血液透析患者红细胞钠、钙水平及其表面形态学改变对血压的影响

Effects of the Dialysate with Different Calcium Concentration for the Level of RBC Ca、Na and RBC Surface Strcture of Hemodialytic Hypertension Patients

目的:通过研究透析液钙浓度对血透患者红细胞钠、钙水平及其表面形态学变化,最终探讨透析性高血压的发病机制。方法:对89例患者在1160次血液透析中的9520个血压记录值进行调查,包括透析进行中1～4小时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP),并对其中40例透析性、药物抵抗性高血压及非高血压患者的血浆钙(Ca)、钠(Na)、S2细胞钙(RBCCa)、钠(RBCNa)、红细胞表面立体形态观察测定。通过对以上检测数据的分析研究从中发现显著性差异和相关性因素。结果:使用透析液Ca为1.25mmol/L(LdCa低钙)患者的血压透析中呈下降P<0.01;Ca为1.75mmol/L(HdCa高钙)血压呈上升P<0.01,在透析第3、4小时最明显。RBCCa测定显示高血压患者透析后明显高于非高血压患者,高血压患者RBCCa0.5797±0.2914mmol/L,非高血压患者RBCCa0.3569±0.1805mmol/L,P<0.05。而RBCNa无显著性差异,P>0.05。在RBC立体形态学扫描电子显微镜(SEM)观察中有意义的发现是,RBC“裙边样”改变在透析前Hd-Ca明显低于LdCa,分别是3.36±1.8047%,9.833±0.2490%,P<0.01,而透析后HdCa明显高于LdCa,分别是9.5233±1.9302%,3.7517±3.5257%,P<0.01。结论:高钙透析液是透析性高血压患者在透析中升压的重要因素之一,其相关因素是HdCa可使RBC表面立体形态改变,RBC“裙边样”变形率增加,RBC表面接触面积增加,在通过外周微血管时阻力增加,这些可能与RBCCa含量增加相关。

Objective Effects of the Dialysate with Different Calcium concentration for the level of RBC Ca,Na and RBC surface streture of hemodialytic patients,there are explored mechanism of hepertention. Methods： 9520 blood pressure （BP） datas of 89 hemodialytic patients was reviewed. They are systolic pressure（SP）,diastolic pressure （DP） and mean arterial pressure（MAP） of the patients were monitored during the hemodialysis （HD） with the dialysate of 1. 25 mmol/1 （Ldca） and 1.75 mmol/L（HdCa） calcium concentration. The surface solid structure of erythrocyte were observed by scanning electronic microscope（SEM）. At the same time,the serum Na^＋ ,Ca^＋＋, The membrane Ca^＋＋ and cytoplasma Ca^＋＋ in the erythrocyte of 40 chronic hemodialytic patients were measured in order to study the effects of the dialysates with different calcium concentration on the blood pressure of hemodialytic patients. Results ： The BP of hemodialytic patients were decreased with the dialysate of LdCa calcium and was increased with the dialysate of HdCa calcium respectively （p〈0.01） at 3th to 4th hour after the beginning of HD. The cytoplasma Ca^＋＋ （0. 5797 ±0. 2914 mmol/L） in the RBC of the patients with hypertension was higher（p〈0. 05） than that （0. 3569±0. 1805） of the patients without hypertension 4th hour after the beginning of HD,but there is no difference （p〉0.05） of the cytoplasma Na^＋ in the RBC of the patients between with hypertension and without hypertension, the changes （3.36±1. 8047%）of the gear and wave at the surface of RBC solid structure pre-HD with HdCa was lower obviously （p〈0.01） than that （9. 833±0. 2490%） of the pre-HD with 1,dCa,hut it was higher obviously （p〈0.01） post-HD with HdCa（9. 5233± 1. 9302%） than that（3. 7517± 1. 9302%） of post-HD with LdCa. Conclusions：HdCa is one of the important factors that could stimulate BP of the HD-patients increased. Hdca could accelerate the changes of gear and hole at the RBC surface solid structure,and increase the interface of RBC and blood viscosity. All of that could stimulate the increased BP of HD-patients.