肾内小动脉重构的研究现状

摘要/Abstract

摘要： 血管重构(VR) 是引起高血压、糖尿病等血管疾病和循环功能紊乱的病理基础, 其能促进靶器官损害和功能衰竭, 提升疾病危险分层, 故逆转VR 已成为临床治疗靶向之一。肾脏是包括高血压、糖尿病等多种疾病的重要靶器官, 肾内小动脉决定了肾脏血流灌注的绝大部分阻力, 其重构直接影响肾脏血流供应, 引发神经内分泌过度激活及其恶性循环,促进肾脏及其他靶器官损害及功能衰竭, 影响预后。本文对VR 尤其肾内小动脉VR 研究现状及其重要意义作一综述。

关键词: 血管重构, 高血压, 糖尿病, 肾内小动脉

Abstract: Vascular remodeling is not only the pathologic cause of circulation dysfunction and vascular disease such as hypertension and diabetes, but also can accelerate the process of dysfunction and failure of target organs.To reverse vascular remodeling has been one of the clinical aims.Kidney is one of the critical common target organs of many kinds of diseases such as diabetes and hypertension. The main part of the intrarenal resistance comes from the intrarenal small arteries, and the remodeling of intrarenal small arteries can reduce the blood supply of kidney and lead to excessive activation of neuroendocrine system as well their vicious cycle, resulting a terrible prognosis together with kidney and other target organs failure.This paper reviews the advance of vascular remodeling especially in the intrarenal small arteries.

Key words: vascular remodeling, hypertension, diabetes, intrarenal small artery

中图分类号:

R544.1+4

黄鑫涛, 洪华山. 肾内小动脉重构的研究现状[J]. 中国临床药理学与治疗学, 2007, 12(4): 371-375.

HUANG Xin-tao, HONG Hua-shan. Remodeling of intrarenal small arteries[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2007, 12(4): 371-375.

