Kev Ntsuam Xyuas Ntawm Angiotensin-hloov Enzyme Inhibitor / angiotensin Receptor Blocker Ntawm Kev Sib Nraus Raum Ua Haujlwm hauv Cov Neeg Mob Nrog Primary Hypertension

Yog xav paub ntxiv. tiv taujtina.xiang@wecistanche.com

Abstract

Ob tograum puasHauv cov neeg mob hypertensive tsis yog sib npaug. Angiotensin-hloov enzyme inhibitor / angiotensin receptor blocker (ACEI / ARB), raws li cov tshuaj tiv thaiv kab mob siab, tuaj yeem tiv thaiv lub raum ua haujlwm thiab ncua nws qhov kev puas tsuaj. Feem ntau cov kev tshawb fawb tsom mus rau tag nrho lub raum ua haujlwm, tab sis kev tshawb fawb txogcais lub raum ua haujlwm(SRF) tsis tshua muaj. Peb tau tshawb xyuas qhov cuam tshuam ntawm ACEI / ARB ntawm SRF hauv cov neeg mob ntshav siab.

Cov neeg mob uas muaj ntshav siab thawj (n{0}}; txiv neej: 213; poj niam: 216) tau txais mus rau peb lub chaw haujlwm thaum Lub Ib Hlis 2014 txog Lub Kaum Ob Hlis 2016 tau suav nrog hauv txoj kev tshawb no. Lub glomerular filtration rate (GFR) ntawm kev sib cais thiab tag nrho lub raum ua haujlwm tau txiav txim siab siv diethylenetriaminepentaacetic acid tagged nrog 99mTc raum dynamic imaging method. Rau tib tus neeg mob, sab nrog GFR siab tau suav tias yog GFR raum siab dua, qhov uas muaj GFR qis tau suav tias yog GFRkidney qis dua. Cov qhab nia ua haujlwm sib cais (Q tus nqi) tau siv los ntsuas qhov sib txawv ntawm ob sab raum ua haujlwm. Cov neeg mob tau muab faib ua 3 pawg raws li Q tus nqi (Pab 1, Q tus nqi<5%; group="" 2,q="" value="" of="" 5%-10%;="" group="" 3,="" q="" value="">10 feem pua). Txhua tus neeg mob tau txais kev kho mob ntshav siab raws li ACEl / ARB. Lub raum dynamic dluab tau ua thaum lub sij hawm 1- xyoo rov qab los soj ntsuam cov kev hloov hauv SBE. Piv nrog rau theem pib, qhov kev poob qis tseem ceeb tau pom hauv cov ntshav creatinine (Scr) hauv pawg 2 thiab Pab Pawg 3 (P.<.05). the="" cystatin="" c="" in="" group="" 3="" showed="" a="" significant="" decline=""><.05). compared="" with="" the="" baseline,="" there="" was="" a="" significant="" decline="" in="" the="" q="" value="" in="" group="" 2.="" whereas="" the="" gfr="" of="" lower="" gfrkidney="" showed="" a="" significant="" increase=""><.05). no="" statistical="" differences="" were="" noticed="" in="" the="" q="" value="" and="" split="" gfr="" in="" group="" 1="" and="" group="" 3="" (p="">.05).

Hauv thawj cov neeg mob ntshav siab. ACEl / ARB txoj kev kho tuaj yeem txhim kho SRF ntawm qis GFR ob lub raum thaum muaj qee qhov sib txawv ntawm SRF. Raws li qhov tshwm sim, qhov sib txawv SRF raug txo. Nyob rau hauv cov ntaub ntawv ntawm Q tus nqi nyob rau hauv ib tug ntau ntawm 5 feem pua ​​​​mus rau 10 feem pua ​​.ACEV/ARB tuaj yeem txhim kho lub raum ua haujlwm zoo. Nws tuaj yeem yog qhov tseem ceeb rau kev tsim cov tshuaj tiv thaiv hypertensive.

