Angiotensin II Acetate

兰卫科普 ——高血压三项应用解析 一 高血压三项应用解析 高血压是指以体循环动脉血压（收缩压或舒张压）增高为主要特征（收缩压≥140毫米汞柱，舒张压≥90毫米汞柱），可伴有心、脑、肾等器官的功能或器质性损害的临床综合征。高血压是现代社会最常见的慢性病，也是心脑血管疾病最主要的危险因素，其发生发展与遗传、环境、生活方式等多种因素有关。在高血压的诊断和治疗过程中，肾素、醛固酮、血管紧张素三项指标具有重要临床意义。本文将详细阐述这三项指标在临床上的应用。 肾素、醛固酮、血管紧张素是人体内调节血压的重要激素。肾素是肾小球旁器、球旁细胞释放的一种蛋白水解酶[1],主要由肾脏分泌，作用于血管紧张素原，生成血管紧张素I。血管紧张素I在血管紧张素转换酶的作用下，转化为血管紧张素II。血管紧张素II可以发挥内分泌、旁分泌和胞分泌的作用[2]。血管紧张素II具有强烈的收缩血管作用，同时促进肾上腺皮质分泌醛固酮。血管紧张素II是肾素-血管紧张素-醛固酮系统调节血压的一个直接作用物质。同时，血管紧张素II也能够作为促生长因子直接促进血管内皮细胞的增生[3]。醛固酮是由肾上腺皮质球状带细胞合成和分泌的一种盐皮质激素，主要作用于肾脏远曲小管和肾皮质集合管，增加对钠离子的重吸收和促进钾离子的排泄，也作用于髓质集合管，促进氢离子的排泄，酸化尿液[4]。 发病率高 致残率高 致死率高 知晓率低 治疗率低 控制率低 我国现有高血压患者2.45亿，而知晓率仅51.6%，治疗率仅45.8%，控制率仅16.8%（中国高血压防治指南2018）。与美国相比，知晓率、治疗率、控制率分别达到82.7%、75.6%、51.8%。[5] 二 临床应用 原发性高血压：病因不明，绝大多数需要长期、甚至终生坚持治疗。 继发性高血压：身体的一些器官或系统病变所导致的临床表现，病因相对明确，对症、对因治疗可以治愈或缓解。文献报道新疆地区继发性高血压发病率在高血压中的占比1999年为9.6%、2005年为14.76%、2008年为39.30%、2014年超过40%，呈现逐年的上升的趋势[6]，这种趋势在其它相关文献中也得到了佐证，如研究者莫剑梅等分析发现继发性高血压发病率占比2011年为27%[7]， 而到了2020年，王梦琳等报道继发性高血压占比为39.26%[8]，趋势明确，上升幅度呈现地域间的差异，这种现象需引起社会的关注。笔者通过查阅资料[9-10]，总结继发性高血压的常见成因，见图1。  图1  继发性高血压常见病因 二 01肾素临床应用 （1）诊断高血压病因：肾素活性检测有助于鉴别原发性高血压和继发性高血压。原发性高血压患者肾素活性多正常或偏低，继发性高血压患者肾素活性多升高。 （2）判断高血压严重程度：肾素活性与高血压严重程度呈正相关，肾素活性越高，血压越高，病情越严重。 （3）指导降压治疗：肾素活性检测有助于选择合适的降压药物。对于肾素活性高者，选用ACEI（血管紧张素转换酶抑制剂）或ARB（血管紧张素受体拮抗剂）类降压药物效果较好。 二 02醛固酮临床应用 （1）诊断醛固酮增多症：醛固酮增多症是引起继发性高血压的常见病因，通过检测醛固酮/肾素比值（ARR）有助于诊断该病。 （2）判断高血压病情：醛固酮水平与高血压病情呈正相关，醛固酮水平越高，病情越严重。 （3）指导降压治疗：对于醛固酮增多症患者，选用醛固酮受体拮抗剂如螺内酯等药物，可降低血压，改善病情。 二 03血管紧张素临床应用 （1）诊断高血压病因：血管紧张素II水平有助于鉴别原发性高血压和继发性高血压。原发性高血压患者血管紧张素II水平多正常，继发性高血压患者血管紧张素II水平多升高。 （2）判断高血压严重程度：血管紧张素II水平与高血压严重程度呈正相关，血管紧张素II水平越高，血压越高，病情越严重。 （3）指导降压治疗：血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体拮抗剂（ARB）类药物，通过抑制血管紧张素II的生成，降低血压，改善病情。 三 三项联合应用优势 （1） 提高诊断准确性：三项指标联合检测，有助于更全面地了解高血压患者的病情，提高诊断准确性。 （2）优化治疗方案：根据三项指标检测结果，制定个体化的治疗方案，提高治疗效果。 （3）预防并发症：三项指标联合检测，有助于发现潜在的危险因素，及时干预，预防并发症。 四 临床应用注意事项 （1）标本采集：采集血液标本时，应避免压迫血管，确保样本质量。 （2）检测方法：选择可靠的检测方法，确保检测结果的准确性。 （3）结果解读：结合患者的病史、临床表现和其他检查结果，综合分析三项指标，避免误诊。 （4）治疗监测：在治疗过程中，定期检测三项指标，评估治疗效果，调整治疗方案。 结语 总之，高血压三项指标在临床上的应用具有重要意义，有助于诊断高血压病因、判断病情严重程度和指导降压治疗。合理运用这三项指标，可以提高高血压的诊疗水平，降低患者的并发症风险，改善预后。 参考文献： [1] Measurement of plasma renin:a critical review of methodology. JRAAS，2010;11(2):89-90. [2] 杨钢主编.内分泌生理与病理生理学.天津科学技术出版社，2000年5月第二版。 [3] M Miyawaki,T Okutani, R Higuchi,N Yoshikawa Plasma angiotensin II concentrations in the early neonatal period.Arch Dis Child Fetal Neonatal Ed2006;91:F359-F362. [4] 杨钢主编.内分泌生理与病理生理学.天津科学技术出版社，2000年5月第二版。 [5] 《中国心血管健康与疾病报告2019》、《中国高血压防治指南2019》。 [6] 李南方，常桂娟，王新玲，等.继发性高血压筛查平台的建设和成功诊断[J].中华医学会第十五次全国心血管病学大会,2013,46-50. [7] 莫剑梅，刘唐威，黄容杰，等.518例初诊高血压患者病因分析[J].心血管系统疾病，2012，10.16121/j.cnki.cn 45-1347/r.2012.02.035. [8]王梦琳，王浩，赵海鹰等.高血压专科3706例住院继发性高血压患者病因构成分析[J].中华高血压杂志，2020，28（02）：155-162. [9]潘晓明，乔森，尹大维，等.探讨高血压的病因、临床治疗方案及效果[J].智慧健康，2022，6（25）：55-57. [10]张宁.高血压的病因及临床治疗[J].中国社区医师，2017，33（02）：36-37. 本文由南京子公司 张翠 提供 指导老师 詹喜焱、熊进 校正 陈子祥

