Mycophenolate mofetil treatment improves hypertension in patients with psoriasis and rheumatoid arthritis
Mycophenolate mofetil treatment improves hypertension in patients with psoriasis and rheumatoid arthritis
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DOI：
10.1681/asn.2006080918
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发表时间：
2006-12-01
影响因子：
13.6
通讯作者：
Rodriguez-Iturbe, Bernardo
中科院分区：
文献类型：
--
作者：
Herrera, Jose;Ferrebuz, Atiho;Rodriguez-Iturbe, Bernardo
在几种实验模型和高血压大鼠品系中获得的证据表明，肾脏中炎症细胞的浸润和氧化应激在高血压的诱导和维持中起作用。人类高血压缺乏类似的证据，至少部分是因为高血压患者的免疫抑制治疗是不合理的。为了解决这一问题，研究了由私人医生处方的霉酚酸酯（MMF）治疗银屑病或类风湿性关节炎的患者，此外，还研究了I级原发性高血压和正常肾功能的患者。8例患者在开始MMF治疗前、治疗期间和停用MMF治疗后1个月进行了研究。其他治疗和饮食在研究的三个阶段中保持不变。MMF治疗与收缩压、舒张压和平均血压显著降低相关。尿中TNF-α的排泄量在MMF治疗后逐渐减少，在停用MMF后增加。尿丙二醛、TNF-α和RANTES排泄在MMF给药期间的减少没有达到统计学显著性，但与BP水平直接正相关。这些数据与肾脏免疫细胞浸润和氧化应激在人类高血压中发挥作用的假设一致。
Evidence that was obtained in several experimental models and in strains of hypertensive rats indicates that infiltration of inflammatory cells and oxidative stress in the kidney play a role in the induction and maintenance of hypertension. Similar evidence is lacking in human hypertension, at least in part, because immunosuppressive treatment is unjustified in patients with hypertension. For addressing this issue, patients who were prescribed by their private physicians mycophenolate mofetil (MMF) for the treatment of psoriasis or rheumatoid arthritis and had, in addition, grade I essential hypertension and normal renal function were studied. Eight patients were studied before MMF was started, during MMF treatment, and 1 mo after MMF treatment had been discontinued. Other treatments and diet were unchanged in the three phases of the study. MMF therapy was associated with a significant reduction in systolic, diastolic, and mean BP. Urinary excretion of TNF-alpha was reduced progressively by MMF treatment and increased after MMF was discontinued. Reduction of urinary malondialdehyde, TNF-alpha, and RANTES excretion during MMF administration did not reach statistical significance but had a direct positive correlation with the BP levels. These data are consistent with the hypothesis that renal immune cell infiltration and oxidative stress play a role in human hypertension.