Cov ntawv luv: 99mTc-DTPA=diethylenetriaminepentaacetic acid tagged nrog 99mTc, ACE=angiotoninase. ACEl =angiotensin-hloov enzyme inhibitors. ARB= angiotensin receptor blocker.AT-I= angiotensin-I. AT-ll= anaiotensin-Il, CysC=cystatin C, DBP= diastolic ntshav siab, GFR= glomerular filtration rate, RAAS= renin-angiotensin - aldosterone tshuaj. SBP=systolic ntshav siab, Scr=serum creatinine, SRF=phua lub raum ua haujlwm, UA=uric acid, UREA=urea nitrogen.

Ntsiab lus: ACEl / ARB, thawj hypertension, lub raum dynamic imaging, phua lub raum ua haujlwm

Cistancheyog tshuaj ntsuab tshaj plaws nyob rau hauv cov tshuaj suav tshuaj los tiv thaiv, txo thiab txawm kho mob raum. Cov khoom xyaw tseem ceeb hauv Cistanche yogphenylethanoidglycosides, echinacoside cov tshuaj, acteoside, thiabflavonoids. Ntau qhov kev sim tshuaj ntsuam xyuas tau ua pov thawj tias tom qab noj ntau npaum li cas Cistanche rau ib hlis hauv cov neeg mob raum, cov ntshav siab tau txo qis, qhov ntsuas cov zis tau txo qis, thiab GFR zoo dua.

Nyem kom paub seb cistanche siv rau dab tsi thiab nws kho lub raum ua haujlwm li cas

1. Taw qhia

Lub raum raug mobyog ib qho teeb meem ntawm thawj cov ntshav siab. Renin-angiotensin-aldosterone system (RAAS), suav nrog hauv zos thiab ncig RAAS, ua lub luag haujlwm tseem ceeb hauv kev tswj cov ntshav siab thiab cov kab mob ntawm lub raum mob ntev.2]Juxtaglomerular cells tuaj yeem tso cov renin thiab tom qab ntawd qhib cov angiotensinogen uas ua rau cov tiam ntawm angiotensin-I (AT-I).3 Hauv pulmonary vascular endothelial hlwb, AT-I tau kis mus rau angiotensin-II (AT-I) los ntawm angiotoninase (ACE). Lub AT-Kuv yuav ua rau kom nce ntshav ntim los ntawm kev koom tes ncaj qha rau hauv kev tsim kho ntawm arteriola lossis txhawb kev tso tawm ntawm aldosterone hauv thaj chaw glomerular ntawm adrenal cortex.[4,5] Hloov pauv, nws tuaj yeem pom tseeb tias cov ntshav siab. los ntawm kev txhawb kev tso tawm ntawm catechol-amine los ntawm lubadrenalmedulla thiab sympathetic paj ending.6] Rau peb qhov kev paub zoo tshaj plaws, AT-Kuv tau cuam tshuam nrog kev txhim kho ntawm glomerular hypertension, uas tom qab ntawd yuav ua rau muaj kev hloov pauv hemodynamic. Cov txheej txheem no tau tshaj tawm tias muaj feem cuam tshuam nrog kev nce siab ntawm glomerular capillary siab, proteinuria kev loj hlob, thiab glomerulosclerosis.8] Tsis tas li ntawd, kev nce qib ntawm cov proteinuria yuav ua rau lub raum tsis zoo. Cov protein raug ntawm tubular hlwb yuav ua rau muaj kev tso tawm ntawm cov proinflammatory cytokines, nrog rau cov cellular aggregation thiab txawm raug mob tom qab ntawd. siv hauv chaw kho mob los hloov kho cov ntshav siab thiab tiv thaiv lub raum ua haujlwm.

