血清血管紧张素转化酶测定及其在肺部疾病的初步应用

本文报告使用国产马尿酰甘氨酰甘氨酸为底物,以紫外分光光度计测定血清血管紧张素转化酶(SACE)的方法。并对69例正常人、55例肺结核、46例肺癌、4例淋巴瘤、3例肺炎及1例临床疑诊为结节病患者进行了SACE测定:结果:正常值35.38±8.7u(X±SD);肺结核、肺癌患者的SACE与正常人无显著差异;1例疑诊为结节病者显著增高(69.45u)。认为SACE测定可作为结节病辅助诊断检测项目之一;对非结节病性肺部疾病的SACE活性变化,有待进一步观测、研究。     

Borrelia burgdorferi infection may be the cause of sarcoidosis.

Serum antibody to Borrelia burgdorferi was measured in 33 patients with sarcoidosis which was confirmed clinically and pathologically. The results showed that 81.8% of the patients were positive for anti-B. burgdorferi antibody. In addition, a strain of B. burgdorferi was isolated from a patient's blood. Fifteen patients received ceftriaxone 2g per day or penicillin 12 million U per day. The antibody titers of the patients decreased to nearly normal levels rapidly. Serum angiotensin converting enzyme (SACE) turned to normal range after the treatment. According to the findings mentioned above, we consider that B. burgdorferi infection may be the cause of sarcoidosis and sarcoidosis might be a specific type of Lyme disease.

     

Serum angiotensin converting enzyme activity in patients with histoplasmosis

The association between increased serum angiotensin converting enzyme (ACE) activity and active sarcoidosis is well documented. During a recent outbreak of acute histoplasmosis, a disease that shares many of the clinical and roentgenographic features of sarcoidosis, we examined serum ACE activity. Twenty-one (25%) of 86 patients with histoplasmosis had increased serum ACE activity. There were neither roentgenographic nor other substantive clinical differences between the groups of patients with increased and normal ACE values. Therefore, an increase in serum ACE activity must not be assumed to be caused by sarcoidosis unless histoplasmosis had been excluded.     

An 82 year-old patient with sarcoidosis

An 82 year-old woman presented with bilateral uveitis suggestive of ocular sarcoidosis, which led to a clouded vision. She was diagnosed as having sarcoidosis because of an elevated level of serum angiotensin converting enzyme (ACE), findings from a Ga67 scintiscan and the bilateral uveitis, although her chest X-ray film was normal. This patient is one of the most oldest patients on record to have sarcoidosis.     

Sarcoidosis: the clinical problem

This paper reviews the clinical manifestations of acute and chronic sarcoidosis. The indications for measuring serum angiotensin converting enzyme and for performing pulmonary function tests, bronchiolo-alveolar lavage and gallium scans are discussed and the modern indications for performing a Kveim Siltzbach test are also considered. The main treatment available for patients with sarcoidosis is systemic steroids and the indications in the various systems for using these drugs are discussed.     

Controlled trial of enalapril in patients with chronic fluid overload undergoing dialysis

About one third of patients receiving dialysis for end stage renal failure have chronic fluid overload despite advice to restrict their oral fluid intake. To investigate the potential of an angiotensin converting enzyme inhibitor in reducing the urge to drink and consequent gain in weight, a double blind, placebo controlled crossover trial of enalapril was conducted in 25 patients receiving dialysis who had fluid overload. The trial comprised a baseline period of four weeks; two periods of treatment, each of four weeks, during which patients received either placebo or enalapril 5 mg twice each week; and a follow up period of four weeks. Five patients withdrew from the trial, one because of an adverse drug reaction to enalapril. A range of biochemical and behavioural variables was measured during the baseline period, at the completion of periods 1 and 2, and during follow up. These variables included gain in weight between dialysis sessions; blood pressure; plasma concentrations of sodium, angiotensin II, and vasopressin; plasma renin and angiotensin converting enzyme activities; osmolality; and estimations of thirst, intake of fluid, and control of drinking. Enalapril caused a significant reduction in gain in weight between dialysis sessions, thirst, and oral intake of fluid in parallel with significantly increased renin activity, significantly decreased angiotensin converting enzyme activity, and decreased concentrations of angiotensin II. Gain in weight and angiotensin converting enzyme activity returned to baseline values once patients stopped taking enalapril. These results suggest that enalapril may act on the renin-angiotensin system and reduce intake of fluid by inhibiting angiotensin converting enzyme.     