December 16, 2024 Basilea Pharmaceutica Ltd, Allschwil (SIX: BSLN), a commercial-stage biopharmaceutical company committed to meeting the needs of patients with severe bacterial and fungal infections, announced today that it has entered into an exclusive distribution and license agreement with Innoviva Specialty Therapeutics, Inc., a wholly owned subsidiary of Innoviva Inc. (NASDAQ: INVA), for the commercialization of Basilea’s hospital anti-MRSA antibiotic Zevtera® (ceftobiprole) in the United States (US). Innoviva Specialty Therapeutics is a US-based biopharmaceutical company with an established hospital sales force and a core competence in commercializing anti-infective medicines. David Veitch, Chief Executive Officer of Basilea, stated: “We are very pleased with our collaboration with Innoviva Specialty Therapeutics for the commercialization of Zevtera in the US. The company is a highly committed, focused and capable partner that shares our vision and ambitions for Zevtera in the US. They also have recent experience of launching a hospital antibiotic in the US. We are looking forward to working with Innoviva Specialty Therapeutics towards a successful launch and bringing Zevtera to patients in need in the US.” “With this agreement, Zevtera will become an important asset in our company’s portfolio, allowing us to advance our strategy of providing differentiated therapies in infectious disease and critical care,” said Pavel Raifeld, Chief Executive Officer, Innoviva, Inc. “There is a significant medical need for treatments targeting complicated Staphylococcus aureus infections, particularly Staphylococcus aureus bacteremia. We are therefore excited to bring this important new medicine to patients who are suffering from these severe infections.” Under the terms of the agreement, Basilea will receive a USD 4 million upfront payment and tiered royalties on net sales in the high-teens to mid-twenties percentage range. Basilea will be eligible to receive sales milestones of up to USD 223 million. In addition, Innoviva Specialty Therapeutics will purchase its demand of Zevtera drug product from Basilea. Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is an advanced generation cephalosporin antibiotic for intravenous administration, with rapid bactericidal activity against a wide range of Gram-positive bacteria, such as Staphylococcus aureus, including methicillin-resistant strains (MRSA), and Gram-negative bacteria.1 In several countries in Europe and beyond, the brand is currently approved and marketed as Zevtera® and Mabelio® for the treatment of adult patients with hospital-acquired bacterial pneumonia (HABP), excluding ventilator-associated bacterial pneumonia (VABP), and for the treatment of community-acquired bacterial pneumonia (CABP). Basilea has entered into license and distribution agreements covering more than 80 countries. In the United States, Zevtera is indicated for the