待肾源移植透析者连续性肾脏替代治疗对顽固性高血压的影响  

Effects of continuous renal replacement therapy on refractory hypertension in maintenance hemodialysis patients

作　　者：朱愿[1] 张晓东[1] 宋洁[1] 李辉[1] 

机构地区：[1]武警后勤学院附属医院血液净化中心,天津市300162

出　　处：《中国组织工程研究》2014年第18期2903-2908,共6页Chinese Journal of Tissue Engineering Research

基　　金：天津市自然科学基金(09JCYBJC09900)~~

摘　　要：背景:维持性血液透析人群中有10%-49%的患者合并顽固性高血压,常规药物治疗效果差。连续性肾脏替代治疗可较好地清除患者血浆中的中、大分子毒素,理论上可通过降低相关毒素水平干预顽固性高血压形成机制。目的:观察连续性肾脏替代治疗对维持性血液透析患者顽固性高血压的影响。方法:45例维持性血液透析合并顽固性高血压患者,随机分为血液透析组22例与连续性血液净化组23例,血液透析组则行常规血液透析治疗,连续性肾脏替代治疗组在常规血液透析治疗基础上每周行连续性肾脏替代治疗1次。结果与结论:治疗3个月后,连续性血液净化组肾素、内皮素、血管紧张素Ⅱ、C-反应蛋白、白细胞介素6、肿瘤坏死因子α水平均低于试验前水平,24 h平均血压下降,且差异均有显著性意义(P<0.05),血液透析组上述各指标较试验前无变化(P>0.05);试验后连续性血液净化组上述各指标均低于血液透析组,差异有显著性意义(P<0.05)。结果显示在常规血液透析基础上行连续性肾脏替代治疗可明显降低合并顽固性高血压维持性血液透析患者的血压,其机制可能是降低了患者血浆中的中、大分子毒素以及炎症因子水平。BACKGROUND：About 10%-49%of maintenance hemodialysis patients are accompanied by refractory hypertension and common drug therapy is ineffective. Continuous renal replacement therapy could clear the middle and giant molecule toxins in the blood plasma of patients, it is theoretical y treat refractory hypertension through reducing the toxin levels. OBJECTIVE：To observe the effect of continuous renal replacement therapy on maintenance hemodialysis patients with refractory hypertension. METHODS：A total of 45 maintenance hemodialysis patients with refractory hypertension were randomly divided into two groups, hemodialysis group （n=22） and continuous blood purification group （n=23）. Hemodialysis group underwent conventional hemodialysis treatment. Continuous blood purification group underwent conventional hemodialysis therapy, and treatment of continuous blood purification weekly. RESULTS AND CONCLUSION：After 3 months of treatment, the renin activity, endothelin, angiotensin II, C-reactive protein, interleukin-6, and tumor necrosis factor-αlevels in continuous blood purification group were significantly lower than the levels before the experiment, while 24-hour mean blood pressure levels were significantly decreased （P〈0.05）. In hemodialysis group, renin activity, endothelin, angiotensin II, C-reactive protein, interleukin-6, and tumor necrosis factor-αlevels and 24-hour mean blood pressure did not change （P〉0.05）. After the test, continuous blood purification group showed significantly lower levels of the above index than the hemodialysis group （P〈0.05）. Continuous renal replacement therapy plus hemodialysis significantly reduce the blood pressure in maintenance hemodialysis patients with refractory hypertension, the potential mechanisms are mediated by lowering the middle and giant molecule toxin as wel as inflammatory factor in plasma.

关 键 词：实验动物 组织构建 连续性肾脏替代治疗 顽固性高血压 血液透析 肾素 内皮素 天津市自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]