Effect of captopril (SQ 14225) on blood pressure, plasma renin activity and angiotensin I converting enzyme activity.

Seven patients with essential hypertension and seven patients with hypertension associated with renal artery stenosis received captopril (SQ 14225), an inhibitor of angiotensin I converting enzyme. There was a significant reduction in mean blood pressure, from 176/113 +/- 4/3 mm Hg during the control period to 140/90 +/- 5/3 mm Hg during captopril administration. Five patients received captopril alone and nine patients needed hydrochlorothiazide in addition to control their blood pressure. Captopril produced a significant increase in peripheral plasma renin activity. When measured 12 hours after the administration of captopril the angiotensin I converting enzyme activity was found to be similar to that during the control period even though the blood pressure was at or near normal. These findings indicate that although captopril is an effective antihypertensive agent, its action does not depend only on inhibition of plasma angiotensin I converting enzyme activity.     

Acquired hypogammaglobulinaemia and sarcoidosis

A syndrome has been described in which hypogammaglobulinaemia is associated with splenomegaly and haemolytic anaemia and also non-caseating granulomata in lymph nodes, liver, spleen and skin. This report describes a patient with this syndrome who in addition had a positive Kveim and elevated serum angiotensin converting enzyme (SACE), suggesting the diagnosis of sarcoidosis.     

Severe refractory sarcoidosis in a 64-year-old man with persistent leucopenia

We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties.     

Enalapril in the treatment of hypertension with renal artery stenosis

The converting enzyme inhibitor enalapril, in single daily doses of 10-40 mg, was given to 20 hypertensive patients with renal artery stenosis. The blood pressure fall six hours after the first dose of enalapril was significantly related to the pretreatment plasma concentrations of active renin and angiotensin II and to the concurrent fall in angiotensin II. Blood pressure fell further with continued treatment; the long term fall was not significantly related to pretreatment plasma renin or angiotensin II concentrations. At three months, 24 hours after the last dose of enalapril, blood pressure, plasma angiotensin II, and converting enzyme activity remained low and active renin and angiotensin I high; six hours after dosing, angiotensin II had, however, fallen further. The rise in active renin during long term treatment was proportionally greater than the rise in angiotensin I; this probably reflects the fall in renin substrate that occurs with converting enzyme inhibition. Enalapril alone caused reduction in exchangeable sodium, with distinct increases in serum potassium, creatinine, and urea. Enalapril was well tolerated and controlled hypertension effectively long term; only two of the 20 patients required concomitant diuretic treatment.     

伴有心房颤动的二尖瓣置换术患者术前外周血ACE、CRP水平

目的了解伴有心房颤动的二尖瓣置换术患者术前外周血血管紧张素转换酶(ACE)及C-反应蛋白(CRP)水平升高是否与心房颤动有关。方法伴有心房颤动的二尖瓣置换术术前患者24例为研究组;仍为窦性心律的二尖瓣置换术术前患者23例为对照组。所有患者术前常规进行心脏超声心动图检查。分别检测两组患者术前外周血ACE、CRP水平。结果两组患者间CRP水平的差异无统计学意义(P>0.05)。伴有心房颤动的二尖瓣置换术患者其外周血中ACE水平高于窦性心律的患者,差异有统计学意义(P<0.05)。伴心房颤动的患者外周血ACE水平与左房(LA)前后径呈直线相关(r=0.478,P=0.001),多元回归分析显示:心房颤动与外周血ACE水平有关(r=0.094,P=0.033)。结论伴有心房颤动的二尖瓣置换术患者其术前外周血ACE水平升高,ACE水平升高与心房颤动有关。     