Raws li qhov loj RAS inhibitor, ACEI / ARB tuaj yeem ua rau txo qis kev kub siab, glomerular hypertension, nrog rau qib proteinuria.10 Ntxiv rau, nws tuaj yeem cuam tshuam cov cellular proliferation thiab hypertrophy, thiab txiav tawm cov cytokines thiab lwm yam chemokines. Tsis tas li ntawd, nws tuaj yeem txo qis qhov sib xyaw ntawm extracellular matrix nyob rau hauv glomerular hlwb thiab ncua kev loj hlob ntawm lub raum ibrosis.1Txawm li cas los xij, qhov ua tau zoo ntawm ACEI / ARB hauv dilating efferent arteriole ntawm glomerulus yog superior rau cov afferent arteriole ntawm lub glomerulus, uas tom qab ntawd ua rau poob ntawm glomerular filtration siab thiab lub raum ua haujlwm, nrog rau glomerular filtration rate (GFR).12Thaum ntxov, ACEIARBmay ua rau qhov nce ntawm cov ntshav creatinine (Scr) thiab potassium concentration.13] Raws li cov lus piav qhia dhau los. , ib feem ntawm qee cov neeg mob ntshav siab tuaj yeem ua rau lub raum tsis ua haujlwm tsis zoo.14]Txawm li cas los xij, tsis tshua muaj kev tshawb fawb tau tsom mus rau kev ua haujlwm ntawm lub raum (SRF) ntawm cov neeg mob tom qab kev tswj hwm mus sij hawm ntev ntawm ACEI / ARB, nrog rau kev hloov pauv hauv qhov sib txawv ntawm GFR qis dua thiab siab dua GFR raum. Tus nqi tshem tawm ntawm cov tshuaj isotope-labeled yog suav tias yog tus qauv ntsuas rau kev soj ntsuam ntawm GFR, nrog diethylenetriaminepentaacetic acid, tagged nrog 2WQ299mTc (99mTe-DTPA) feem ntau siv hauv chaw kho mob. Cov txheej txheem zoo li no muaj txiaj ntsig zoo nrog kev rov tsim dua tshiab. Hauv txoj kev tshawb no, 99mTc-DTPA lub raum dynamic imaging txoj kev tau siv los txiav txim tag nrho thiab faib GFR, nrog rau lub hom phiaj los soj ntsuam cov teebmeem ntawm ACEI / ARB ntawm SRF hauv cov neeg mob ntshav siab.

2. Cov ntaub ntawv thiab cov txheej txheem

2.1. Cov kawm

Cov neeg mob ntshav siab thawj zaug tau lees paub rau peb lub chaw haujlwm thaum Lub Ib Hlis 2014 thiab Kaum Ob Hlis 2016 tau suav nrog hauv qhov kev tshawb fawb rov qab no. Kev kuaj mob ntshav siab tau ua raws li cov txheej txheem tau hais los ntawm Tuam Tshoj Medical Association.15] Kev kuaj mob ntshav siab tau ua raws li cov qauv hauv qab no: qhov muaj cov ntshav siab systolic (SBP) ntau dua lossis sib npaug li 140 mmHg thiab / lossis cov ntshav diastolic. siab (DBP) Ntau dua lossis sib npaug li 90 mmHg ntawm 3 hnub sib txawv yam tsis muaj kev tswj hwm cov tshuaj tiv thaiv ntshav siab. Cov txheej txheem cais tawm yog raws li hauv qab no: cov neeg mob ntshav siab, ntshav qab zib mellitus, kab mob hauv lub raum,

