Aldosterone: direct effects on and production by the heart.
Aldosterone: direct effects on and production by the heart.
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醛固酮：直接作用于心脏并由心脏产生。
DOI：
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发表时间：
2003
影响因子：
5.8
通讯作者：
P. White
中科院分区：
文献类型：
--
作者：
P. White
醛固酮是一种生理上最重要的矿质皮质激素，它的主要作用是通过上皮细胞的电解质运输，特别是在肾脏，但也在其他组织，如唾液腺和结肠。醛固酮通过直接或间接增加上皮性钠通道和钠，钾-三磷酸腺苷酶(1)的活性来增加钠(从而水)的吸收和钾的排泄。无论是遗传原因还是原发性醛固酮增多症(增生性或分泌性醛固酮腺瘤)所致的醛固酮过多，都会导致高血压。高血压反过来会对心血管系统产生严重的不良影响，包括左心室肥厚和心脏纤维化。越来越多的临床证据表明，醛固酮对心脏有直接的不良影响，这种影响与其对血压的影响无关。与同等严重程度的高血压患者相比，原发性醛固酮增多症患者更有可能出现左心室肥厚和中风。更重要的是，严重心力衰竭患者在常规治疗血管紧张素转换酶(ACE)抑制剂地高辛和速尿的基础上，给予盐皮质激素受体拮抗剂螺内酯，可将发病率和死亡率降低30%。本研究中使用的螺内酯剂量(25毫克)对血压没有增加作用，表明有直接的心脏保护作用(2)。值得注意的是，螺内酯只有在胶原合成标志物--III型前胶原氨基端肽的中值基线水平高于基线中值的患者中才有显著的益处。基线水平升高与死亡和住院风险增加相关，而螺内酯治疗可降低循环水平。这些结果表明，限制心脏纤维化可能是螺内酯使充血性心力衰竭患者受益的机制之一(3)。本文综述了有关醛固酮对心脏的直接作用和心脏内合成醛固酮的最新证据。有关醛固酮在充血性心力衰竭中的作用以及使用醛固酮拮抗剂治疗心脏病的详细信息可从其他综述中获得(4)。
The main effects of aldosterone, the most physiologically important mineralocorticoid, are on electrolyte transport across epithelia, particularly in the kidney, but also in other tissues, such as salivary glands and colon. Aldosterone acts to increase sodium (and consequently water) resorption and potassium excretion by directly or indirectly increasing the activity of epithelial sodium channels and sodium, potassium-adenosine triphosphatase (1). Aldosterone excess, whether from genetic causes or primary aldosteronism (hyperplasia or aldosterone-secreting adenomas), is well documented to cause hypertension. Hypertension, in turn, has significant adverse effects on the cardiovascular system, including left ventricular hypertrophy and cardiac fibrosis. Clinical evidence has been accumulating at an accelerating rate suggesting that aldosterone has direct adverse effects on the heart that are independent of its effects on blood pressure. Patients with primary aldosteronism are more likely to have left ventricular hypertrophy and stroke than patients with essential hypertension of comparable severity. More importantly, patients with severe heart failure have a 30% reduction in morbidity and mortality when given a mineralocorticoid receptor antagonist, spironolactone, in addition to conventional therapy of an angiotensin-converting enzyme (ACE) inhibitor, digoxin, and furosemide. The dose of spironolactone used in this study (25 mg) had no incremental effect on blood pressure, suggesting a direct cardioprotective effect (2). Remarkably, spironolactone had a significant beneficial effect only in patients with above median baseline levels of a marker of collagen synthesis, procollagen type III amino-terminal peptide. Elevated baseline levels of this peptide were associated with an increased risk of death and hospitalization, and circulating levels were decreased by spironolactone treatment. These results suggest that the limitation of cardiac fibrosis may be one of mechanisms by which spironolactone benefits patients with congestive heart failure (3). The present article reviews recent evidence for direct cardiac effects of aldosterone and synthesis of aldosterone within the heart. Details of the role of aldosterone in congestive heart failure and the use of aldosterone antagonists in treating heart disease can be obtained from other reviews (4).
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影响因子：
3.5
作者：
Bassett, MH;Zhang, Y;Rainey, WE
通讯作者：
Rainey, WE
影响因子：
37.8
作者：
M. Kupari;A. Hautanen;L. Lankinen;P. Koskinen;J. Virolainen;H. Nikkila;P. White
通讯作者：
M. Kupari;A. Hautanen;L. Lankinen;P. Koskinen;J. Virolainen;H. Nikkila;P. White
压力反射敏感性和肾素血管紧张素系统基因的变异。
影响因子：
24
作者：
Ylitalo,A;Airaksinen,KE;Hautanen,A;Kupari,M;Carson,M;Virolainen,J;Savolainen,M;Kauma,H;Kesäniemi,YA;White,PC;Huikuri,HV
通讯作者：
Huikuri,HV
影响因子：
--
作者：
C. Clyne;Y Zhang-;L. Slutsker;J. Mathis;P. White;W. Rainey
通讯作者：
C. Clyne;Y Zhang-;L. Slutsker;J. Mathis;P. White;W. Rainey
影响因子：
2.1
作者：
WHITE, PC;SLUTSKER, L
通讯作者：
SLUTSKER, L