INCREASED PLASMA INACTIVE RENIN IN DIABETES-MELLITUS - A MARKER OF MICROVASCULAR COMPLICATIONS
INCREASED PLASMA INACTIVE RENIN IN DIABETES-MELLITUS - A MARKER OF MICROVASCULAR COMPLICATIONS
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DOI：
10.1056/nejm198505303122202
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
BRYERASH, M
中科院分区：
文献类型：
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作者：
LUETSCHER, JA;KRAEMER, FB;BRYERASH, M
血浆肾素以活性形式存在，或以非活性酶原的形式存在，类似于人类肾脏匀浆中存在的原肾素。探讨糖尿病及其微血管并发症与透析激活的血浆非活性肾素水平和pH 3.3的关系。测定了235例糖尿病患者和90例非糖尿病对照组的血浆非活性肾素水平。对照组血浆非活性肾素水平随年龄增长略有升高，但从未超过每小时50 ng/ml。在发病3年内研究的年轻糖尿病患者中，非活性肾素水平正常，而在一些无并发症的老年糖尿病患者中，多年来一直保持在年龄调整后的正常范围内。然而，在视网膜病变或蛋白尿患者中，除极少数例外，血浆非活性肾素水平高于正常范围，在肾病患者中达到正常上限的50%-20%。在水平高于正常范围的患者中，神经病变的发生率也明显更高。在37%的糖尿病患者中，在常规治疗的1-3年期间，血浆非活性肾素显著升高，但在另一组接受强化治疗的糖尿病患者中，仅有7%的患者血浆肾素水平上升，43%的患者下降。结论：高水平的血浆非活性肾素水平与微血管并发症的存在密切相关，糖尿病的强化治疗可以改善非活性肾素水平。
Plasma renin exists in an active form or as an inactive zymogen that resembles a prorenin present in homogenates of human kidneys. The relation of diabetes and its microvascular complications with the level of plasma inactive renin activated by dialysis to pH 3.3 was examined. Plasma inactive renin was measured in 235 diabetic patients and 90 nondiabetic controls. In the controls, the level of plasma inactive renin increased slightly with age but was never above 50 ng/ml per h. In young diabetic patients studied within 3 yr of the onset of diabetes the concentration of inactive renin was normal, and in some older diabetics without complications it remained within the age-adjusted normal range for many years. However, in patients with retinopathy or albuminuria, plasma inactive renin was above the normal range with few exceptions, reaching levels 50-20% above the upper limits of normal in patients with nephropathy. The frequency of neuropathy was also significantly higher among patients with levels above the normal range. In 37% of the diabetics followed during 1-3 yr of conventional treatment, plasma inactive renin increased significantly, but in another group of diabetics under intensive treatment, the level rose in only 7% and fell in 43%. It is concluded that there is a close association between a high level of plasma inactive renin and the presence of microvascular complications, and that the level of inactive renin can be modified by intensive treatment of diabetes.