参考文献

1 Baumbach GL, Heistad DD.Remodeling of cerebral arterioles in chronic hypertension[J].Hypertension, 1989;13:968-972.
2 Dzau VJ, Gibbons GH, Morishita R, et al.New perspectives in hypertention research:potentials of vascular biology[J].Hypertention, 1994;23:1132-1140.
3 Skov K,Mulvany MJ.Structure of renal afferent arterioles in the pathogenesis of hypertension[J].Acta Physiol Scand, 2004; 181:397-405.
4 Notoya M, Nakamura M, Mizojiri K.Effects of lisinopril on the structure of renal arterioles[J].Hypertension, 1996;27:364-370.
5 KettMM, Alcorn D, Bertram JF, et al.Enalapril does not prevent renal arterial hypertrophy in spontaneously hypertensive rats [J].Hypertension, 1995;25:335-342.
6 Li QP, Leng J, Peng T, et al.Regression of vascular remodeling in renovascular hypertensive rats by tetrandrine and enalapril [J].Acta Pharm Sin, 2003;38:328-332.
7 杨向群, 章建梁, 冀凯宏, 等.不同年龄自发性高血压大鼠肾内小动脉的形态学重建[J].第二军医大学学报, 1999; 20:547-550.
8 彭韬, 李庆平.粉防己碱对肾性高血压大鼠小血管重构的影响[J].南京医科大学学报, 2003;23:8-12.
9 任海玲, 江时森, 谢渡江, 等.压力超负荷大鼠心、肺、肾血管重构的动态研究[J].中国微循环, 2003;7:95-98.
10 Smeda JS, Lee RM, Forrest JB.Structural and reactivity alterations of the renal vasculature of spontaneously hypertensive rats prior to and during established hypertension[J].Circ Res, 1988; 63:518-533.
11 Skov K, Nyengaard JR, Korsgaard N, et al.Number and size of renal glomeruli in spontaneously hypertensive rats[J].Hypertension, 1994;12:1373-1376.
12 Turoni CM, Reynoso HA,Maranon RO, et al.Structural changes in the renal vasculature in streptozotocin-induced diabetic rats without hypertension[J].Nephron Physiol, 2005;99:50-57.
13 Reddi AS, Nimmagadda VR, Arora R.Effect of antihypertens-ive therapy on renal artery structure in type 2 diabetic rats with hypertension[J].Hypertension, 2001;37:1273-1278.
14 Skov K, Hamet P, Nyengaard JR, et al.Morphology of renal afferent arterioles and glomeruli, heart weight, and blood pressure in primates[J].Hypertension, 2001;14:331-337.
15 Lovett JK, Rothwell PM.Site of carotid plaque ulceration in relation to direction of blood flow:an angiographic and pathological study[J].Cerebrovasc Dis, 2003;16:369-375.
16 Simon G.Pathogenesis of structural vascular changes in hypertension[J].Hypertension, 2004;22:3-10.
17 Miao CY, Xie HH, Zhan LS.Blood pressure variability is more important than blood pressure level in determination of end-organ damage in rats[J].J Hypertens, 2006;24:1125-1135.
18 Koller A.Flow-dependent remodeling of small arteries:the stimuli and the sensors are (still) in question[J].Circ Res, 2006;99:6-9.
19 Chiu JJ, Lee PL, Chen CN, et al.Shear stress increases ICAM-1 and decreases VCAM-1 and E-selectin expressions induced by tumor necrosis factor-[alpha] in endothelial cells[J].Arterioscler Thromb Vasc Biol, 2004;24:73-79.
20 Amman K.Hypertrophy and hyperplasia of smooth muscle cells of small intramyocardial arteries in spontaneously hypertensive rats [J].Hypertension, 1995;25:124-131.
21 Hamet P, deBlois D, Dam TV, et al.Apoptosis and vascular wall remodeling in hypertension[J].Can J Physiol Pharmacol, 1996; 74:850-861.
22 Herrmann J, Samee S, Chade A, et al.Differential effect of experimental hypertension and hypercholesterolemia on adventitial remodeling[J].Arterioscler Thromb Vasc Biol, 2005;25: 447-453.
23 李悦梅, 万载阳, 杨保堂, 等.两肾一夹肾血管性高血压大鼠(2K1C-RHR) 肾脏内的血管重构[J].高血压杂志, 2003;11:147-150.
24 Verrecchia F, Mauviel A.Transforming growth factor-beta signaling through the Smad pathway:role in extracellular matrix gene expression and regulation[J].J Invest Dermatol, 2002; 118:211-215.
25 Savoia C, Schiffrin EL.Vascular inflammation in hypertension and diabetes:molecular mechanisms and therapeutic interventions[J].Clin Sci, 2007;112:375-384.
26 Koh KK, Quon MJ, Han SH, et al.Vascular and metabolic effects of candesartan:insights from therapeutic interventions[J]. Hypertens Suppl, 2006;24:S31-S38.
27 Skov K, Fenger-Gron J, Mulvany MJ.Effect of an angiotensinconverting enzyme inhibitor, a calcium antagonist, and an endothelin receptor antagonist on renal afferent arteriolar structure [J].Hypertension, 1996;28:464-471.
28 Dandona P, Kumar V, Aljada A, et al.Angiotensin II receptor blocker valsartan suppresses reactive oxygen species generation in leukocytes, nuclear factor-kappa B, in mononuclear cells of normal subjects:evidence of an anti-inflammatory action[J]. Clin Endocrinol Metab, 2003;88:4496-4501.
29 Zhou J, Pavel J, Macova M.AT1 receptor blockade regulates the local angiotensin II sy stem in cerebral microvessels from spontaneously hypertensive rats[J].Stroke, 2006;37:1271-1276.
30 Ruiz-Ortega M, Ruperez M, Esteban V, et al.Angiotensin II: a key factor in the inflammatory and fibrotic response in kidney diseases[J].Nephrol Dial Transplant, 2006;21:16-20.