gout, urinary system kab mob, los yog malignancy; cov neeg uas muaj kev fab tshuaj lossis tsis kam ua rau ACEI/ARB; cov neeg uas muaj lub plawv tsis ua hauj lwm hnyav, New York Heart Association chav kawm Ⅲ-IⅣV; cov neeg uas muaj mob cerebral lossis kab mob siab; los yog cov neeg muaj lub raum hlab ntsha stenosis tom qab kuaj ultrasonic. Cov neeg mob uas muaj lub raum tsis txaus nrog Scr siab dua 265μmol / L tsis suav nrog hauv txoj kev tshawb no. Txoj kev tshawb no tau zam qhov kev pom zoo ntawm Ethical raws li nws yog kev tshuaj xyuas rov qab. Tsuas yog cov ntaub ntawv kho mob ntawm cov neeg mob tau sau tseg yam tsis muaj kev cuam tshuam hauv cov txheej txheem kho mob. Tsis muaj kev pheej hmoo ntawm lub cev rau cov neeg mob, thiab kev ceev ntiag tug ntawm cov neeg mob tsis tau qhia tawm. Yog li ntawd, kev pom zoo tsis tau muab rau hauv qhov kev tshawb fawb no.

2.2. Pab pawg

Qhov sib txawv SRF (O tus nqi) tau siv los ntsuas qhov sib txawv ntawm ob sab ntawm lub raum ntawm tib tus neeg mob. Cov neeg mob tau muab faib ua 3 pawg raws li tus nqi O, Q tus nqi ntawm<5%(group 1),="" 5%≤q=""><10%(group 2),="" and="" ≥10%(group="" 3),="" respectively.="" for="" the="" same="" patient,="" the="" side="" with="" high="" gfr="" was="" considered="" a="" higher="" gfr="" kidney,="" whereas="" that="" with="" a="" low="" gfr="" was="" considered="" a="" lower="" gfr="" kidney.="" all="" the="" patients="" received="" renal="" dynamic="" imaging="" again="" during="" the="" 1-year="">

2.3. Cov txheej txheem

Tag nrho cov kev kawm uas muaj nyob rau hauv txoj kev tshawb no tau txais kev kho mob antihypertensive raws li ACEI / ARB, thiab tom qab ntawd cov neeg mob cov yam ntxwv suav nrog hnub nyoog, poj niam txiv neej, cov ntaub ntawv keeb kwm, ntshav siab, thiab lub cev qhov hnyav tau sau. Tsis pub dhau 24 teev tom qab nkag, peb tau txiav txim siab ceev cov ntshav qabzib (FBG), tag nrho cov roj cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate transaminase, albumin, Scr, urea nitrogen (UREA), Cystatin. C (CysC), thiab uric acid (UA) tom qab 8 teev ntawm kev yoo mov. Cov ntsuas ntsuas tau siv lub tshuab biochemistry tsis siv neeg (Hitachi 7600A, Tokyo, Nyiv) thiab ADVIA 2400 biochemical analyzer (Simens, Berlin, Lub teb chaws Yelemees). Cov khoom siv coj mus muag siv rau kev txiav txim siab ntawm FBG, ntshav rog, siab ua haujlwm, Scr, thiab UA tau yuav los ntawm LeadMan (Peking. China). CysC tau ntsuas siv cov txheej txheem tiv thaiv kab mob colloidal kub.

Lub raum dynamic 99mTc-DTPA tau saib xyuas siv Millennium Hawkeye VG Imaging facility (GE Healthcare, CA). 99mTc-DTPA tau muab tso rau hauv txoj cai nruab nrab ntawm cov hlab ntsha hauv cov qauv bolus. Ib leeg-photon emission suav tomography tau siv rau kev sau cov duab dynamic, ua raws li piav qhia txog thaj chaw ntawm lub raum thiab lub plab aorta. Rau lub hauv paus no, GFR ntawm tag nrho thiab cais lub raum tau suav nrog nrog cov tsis muaj feem cuam tshuam nrog cov ntshav perfusion ntawm lub raum thiab lub raum ua haujlwm curvature. Tsis tas li ntawd, lub raum morphology thiab kev ua haujlwm thiab kev tso zis ntawm cov zis tau raug saib xyuas.16GFR ntawm lub raum sib cais tau saib xyuas siv 99mTC-DTPA, suav nrog QR, QL, thiab Q, raws li. Q tus nqi raug xam raws li cov qauv hauv qab no raws li tau piav qhia dhau losdl17:QL=GFRJ/GFRg ntxiv rau L; QR=GFRR/GFRR plus L; Q=|QL-QR|.