treatment of adult patients with Staphylococcus aureus bloodstream infections (bacteremia) (SAB), including right-sided infective endocarditis, and adult patients with acute bacterial skin and skin structure infections (ABSSSI) and for adult and pediatric patients (3 months to less than 18 years old) with community-acquired bacterial pneumonia (CABP).2 Basilea’s ceftobiprole phase 3 program is funded in part with federal funds from the US Department of Health and Human Services (HHS); Administration for Strategic Preparedness and Response (ASPR); Biomedical Advanced Research and Development Authority (BARDA), under contract number HHSO100201600002C. Basilea has been awarded approximately USD 112 million, or approximately 75 percent of the costs related to the Staphylococcus aureus bacteremia (SAB) and acute bacterial skin and skin structure infections (ABSSSI) phase 3 studies, regulatory activities and non-clinical work. Innoviva is a diversified holding company with a core royalties portfolio, a leading critical care and infectious disease platform known as Innoviva Specialty Therapeutics (“IST”), and a portfolio of strategic investments in healthcare assets. Innoviva’s other innovative healthcare assets include infectious disease and critical care assets stemming from acquisitions of Entasis Therapeutics, including XACDURO® (sulbactam for injection; durlobactam for injection), co-packaged for intravenous use approved for the treatment of adults with hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia caused by susceptible strains of Acinetobacter baumannii-calcoaceticus complex and the investigational zoliflodacin currently being developed for the treatment of uncomplicated gonorrhea, and La Jolla Pharmaceutical Company, including GIAPREZA® (angiotensin II), approved to increase blood pressure in adults with septic or other distributive shock and XERAVA® (eravacycline) for the treatment of complicated intra-abdominal infections in adults. Basilea is a commercial-stage biopharmaceutical company founded in 2000 and headquartered in Switzerland. We are committed to discovering, developing and commercializing innovative drugs to meet the needs of patients with severe bacterial and fungal infections. We have successfully launched two hospital brands, Cresemba for the treatment of invasive fungal infections and Zevtera for the treatment of bacterial infections. In addition, we have preclinical and clinical anti-infective assets in our portfolio. Basilea is listed on the SIX Swiss Exchange (SIX: BSLN). Please visit basilea.com. References Summary of Product Characteristics (SmPC) Zevtera: https://www.medicines.org.uk/emc/product/9164/smpc [Accessed: December 15, 2024] Full US prescribing information: https://www.basilea.com/ZEVTERA_US_prescribing_information_46b9y4wk The content above comes from the network. if any infringement, please contact us to modify.