Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions
Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions
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非甾体抗炎药与严重胃肠道不良反应
作者：
P. Cohen
Sir，-Dr Helmer Ring-Larsen和其他人（5月24日，第1351页）认为，与仰卧位相比，直立位对利尿剂的肾反应迟钝是由于几种激素机制的激活。他们发现了交感神经系统和肾醛甾酮轴活性增加的证据，并提到加压素是另一种重要的体内平衡措施。然而，他们没有考虑心房利钠因子的可能作用。一些观察结果表明，这种新的利尿和利钠肽在容量体内平衡中具有重要作用。我们和其他人已经表明，高血压或充血性心力衰竭患者的血浆心钠素浓度大大增加，这与右心房压密切相关。23在肝硬化患者中，我们发现停止利尿剂治疗可增加心钠素的循环浓度。4肾功能不全，不充分性大大增加，并与体积膨胀程度密切相关; 5体位的改变影响血浆心钠素值。6仰卧位时，由于心脏收缩、舒张、舒张和舒张功能的改变，中心静脉压和右心房压增加。音量变换这种由头部浸泡引起的增加，已经被证明可以刺激健康受试者和肝硬化患者心钠素的释放。“这些发现支持了这样一种观点，即心钠素是健康和疾病中容量调节的重要因素。心钠素浓度的测定在容量调节的研究中可能是有用的，并可能阐明尚未解决的体位依赖性利尿的复杂性。亚历山大L GERBES RAINERM ARENDT
SIR,-Dr Helmer Ring-Larsen and others (24 May, p 1351) suggest that the blunted renal response to a diuretic agent in the upright as compared with the supine position is due to the activation of several hormonal mechanisms. They found evidence for increased activity of the sympathetic nervous system and of the reninaldosterone axis and mention vasopressin as another important homoeostatic measure. However, they do not consider the possible role of the atrial natriuretic factor. Several observations indicate that this novel diuretic and natriuretic peptide' has a substantial role in volume homoeostasis. We and others have shown that patients with hypertension or congestive heart failure show greatly increased plasma concentrations of atrial natriuretic factor, which are well correlated with right atrial pressures.23 In patients with cirrhosis we showed that discontinuation of diuretic treatment could increase circulating concentrations of atrial natriuretic factor.4 Values in children with renal, insufficiency are greatly increased and correlate well with the degree ofvolume expansion; they are significantly reduced after volume reduction by haemodialysis.5 Changes in posture influence plasma atrial natriuretic factor values.6 In the supine position central venous and right atrial pressure increase due to volume shifting. Such an increase, induced by head out water immersion, has been shown to stimulate release of atrial natriureticfactorinhealthy subjects7andin patients with cirrhosis.' These findings support the contention that atrial natriuretic factor is an important factor in volume regulation in health as well as disease. Determination of atrial natriuretic factor concentrations might be useful in studies ofvolume regulation and might elucidate the still unresolved complex of posture dependent diuresis. ALEXANDER L GERBES RAINERM ARENDT