2.4. Kev txheeb cais

SPSS 22.0 software tau siv rau kev txheeb xyuas kev txheeb xyuas (SPSS Inc, Chicago, IL). Cov ntaub ntawv ntsuas tau raug sim rau qhov kev faib tawm ib txwm muaj. Cov ntaub ntawv uas ib txwm muab faib tau nthuav tawm raws li qhov ntsuas ± tus qauv sib txawv. Ib tug tub-ntxhais kawm ntawv t-test tau ua rau kev sib piv ntawm pab pawg. Kev txheeb xyuas qhov sib txawv tau ua rau kev sib piv ntau pawg. Rau cov ntaub ntawv nrog qhov sib txawv tseem ceeb tom qab kev sib piv ntau pawg, LSD txoj kev siv rau kev sib piv. Cov ntaub ntawv uas tsis yog ib txwm muab faib tau raug sim siv qhov ntsuas tsis yog parametric thiab tau nthuav tawm raws li qhov nruab nrab. P<.05 was="" considered="" to="" be="" statistically="">

3. Cov txiaj ntsig

3.1. Cov yam ntxwv ntawm tus neeg mob

There were no statistical differences in age, sex, body mass index, SBP, DBP, alanine aminotransferase, aspartate transaminase, albumin, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and FBG(P>.05). Besides, there were no statistical differences in the treatment regimen of ACEI/ARB among the 3 groups (P>.05, Tab 1).

3.2.Kev sib piv ntawm Scr, UREA, CysC, UA, thiab ntshav siab

Ua ntej kev kho mob, Scr thiab CysC hauv pab pawg 3 tau nce siab dua li ntawm Pawg 1 thiab Pab Pawg 2 (P<.05).in the1-year="" follow-up,="" there="" were="" no="" obvious="" changes="" in="" the="" urea="" compared="" with="" the="" baseline="" line="" in="" 3="" groups(p="">.05). Tom qab kev kho mob, Scr thiab CysC pom qhov poob qis dua piv nrog cov

Cov theem pib, tshwj xeeb tshaj yog nyob rau hauv Pawg 3 (P<.05). compared="" with="" the="" baseline="" level,="" a="" significant="" decline="" was="" noticed="" in="" the="" sbp="" and="" dbp="" in="" group="" 1,="" group="" 2,="" and="" group="" 3,="" especially="" group="" 3=""><.05, table="">

3.3.Kev sib piv ntawm SRF

Ntawm cov neeg mob ntshav siab thawj zaug, kev raug mob raum ob sab sib txawv. Ua ntej kev kho mob, muaj qhov sib txawv ntawm qhov sib cais ntawm lub raum GFR ntawm tib tus neeg mob (P<.05). after="" treatment,="" no="" statistical="" differences="" were="" noticed="" in="" the="" split="" renal="" gfr="" compared="" to="" baseline="" (p="">.05, Tab 3).

3.4.Kev sib piv ntawm phua lub raum GFR thiab Q tus nqi hauv txhua pab pawg

Piv nrog rau theem pib, qhov kev poob qis tseem ceeb tau pom nyob rau hauv SRF qhov sib txawv hauv Pab Pawg 2 tom qab 1-kev kho mob xyoo, sawv cev los ntawm qhov poob ntawm O tus nqi. Kev nce siab tseem ceeb tau pom nyob rau hauv GFR ntawm qis GFR raum (P<.05). in="" groups="" 1="" and="" 3,="" there="" were="" no="" statistical="" differences="" in="" the="" o="" value="" and="" split="" renal="" gfr="" compared="" with="" the="" baseline="" levels(p="">.05, Tab 4).

