頁籤選單縮合
題 名 | 血管收縮素轉化酶抑制劑在糖尿病病人的使用=The Use of Angiotensin Converting Enzyme Inhibitors in Diabetes Mellitus |
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作 者 | 曾慶孝; | 書刊名 | 內科學誌 |
卷 期 | 10:2 1999.04[民88.04] |
頁 次 | 頁36-41 |
分類號 | 418.271 |
關鍵詞 | 血管收縮素轉化酶抑制劑; 鈣離子阻斷劑; 腎臟病變; 心臟血管疾病; 內皮細胞功能障礙; Angiotensin converting enzyme inhibitor; Calcium antagonist; Nephropathy; Cardiovascular disease; Endothelial dysfunction; |
語 文 | 中文(Chinese) |
中文摘要 | 血管收縮素轉化□抑制劑(angiotensin converting enzyme inhibitor, ACEI) 被核准用來治療高血壓已接近廿年。在糖尿病病人使用ACEl不但可以降低腎臟白蛋白的排 泄速率,延緩腎臟病變的發展,近年由「英國前瞻性糖尿病研究」(the United Kingdom Prospective Diabetes Study, UKPDS)更證實了使用ACEI captopril或貝它阻斷劑atenolol 來嚴格控制第二型糖尿病的高血壓可以有效地預防糖尿病慢性併發症的發生。最近由the Appropriate Blood Pressure Control in Diabetes (ABCD)及the Fosinopril versus Amlodipine Cardiovascular Event Trial (FACET)的兩個長期前瞻性研究亦發現在第二型 糖尿病病人使用ACEl比使用鈣離子阻斷劑有顯著較低的心臟血管病變事件的發生和死亡。 ACEl改善腎臟病變的機轉被認為與它降低腎臟出支動脈壓(efferent arteriolar pressure) 進而減少腎絲球內微血管壓力有關。ACEl減少心臟血管疾病事件的原因尚未完全清楚,它 可能透過降低血壓、改善腎臟機能、促進血栓溶解、及不影響血糖控制和脂質代謝等方式來 作用。近年有人認為ACEl可以改善內皮細胞的功能障礙而預防心臟血管疾病的發生,但目 前並沒有研究證實糖尿病病人的內皮細胞功能障礙可以藉著ACEl的投與而獲得改善。有人 建議將ACEl列為糖尿病併發高血壓的第一線治療藥物,但它可能引起的嚴重副作用如致畸 胎性、高血鉀症、和嚴重低血糖症等仍然是臨床醫師不可忽咯的。 滿C |
英文摘要 | Angiotensin converting enzyme inhibitors (ACEI) has been used for the treatment of hypertension for nearly 20 years. The recently published United Kingdom Prospective Diabetes Study (UKPDS) confirmed the beneficial effects of intensive blood pressure control on the prevention of diabetic complications in type 2 diabetic patients with either captopril or atenolol. In the Appropriate Blood Pressure Control in Diabetes (ABCD) and the Fosinopril versus Amlodipine Cardiovascular Event Trial (FACET), ACEIs have a beneficial effect on preventing cardio-vascular events when compared with calcium antagonists in type 2 diabetes. Besides, ACEIs have extra beneficial effects of preventing the progression of nephropathy. The renal protection effect is thought to be due to a specific action of decreasing efferent arteriolar resistance to a greater extent than afferent resistance resulting in a decrease in intraglomerular capillary pressure and single nephron glomerular filtration rate (GFR). Although there is evidence that ACEIs improve endothelial dysfunction in animal models and nondiabetic subjects, this beneficial effect has not yet been proven in diabetic patients. ACEIs may be considered as a first-line medication to be used in treating diabetic patients with hypertension. However, the possible risk of hyperkalemia, hypo-glycemia and teratogenecity in pregnant women should be kept in mind besides its commonly encountered side effect of dry cough. |
本系統中英文摘要資訊取自各篇刊載內容。