犬心房组织血管紧张素转化酶和C反应蛋白水平与心房颤动关系的研究

目的探讨血管紧张素转化酶（ACE）和C反应蛋白（CRP）在慢性房颤犬心房组织中的表达及意义。方法随机将健康杂种犬16条分为正常对照组、单纯房颤起搏组各8只。房颤组植入埋藏式高频率心脏起搏器［（500±20）次/min］,起搏24周后处死动物,分别于左、右心房取材,采用免疫组织化学法,检测心房组织中血管紧张素转化酶（ACE）、C反应蛋白（CRP）以及血管紧张素转化酶抑制剂（ACEI）的表达变化。正常对照组未植入起搏器,与房颤组同步行相应检查。结果与对照组比较,房颤组心房组织中ACE和CRP表达水平显著增强,而ACEI的表达水平明显下降,各组间比较差异显著（P<0.01）。结论肾素血管紧张素（RAS）系统、炎症与房颤之间可能存在着一定的联系,阻断RAS系统有可能抑制房颤的发生、发展。     

各型痴呆患者血浆同型半胱氨酸水平对比分析

目的：探讨各型老年期痴呆患者血浆同型半胱氨酸（ Hcy ）水平变化特点。方法采用放射免疫比浊法测定阿尔茨海默病（AD）42例、血管性痴呆（VD）40例、帕金森痴呆（PDD）33例及对照组50例,空腹血浆Hcy及血管紧张素转化酶水平。结果 PDD组血浆Hcy水平低于VD组、AD组、对照组（ P＜0．05）,而血管紧张素转化酶水平高于VD组、AD组、对照组（ P＜0．05）;VD组、AD组、对照组的Hcy水平及血管紧张素转化酶水平比较差异均无统计学意义（ P＞0．05）。结论可能血浆Hcy水平与稳定期老年性痴呆无关联。     

Serum angiotensin converting enzyme in Sjogren's syndrome--a case report and study of 21 further cases

We report the case of an elderly woman with primary Sjogren's syndrome and abnormal liver function tests indicative of primary biliary cirrhosis. She was found to have a raised serum angiotensin converting enzyme activity. We proceeded to study 21 further cases of Sjogren's syndrome to discover whether raised levels of this enzyme were a feature of Sjogren's syndrome. None of them had any features to suggested associated primary biliary cirrhosis. The cases included 12 with associated rheumatoid arthritis, two with systemic sclerosis, three with systemic lupus erythematosus and four with primary Sjogren's syndrome. In only two of these 21 patients was a raised serum angiotensin converting enzyme obtained, the elevation being modest. We conclude that a raised activity of the enzyme is not usually associated with primary or secondary Sjogren's syndrome, and that discovery of such an abnormality should prompt a search for an associated condition.     

Hyaluronate in bronchoalveolar lavage fluid: a new marker in sarcoidosis reflecting pulmonary disease

Hyaluronate (hyaluronic acid) was not detectable in bronchoalveolar lavage fluid from smoking or nonsmoking healthy volunteers but was present in fluid from 23 patients with sarcoidosis; the mean concentration was 16 micrograms/1 returned fluid (range less than or equal to 5-430) or, expressed in relation to the amount of albumin recovered, 0.22 micrograms/mg albumin (range less than or equal to 0.05-3.6). The serum hyaluronate concentrations in the patients with sarcoidosis were normal. There was a significant inverse correlation between vital lung capacity and hyaluronate concentrations in bronchoalveolar lavage fluid (p less than 0.001), and patients with abnormal lung volumes had hyaluronate concentrations that were on average six times higher than those in patients with normal vital capacity. Duration of disease, pulmonary radiological findings, and markers for macrophage activation (angiotensin converting enzyme) and lymphocyte activation (beta 2 microglobulin) were not correlated with bronchoalveolar lavage fluid hyaluronate. It was concluded that in sarcoidosis release of hyaluronate into the airways is related to lung volume and therefore to the course of the disease. Increased synthesis of hyaluronate in lung parenchyma may reflect activation of fibroblasts, and measurements of hyaluronate may have clinical value for prognosis and treatment.     

