseline RAS biomarkers (renin, angiotensin-I, angiotensin-II, and angiotensin-I/angiotensin-II ratio), and the change in renin from 0 to 3 h.
    We included n = 321 patients, of whom, 270 were ACEi and ARB-unexposed, 29 were ACEi-exposed and 22 ARB-exposed. In ACEi/ARB-unexposed patients, angiotensin-treated patients, compared to placebo, had higher hour-1 mean arterial pressure (9.1 mmHg [95% CI 7.6-10.1], p < 0.0001), lower norepinephrine equivalent dose over 48-h (p = 0.0037), and lower study-drug dose over 48-h (p < 0.0001). ACEi-exposed patients treated with angiotensin-II showed similarly higher hour-1 mean arterial pressure compared to ACEi/ARB-unexposed (difference in treatment-effect: - 2.2 mmHg [95% CI - 7.0-2.6], pinteraction = 0.38), but a greater reduction in norepinephrine equivalent dose (pinteraction = 0.0031) and study-drug dose (pinteraction < 0.0001) over 48-h. In contrast, ARB-exposed patients showed an attenuated effect of angiotensin-II on hour-1 mean arterial pressure versus ACEi/ARB-unexposed (difference in treatment-effect: - 6.0 mmHg [95% CI - 11.5 to - 0.6], pinteraction = 0.0299), norepinephrine equivalent dose (pinteraction < 0.0001), and study-drug dose (pinteraction = 0.0008). Baseline renin levels and angiotensin-I/angiotensin-II ratios were highest in ACEi-exposed patients. Finally, angiotensin-II treatment reduced hour-3 renin in ACEi/ARB-unexposed and ACEi-exposed patients but not in ARB-exposed patients.
    In vasodilatory shock patients, the cardiovascular and biological RAS response to angiotensin-II differed based upon prior exposure to ACEi and ARB medications. ACEi-exposure was associated with increased angiotensin II responsiveness, whereas ARB-exposure was associated with decreased responsiveness. These findings have clinical implications for patient selection and dosage of angiotensin II in vasodilatory shock. Trial Registration ClinicalTrials.Gov Identifier: NCT02338843 (Registered January 14th 2015).
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