4. Kev sib tham

Ntshav siab thaum ntxov tuaj yeem ua rau muaj kev puas tsuaj ntau yam hauv nruab nrog cev, ntawm cov uas lub raum tsis ua haujlwm tau tshwm sim los ntawm qhov pib lig thiab kev loj hlob sai. Thaum kawg, nws yuav ua rau lub raum tsis ua haujlwm thiab txawm tias tuag, uas tau txais kev saib xyuas ntau dua. Raws li kev tshawb fawb yav dhau los, qhov tshwm sim ntawm lub raum tsis ua haujlwm los ntawm kev kub siab thawj zaug tsuas yog ua tsis tau zoo rau cov teeb meem hauv plawv, ntawm cov neeg mob coob leej tuag los ntawm lub raum tsis ua haujlwm. Lub raum arterioles, uas tom qab ntawd ua rau muaj kev hloov pauv hauv ischemic hauv glomerulus, nrog rau lub raum tsis ua haujlwm thiab tsis ua haujlwm.1Cov neeg mob ntshav siab, qhov poob ntawm cov ntshav perfusion hauv 2 lub raum yuav tsis sib haum, uas yuav ua rau lub raum tsis ua haujlwm puas tsuaj. 20Rau peb qhov kev paub zoo tshaj plaws, tsis tshua muaj kev tshawb fawb tau tsom mus rau kev soj ntsuam ntawm kev sib cais lub raum tsis ua haujlwm vim tias muaj ntshav siab.2II hauv kev tshawb fawb dhau los, Schutten li al suav nrog 146 tus neeg mob ntshav siab, thiab tom qab ntawd cov qib rennin thiab aldosterone ntawm ob sab tau txiav txim siab ua ke nrog cov lub raum ntshav khiav. Txoj kev tshawb no pom tau hais tias qhov nruab nrab ntawm cov ntshav ntws hauv lub raum sab laug hauv cov neeg mob ntshav siab thawj zaug tau qis dua li ntawm lub raum sab xis. Tsis tas li ntawd, muaj qhov cuam tshuam tsis zoo ntawm lub raum cov ntshav ntws thiab qhov sib piv ntawm aldosterone-renin. Qhov no qhia tau hais tias tej zaum yuav muaj qhov sib txawv ntawm lub raum kev puas tsuaj ntawm ob lub raum ntawm cov neeg mob ntshav siab.22 Ib qho kev sim tsiaj tau qhia tias kev faib cov hlab ntsha ntawm ob lub raum txawv. Hypoxia tuaj yeem ua rau muaj kev ua siab zoo, uas ua rau lub raum fibrosis thiab txo cov ntshav hauv lub raum. Yog li ntawd, theem ntawm fibrosis nyob rau hauv ob lub raum tsis yog parallel.123] Rau cov neeg mob uas muaj unilateral lub raum hlab ntsha stenosis, lub raum tsis ua hauj lwm feem ntau tsis tau kuaj pom vim hais tias ntawm lub compensatory muaj nuj nqi ntawm lub raum tsis ua hauj lwm contralateral. Lub raum dynamic imaging tau pab rau kev ntsuam xyuas ntawm SRF. Yog li ntawd, nws tau siv dav hauv kev kuaj mob ntawm unilateral lub raum hlab ntsha stenosis.24Nyob rau hauv txoj kev tshawb no, xws li ib txoj kev tau siv los txiav txim SRF, uas qhia tau hais tias nyob rau hauv cov neeg mob uas muaj thawj kub siab, GFR ntawm ib lub raum yog ho siab dua li ntawm. lwm yam, thiab kev puas tsuaj ntawm ob lub raum tsis sib npaug. Qhov no tau ua raws li cov kev tshawb fawb yav dhau los.

