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題名 | 血管張力素轉換酶之現況與未來=Angiotensin Converting Enzyme Inhibitors Present and Future |
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作者 | 謝博軒; 王家儀; | 書刊名 | 醫學研究 |
卷期 | 15:2 1994.09[民83.09] |
頁次 | 頁73-84 |
分類號 | 418.22 |
關鍵詞 | 血管張力素轉換酶抑制劑; 心臟血管疾病; 高血壓; Angiotensin converting enzyme inhibitors; Cardiovascular disor ders; Hypertension; |
語文 | 中文(Chinese) |
中文摘要 | 腎素-血管張力素系統在血壓調控和心臟血管系統恆定的維持上扮演著重要的角色,而且它涉及許多心臟血管疾病的病理機轉。其中血管張力素轉換酶(ACE)的發展更在高血壓和鬱血性心臟衰竭病人的治療上扮演著重要的角色,近來更發現使用血管張力素轉換酶抑制劑治療鬱血性心臟衰竭或其他心臟血管疾病時,對組織中血管張力素轉換酶的抑制作用,較對循環中者為重要,而一些研究報告也指出循環中屬內分泌的腎素-血管張力素系統與急性反應有關,而組織中的腎素-血管張力素則涉及較慢性的變化,例如高血壓及其他心臟血管異常造成的次發性結構改變如心肌肥大,冠狀動脈疾病和粥腫樣動脈硬化等。許多實驗室和臨床研究顯示血管張力素轉換酶抑制劑是一種重要的長期抗高血壓藥物,並可改善心臟血管疾病,次發性心臟血管結構的改變,及促進鈉排泄的作用均可能經由抑制組織中的腎素-血管張力素系統。 展望未來,由於分子生物學技術的進展,將使我們更瞭解組織中腎素-血管張力素系統的角色和作用,而能設計出更具組織專一性的血管張力素轉換酶抑制劑,對高血壓和心臟血管疾病的預防和治療上提供新的策略。 |
英文摘要 | The rennin angiotensin system (RAS) plays an important role in the regulation of blood pressure and cardiovascular homeostasis and is involved in the pathogenesis of a number of cardiovascular disorders. The angiotensin converting enzyme (ACE) inhibitors represent an important new development in the treatment of hypertension and congestive heart failure. Moreover, the demonstration of the expression of the components of the RAS in several extrarenal tissues, as well as local generation of angiotensin II, has confirmed the existence of a tissue RAS that may serve organ-specific functions and act independently from the endocrine RAS. The concept of paracrine/autocrine functions of the local RAS has changed our understanding of the functions of the endocrine RAS and suggests that tissue ACE inhibition may be of greater importance than inhibition of circulating ACE in the treatment of congestive heart failure and other cardiovascular disorders. Whereas the circulating or endocrine RAS seems to be involved in more chronic situations, such as secondary structural changes of the cardiovascular systems, and therefore could contribute to the pathogenesis of hypertension as well as other cardiovascular disorders, such as cardiac hypertrophy, coronary artery disease, and atherosclerosis. Several experimental and clinical findings suggest that reversal of cardiovascular structural changes secondary to cardiovascular structural changes secondary to cardiovascular disease and enhancement of renal sodium exeretion by ACE inhibitors are important long-term antihypertensive actions possible mediated by inhibition of the tissue RAS. Information of these molecular studies offers new sights into complex multigenetic diseases such as primary hypertension and also provides us with better understanding of the roles and functions of tissue RAS. Moreover, it is expected that more organ-specific ACE inhibitors could be designed and they may help us to develop new strategies for therapy and prevention of hypertension and other cardiovascular disorders. |
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