维持性血液透析中并发高血压患者血清ET-1、NO水平变化  

Changes of ET-1 and NO in the maintenance hemodialysis complicated with intradialytic hypertension

作　　者：白亚玲[1] 徐金升[1] 孙利军[1] 张俊霞[1] 崔立文[1] 张胜雷[1] 

机构地区：[1]河北医科大学第四医院,石家庄050011

出　　处：《山东医药》2013年第18期6-8,共3页Shandong Medical Journal

基　　金：河北省自然科学基金资助项目(H2012206157)

摘　　要：目的观察维持性血液透析(MHD)中并发高血压的患者血清内皮素-1(ET-1)、一氧化氮(NO)水平的变化,并探讨其意义。方法选择河北医科大学第四医院血液净化中心行MHD 3个月以上的患者18例,根据透析结束时平均动脉压(MAP)是否升高≥15 mmHg分为透析中高血压组(A组)10例和透析中血压平稳组(B组)8例。比较两组透析前后心输出量(CO)、外周血管阻力(SVR)、每搏输出量(SV)、心率(HR)、平均动脉压(MAP);于透析前后分别留取血标本,检测肾上腺素、去甲肾上腺素、肾素、ET-1、NO水平。结果 A组透析后NO水平低于透析前,ET-1水平高于透析前(P均<0.05);B组透析前后NO、ET-1水平差异无统计学差异(P均>0.05)。A组透析后SVR、ET-1高于B组,NO低于B组(P均<0.05)。结论 MHD中并发高血压患者血ET-1水平升高、NO水平降低,所致的SVR增加可能是透析中高血压形成的重要原因。Objective To observe the changes of endothelin-1（ET-1） and nitric oxide（NO） in the serum of patients in the maintenance hemodialysis（MHD） complicated with intradialytic hypertension,and to investigate the significance.Methods A total of 18 patients,who underwent MHD for more than 3 months in the blood purification center of the 4th hospital of Hebei medical university,were registered.The patients were then subdivided into two groups： 10 cases of intradialytic hypertension（group A,MAP rise ≥ 15 mmHg at the late stage or the end of the hemodialysis） and 8 cases of stable BP during hemodialysis（group B,MAP change 15 mmHg at the late stage or the end of the hemodialysis）.The cardiac output（CO）,peripheral vascular resistance（SVR）,stroke volume（SV）,heart rate（HR） and mean arterial pressure（MAP） were compared before and after the hemodialysis.Blood samples were taken before and after the hemodialysis session.Adrenaline,noradrenaline,renin and ET-1 were detected by the ELISA method,and NO was determined by the nitric acid reductase method.Results There was no inter-group difference in the pre-dialysis values of age,vintage of dialysis,dry weight and height（P 0.05）.In group A,post-dialysis value of NO was significantly lower than that of pre-dialysis（P 0.05）,whereas the level of ET-1 was significantly higher than pre-dialysis（P 0.05）;in group B,there were no obvious changes in NO and ET-1 between pre-dialysis and post-dialysis（all P 0.05）.The levels of SVR and ET-1 of post-dialysis in group A were higher than group B,whereas the level of NO was significantly lower than group B（all P 0.05）.Conclusion The increase of SVR caused by the elevation of ET-1 and decrease of NO may be one of the important reasons in the formation of intradialytic hypertension in the maintenance hemodialysis.

关 键 词：血液透析 高血压 内皮素-1 一氧化氮 

分 类 号：R459.5[医药卫生—治疗学]