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目的血清肌酐(Scr)、血管紧张素Ⅱ(Ang Ⅱ)、内皮素-1(ET-1)和一氧化氮(NO)水平升高是慢性肾病的主要标志。机体淋巴细胞和血管内皮细胞均可通过分泌上述活性分子,参与慢性肾病的发病过程。本实验通过观察高通量透析(HFHD)对维持性血液透析(MHD)患者血管活性物质的影响,从而探讨HFHD改善MHD患者体内这些生物活性物质分泌的作用,为临床治疗提供理论依据及新思路,也为进一步研究机体免疫系统参与慢性肾病的发生机制奠定基础。方法将MHD患者20例随机分为低通量血液透析(LFHD)组和高通量血液透析(HFHD)组各10例。选取尿毒症非透析患者20例,另选取20例正常健康体检者作为健康对照组。HFHD组改用可重复使用高通量透析器Polyflux17R,LFHD组继续采用可重复使用透析器Polyflux8LR。分别检测HFHD组及LFHD组患者单次治疗前后及3个月透析前检测的Scr、Ang Ⅱ、ET-1和NO;另抽取尿毒症非透析组和健康对照组各20例的清晨空腹肘静脉血标本同时检验。NO测定用硝酸还原酶法,ET-1、Ang Ⅱ检测均采用放免法。Cr的测定采用常规生化法。透析组患者同时监测血压变化。结果两组患者单次透析后HFHD组Ang Ⅱ、ET-1水平较LFHD组显著降低(P<0.05)。治疗3个月后,HFHD组患者NO、ET-1、平均动脉压与治疗前显著下降(P<0.05)。结论高通量血液透析可以提高上述生物活性物质的清除,使MHD患者高血压得到改善;本实验结果为将来进一步研究淋巴细胞和内皮细胞参与慢性肾病发病的机制提供临床实验依据。
Objectives Serum creatinine (Scr), angiotensin Ⅱ (Ang Ⅱ), endothelin-1 (ET-1) and nitric oxide (NO) levels are the main markers of chronic kidney disease. The body’s lymphocytes and vascular endothelial cells can participate in the pathogenesis of chronic kidney disease through the secretion of these active molecules. The purpose of this study was to investigate the effect of HFHD on vasoactive substances in patients with maintenance hemodialysis (MHD) and to explore the role of HFHD in improving the secretion of these bioactives in MHD patients, providing a theoretical basis and new ideas for clinical treatment , But also lay the foundation for further research on the mechanism of the body’s immune system participating in chronic kidney disease. Methods Twenty patients with MHD were randomly divided into two groups: low-flux hemodialysis (HFHD) group and high-flux hemodialysis (HFHD) group. Twenty patients with uremia without dialysis were selected and 20 normal healthy subjects were selected as healthy control group. The HFHD group switched to the Polyflux 17R, a reusable high-flux dialyzer, and the LFHD group continued to use the Polyflux 8LR, a reusable dialyzer. The levels of Scr, Ang Ⅱ, ET-1 and NO detected before and after single treatment and three months before dialysis in HFHD group and LFHD group were also measured respectively. Another 20 patients with uremia non-dialysis group and healthy control group Blood samples tested at the same time. NO determination by nitrate reductase method, ET-1, Ang Ⅱ were detected by radioimmunoassay. The determination of Cr using conventional biochemical methods. Patients in the dialysis group also monitored blood pressure changes. Results The levels of Ang Ⅱ and ET-1 in HFHD group were significantly lower than those in LFHD group after single dialysis (P <0.05). After 3 months of treatment, NO, ET-1 and mean arterial pressure were significantly decreased in HFHD group (P <0.05). Conclusion High-throughput hemodialysis can improve the clearance of above bioactive substances and improve the hypertension of patients with MHD. The results of this experiment will provide the clinical experimental basis for further studying the mechanism of lymphocytes and endothelial cells participating in the pathogenesis of chronic kidney disease.