ACEI, ib hom tshuaj antihypertensive, tau siv dav hauv kev kho mob ntshav qab zib mellitus, plawv tsis ua haujlwm, thiab kab mob plawv. Hauv kev tshawb fawb yav dhau los, GFR ntawm cov neeg mob uas muaj ntshav siab tseem ceeb nrog rau lub raum tsis ua haujlwm tau txais kev tswj hwm ACEI ntev tau pom tias muaj kev nce ntxiv, tshwj xeeb tshaj yog rau cov neeg uas muaj lub raum qis qis, tab sis autoregulating muaj nuj nqi tseem muaj. Tom qab ntawd, txoj kev tshawb fawb AASK tau tshawb xyuas qhov tshwm sim ntawm hypertensive lub raum tsis ua haujlwm; ramipril yog qhov zoo tshaj rau kev sib xyaw ntawm amlodipine thiab metoprolol nyob rau hauv qhov kev pom ntawm cov txiaj ntsig nyuaj hauv lub raum theem kawg.127] AIPRI txoj kev tshawb fawb tau lees paub tias ACEI tuaj yeem txo qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm.28II hauv kev saib tshuaj, ACEI tuaj yeem ua rau RAAS, thiab inhibit qhov Kev xa tawm ntawm AT-I mus rau AT-II, uas ua rau txo qis ntawm AT-II concentration. Tsis tas li ntawd, nws tuaj yeem cuam tshuam qhov degradation ntawm bradykinin, uas tom qab ntawd ua lub luag haujlwm tiv thaiv ntawm lub raum ua haujlwm. Raws li tus neeg sawv cev tiv thaiv ntshav siab tshiab, ARB feem ntau lees txais los ntawm cov neeg mob piv rau ACEI vim nws ua rau hnoos qhuav, qhov ncauj qhuav, thiab mob taub hau. Hauv IDNT txoj kev tshawb fawb tau ua nyob rau xyoo 2000, qhov kev pheej hmoo ntawm Scr ntau ntau hauv pawg Irbesartan tau qis dua li ntawm pawg placebo.27 Hauv kev xav tshuaj, ARB tuaj yeem khi nrog angiotensin type 1 receptor hauv kev sib tw, uas tom qab ntawd txiav tawm cov haujlwm. ntawm AT-II. Lub caij no, nws tuaj yeem pab txhawb rau kev sib txuas ntawm bradykinin thiab ua haujlwm tiv thaiv. Hauv cov ntsiab lus, ACEJ / ARB tuaj yeem thaiv cov RAAS thiab tom qab ntawd coj mus rau lub raum cov hlab ntsha thiab nce hauv lub raum cov ntshav ntws.28] Tsis tas li ntawd, ACEI / ARB tuaj yeem txo qis glomerular filtration siab, txo cov protein pom los ntawm glomerular capillaries. , inhibit qhov sib txuam ntau ntawm cov kab mob extracellular matrix, thiab txo qis kev loj hlob ntawm glomerular sclerosis. Ntau qhov kev tshawb fawb soj ntsuam tau lees paub tias ACEI / ARB tau pom tias muaj peev xwm kho tau qhov tseem ceeb rau cov neeg mob uas lub raum tsis txaus. Ib txoj kev tshawb fawb loj qhia tau tias ACEI/ARB txo qis tag nrho cov neeg tuag vim tsis tau lim ntshav rau cov neeg mob lub raum tsis ua haujlwm.30 Maione thiab al qhia tias ACEI txo qis kev pheej hmoo ntawm cov kab mob plawv tsis ua rau tuag taus. ACEI/ARB kuj tseem tuaj yeem txo qis qhov tshwm sim ntawm cov kab mob hauv lub raum kawg thiab cov proteinuria.31Nyob rau hauv cov lus qhia txog kev kub siab, ACEI/ARB tau pom zoo hauv kev kho mob ntshav siab nrog rau cov kab mob raum ntev. ACEI / ARB tuaj yeem tswj cov ntshav siab thiab tiv thaiv lub raum los ntawm kev thaiv RAAS, thiab lub raum puas hauv ntshav siab tsis yog sib npaug. Yog li, peb kwv yees tias ACEI / ARB tuaj yeem cuam tshuam rau SRF. Txawm li cas los xij, tsis tshua muaj kev tshawb fawb tau tsom mus rau qhov ua tau zoo ntawm kev siv mus sij hawm ntev ntawm ACEI / ARB ntawm kev ua haujlwm ntawm ob lub raum.