[1]	马言, 田高鹏, 石兴文, 孙婷, 谢晶晶, 甄东户. 探讨T2DM人群中25（OH）D与代谢相关性脂肪肝的相关性[J]. 中国临床药理学与治疗学, 2023, 28(9): 1018-1026.
[2]	许宜琪, 吴茜, 刘书, 刘帆, 邢春燕, 李勤, 何俊俊, 何春玲, 赵咏莉, 高家林. 雷公藤多苷治疗糖尿病肾脏病的临床疗效及抗炎抗纤维化分析[J]. 中国临床药理学与治疗学, 2023, 28(9): 1034-1042.
[3]	马仙康, 杨丽霞, 崔阳阳, 米登海. 当归多糖通过抑制GRP78、p-PERK、p-Eif2α表达改善糖尿病KK-Ay小鼠肝内质网应激[J]. 中国临床药理学与治疗学, 2023, 28(8): 926-936.
[4]	李坤, 李璐璐, 李楠楠, 胡卫红, 周建超. 成人肾移植术后血糖控制和CYP3A5基因多态性对他克莫司谷浓度的影响[J]. 中国临床药理学与治疗学, 2023, 28(7): 767-774.
[5]	侯瑞英, 郭莉阁, 焦伟杰, 杜蕾, 吴桂月, 赵旭. 消渴舒方对2型糖尿病模型大鼠血清炎症因子的影响及其机制研究[J]. 中国临床药理学与治疗学, 2023, 28(4): 377-382.
[6]	宁思思, 赵玉红, 颜蕾, 唐敏娜, 张凝之, 张泳巧, 崔兆强. 高血压合并慢性肾脏病患者的降压目标之争议[J]. 中国临床药理学与治疗学, 2023, 28(4): 463-467.
[7]	张雪娇, 刘洁婷, 李鲁新, 陈培剑, 丁明璐, 孙梦伟, 初彦辉, 张珍. 达格列净对1型糖尿病小鼠心肌损伤的影响及机制研究[J]. 中国临床药理学与治疗学, 2023, 28(3): 257-265.
[8]	白佳, 杨虹, 李玲玲, 张洋洋, 杨莹, 吕海宏. 维生素D通过线粒体/自噬途径影响糖尿病神经病变机制的研究[J]. 中国临床药理学与治疗学, 2023, 28(2): 214-219.
[9]	赵世峰, 宋向明, 姚建平. 新型胰高血糖素样肽-1受体/葡萄糖依赖性促胰岛素多肽受体双重激动剂——Tirzepatide[J]. 中国临床药理学与治疗学, 2023, 28(2): 220-227.
[10]	杜小雨, 李宇蒙, 吴惠珍, 邱博. 多格列艾汀治疗2型糖尿病的药理作用和临床评价[J]. 中国临床药理学与治疗学, 2023, 28(10): 1177-1183.
[11]	蔡静, 潘斌晶, 刘靖芳. 降糖药物与肌肉减少症关系的研究进展[J]. 中国临床药理学与治疗学, 2023, 28(1): 101-108.
[12]	杨丽, 柏虎虎, 贺沙沙, 金月, 刘成松. TRPM3的酪氨酸磷酸化参与糖尿病诱发的热痛觉过敏[J]. 中国临床药理学与治疗学, 2022, 27(9): 971-976.
[13]	翟葳葳, 余巧玲, 刘平, 邱博, 吴惠珍. 非奈利酮在2型糖尿病合并慢性肾病治疗中的研究进展[J]. 中国临床药理学与治疗学, 2022, 27(9): 1067-1074.
[14]	付虹, 田磊. 缺血性脑卒中伴高血压病患者个体化精准治疗的研究[J]. 中国临床药理学与治疗学, 2022, 27(8): 870-876.
[15]	陈文刚, 殷勤, 张巍巍, 周露露, 寇婉青, 袁小龙. 皖南地区高血压患者MTHFR基因多态性分布及与血Hcy相关性研究[J]. 中国临床药理学与治疗学, 2022, 27(7): 768-774.