Diabetic Control and the Renin‐Angiotensin System, Catecholamines, and Blood Pressure
Diabetic Control and the Renin‐Angiotensin System, Catecholamines, and Blood Pressure
复制标题
糖尿病控制与肾素-血管紧张素系统、儿茶酚胺和血压
作者：
J. Ferriss;J. O'hare;C. Kelleher;P. Sullivan;M. Cole;H. Ross;D. O’sullivan
糖尿病酮症通常伴有明显的继发性醛固酮增多症。大多数患者在治疗前血浆肾素、血管紧张素II和醛固酮水平显著升高，随着代谢控制的恢复，血浆肾素、血管紧张素II和醛固酮水平迅速降至正常水平。少数患者治疗前血浆肾素、血管紧张素II和醛固酮水平保持在正常范围内，主要是那些长期伴有糖尿病并发症的患者。在有糖尿但无酮尿的中度高血糖患者中，这三种物质的血浆水平明显高于控制改善时的水平。偶尔，中度高血糖患者有轻度继发性醛固酮增多症。这类患者的代谢控制得到改善，导致血浆容量和总交换性钠升高，后者明显高于正常水平。血浆儿茶酚胺水平在糖尿病酮症酸中毒中显著升高，可能是酮症酸中毒状态的结果。中度高血糖的非酮症患者，基础血浆去甲肾上腺素水平正常；然而，儿茶酚胺对运动的反应可能被夸大了。流行病学和动物研究表明血压和血糖水平之间存在关系。改变糖尿病代谢控制对血压影响的临床研究很少，这是一个需要进一步研究的重要领域。
Diabetic ketoacldosis is usually associated with marked secondary hyperaldosteron-ism. Plasma levels of renin, angiotensin II, and aldosterone are markedly raised before treatment in most patients, with values falling rapidly toward normal as metabolic control is restored. In a few patients, mostly those with long-term complications of diabetes, plasma levels of renin, angiotensin II, and aldosterone before treatment remain within the normal range. In moderately hyperglycemic patients who have glycosuria but not ketonuria, plasma levels of all three substances are significantly higher than when control is improved. Occasionally, moderately hyperglycemic patients have mild secondary hyperaldosteronism. Improved metabolic control in such patients causes a rise in plasma volume and a rise in total exchangeable sodium, the latter to levels significantly above normal. Plasma catecholamine levels are markedly elevated in diabetic ketoacidosis, probably as a consequence of the ketoacidotic state. In nonketotic patients with moderate hyperglycemia, basal plasma norepinephrine levels are normal; catecholamine responses to exercise may be exaggerated, however. Epidemiological and animal studies suggest a relationship between blood pressure and blood glucose levels. There are few clinical studies of the effects of altering metabolic control of diabetes on blood pressure, and this is an important area for further study.
利用连续皮下胰岛素输注短期改善血糖控制：对胰岛素依赖型糖尿病中反调节激素和血脂的 24 小时综合浓度的影响。
DOI：
10.1210/jcem-54-3-504
发表时间：
1982
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Hershcopf,R;Plotnick,LP;Kaya,K;Benedict,GW;Hadji-Georgopoulos,A;Margolis,S;Kowarski,AA
通讯作者：
Kowarski,AA