Nyob rau hauv txoj kev tshawb no, peb piv cov concentrations ntawm CysC thiab Scr nyob rau hauv 3 pawg thiab pom tias Scr thiab CysC theem poob, tshwj xeeb tshaj yog nyob rau hauv pab pawg neeg 3 tom qab kev kho mob. Cov txiaj ntsig tau qhia tias kev kho ACEI / ARB tuaj yeem ncua lub raum kev ua haujlwm tsis zoo lossis tseem txhim kho lub raum ua haujlwm, tshwj xeeb tshaj yog rau cov neeg uas muaj O tus nqi ntawm 210 feem pua. Txawm li cas los xij, tsis muaj qhov sib txawv ntawm cov ntaub ntawv tau pom nyob rau hauv kev faib raum GFR nyob rau hauv txhua rooj plaub tom qab kev kho mob piv nrog cov theem pib. Qhov laj thawj yog vim li cas qhov kev kho mob ntawm ACEI / ARB sib txawv hauv 3 pawg. Peb txuas ntxiv ua pab pawg raws li O tus nqi thiab txheeb xyuas qhov kev txhim kho ntawm ACEI / ARB ntawm GFR thaum O qhov tseem ceeb nyob hauv ntau qhov sib txawv. Cov txiaj ntsig tau pom tias nyob rau hauv cov xwm txheej ntawm O tus nqi hauv thaj tsam ntawm 5 feem pua ​​​​rau 10 feem pua, ACEI / ARB tuaj yeem txo qhov kev ua haujlwm sib txawv ntawm lub raum cais, nrog rau kev txhim kho GFRin qis GFRkidney.Nyob rau hauv lub xub ntiag ntawm O tus nqi ntau dua. los yog sib npaug 10 los yog<5, these="" effects="" were="" not="" obvious.="" these="" results="" indicated="" that="" when="" the="" srf="" difference="" increased="" gradually,="" acei/arb="" could="" protect="" the="" renal="" function="" effectively.="" however,="" the="" protective="" effect="" of="" acei/arb="" declined="" when="" the="" renal="" function="" difference="" increased="" to="" a="" certain="">

Muaj qee qhov kev txwv rau txoj kev tshawb no. Peb tsuas yog tsom rau cov neeg mob ntshav siab nrog qib creatinine<265μmol .="" in="" the="" future,="" further="" studies="" are="" required="" to="" investigate="" the="" efficiency="" of="" acei/arb="" treatment="" on="" the="" srf="" in="" patients="" with="" severe="" renal="">

Hauv cov ntsiab lus, lub raum dynamic imaging yog ib qho txheej txheem siv los ntsuas GFR thiab kuaj pom lub raum hlab ntsha stenosis. Txawm hais tias nws tseem tuaj yeem siv los ntsuas qhov sib txawv SRF (O tus nqi), O tus nqi tsis tau siv dav hauv kev kho mob, thiab kev tshawb fawb txog O tus nqi tsawg heev. Peb txoj kev tshawb fawb tau pom tias ACEI / ARB tuaj yeem txhim kho GFR ntawm qis GFR ob lub raum hauv cov neeg mob ntshav siab thaum tus nqi O nyob rau hauv ib qho kev sib txawv. Yog li, nyob rau hauv cov xwm txheej ntawm O tus nqi nyob rau hauv thaj tsam ntawm 5 feem pua ​​​​rau 10 feem pua, ACEI / ARB yuav yog qhov kev xaiv zoo dua los txhim kho lub raum ua haujlwm. Nws yog qhov muaj txiaj ntsig zoo rau kev xaiv cov tshuaj antihypertensive