原发性高血压患者G蛋白β3亚单位基因C825T多态性的研究

目的：研究中国大陆高血压人群中G蛋白β，亚单位(GNB3)基因(C825T多态性的分布及与血浆肾素-血管紧张素系统(RAS)活性的关系。方法：确诊原发性高血压的患者408例作为试验组，140例健康成年人作为正常对照组，61例有高血压家族史的健康成年人作为高血压家族史阳性正常对照组。C／T多态性测定采用PCR—RFLP方法。结果：各组GNB3 825T等位基因频率为45．6%～56．4％，各基因型在原发性高血压患者与正常人间分布差异无显著性。TT型高血压患者有较高的醛固酮水平和较低的血浆血管紧张素转换酶活性。结论：G蛋白β，亚单位825TT基因型的中国大陆人群原发性高血压患者有较高的醛固酮水平和较低的血浆血管紧张素转换酶活性。     

血管紧张素转换酶和内皮素与糖尿病微血管病变的关系

目的 探讨血管紧张素转换酶（angiotensin converting enzyme,ACE)和血浆内皮素（endothelin,ET)水平与糖尿病微血管病变的关系。方法 用紫外分光光度法和直接放射免疫法测定55例糖尿病患者和30名正常人血清ACE和血浆ET水平。结果 糖尿病微血管病变患者血清ACE和血浆ET水平显著高于糖尿病无微血管病变患者,且随着糖尿病微血管病变的加重,血清ACE和血浆ET水平显著增高。糖尿病患者血清ACE和血浆ET水平呈显著正相关。结论 糖尿病微血管病变患者血清ACE和血清ET水平增高可能与糖尿病微血管病变的发生发展有关。     

肝纤维化大鼠肝脏ACE/ACE 2的动态变化

目的研究肝纤维化进程中大鼠肝脏血管紧张索转换酶（ACE）、血管紧张索转换酶2（ACE2）水平AACE／ACE2的动态变化。方法制备四氯化碳（CCI。）诱导大鼠肝纤维化模型,分别于造模第15、30、45、60天处死模型组大鼠各6只,各组大鼠肝组织行HE和Masson染色,Westernblot法检测肝组织匀浆ACE、ACE。蛋白表达。结果在大鼠肝纤维化过程中,肝组织ACE、ACE2水平呈上升趋势;第15、30天模型组ACE／ACE2比值较对照组降低【尸〈005）,而第45天模型组其比值高于对照组（P〈005）,第60天时该比值明显增高（P〈001）。结论ACE、ACE2均参与大鼠肝纤维化形成。     

Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy

The effects of angiotensin converting enzyme inhibition with captopril were investigated in patients with diabetic nephropathy and hypertension. After nine days' treatment with captopril glomerular filtration rate was unchanged in 13 patients, whereas renal plasma flow had increased from 265 to 302 ml/min/1.73 m2 body surface area (p less than 0.05) and the filtration fraction had decreased from 14.3 to 12.8% (p less than 0.025). During two years' treatment with captopril in 14 patients the mean arterial blood pressure had fallen by 5 mm Hg (p less than 0.005) and the deterioration in glomerular filtration rate had decreased from 10.3 to 2.4 ml/min/year (p less than 0.005). There was no correlation between the fall in blood pressure and the reduction in the deterioration of glomerular filtration rate. These findings suggest that the effects of angiotensin converting enzyme inhibition on renal haemodynamics protect renal function. Inhibitors of angiotensin converting enzyme should be considered for lowering blood pressure in patients with diabetic nephropathy.     

Bronchial hyperreactivity in patients who cough after receiving angiotensin converting enzyme inhibitors

Angiotensin converting enzyme inhibitors cause cough in some patients, but the mechanism of this effect is not known. Six patients in whom these inhibitors had caused cough and a further two patients in whom they were suspected to have caused worsening of bronchial asthma were studied. Nine patients in whom angiotensin converting enzyme inhibitors had not been associated with cough served as controls. In the controls lung function and bronchial reactivity were measured once; for the study patients these and the cough index were measured twice before rechallenge for two weeks with an angiotensin enzyme inhibitor and once afterwards. Rechallenge with drug for two weeks caused a significant decrease in the mean concentration of histamine causing a 35% fall in airways conductance and a significant increase in the cough index. Patients with cough showed bronchial hyperactivity compared with the controls, which increased after rechallenge with the inhibitors. Cough associated with converting enzyme inhibitors may be a variant of the cough in asthma.