血液透析滤过治疗尿毒症难治性高血压的临床研究

Hemodiafiltration＇s clinical treatment on refractory hypertension of uremia patients

目的比较血液透析滤过与标准血液透析治疗慢性肾功能衰竭（CRF）患者难治性高血压的疗效及其机制探讨。方法将60例CRF伴难治性高血压患者随机分为2组。A组（HD组）应用每周3次标准血液透析（HD）治疗；B组（HDF组）行每周1次常规标准血液透析（HD）治疗和每周2次血液透析滤过（HDF）治疗。比较两组患者治疗前及治疗后8周甲状旁腺素（iPTH）、血浆肾素（RA）、血管紧张素Ⅱ（AngⅡ）、平均动脉压的变化。结果B组患者iPTH、血浆肾素（RA）、血管紧张素Ⅱ（AngⅡ）较A组均明显下降，平均动脉压亦下降更加显著。结论血液透析滤过能有效地清除血浆RA、AngⅡ、甲状旁腺素（iPTH）等中分子毒素，治疗难治性高血压效果优于血液透析，值得临床推广。

Objective To compare the HDF with standard blood dialysis treatment of chronic renal failure （CRF） in patients with refractory hypertension and its mechanism. Method sixty cases of CRF in patients with refractory hypertension were randomly divided into 2 groups. A group （HD）, 3 times a week application standard hemodialysis treatment; B group （HDF）, ist week trip conventional HD treatment and 2 times per week HDF treatment. Comparing the two groups of patients before treatment and after treatment for 8 weeks parathyroid hormone（iPTH）, plasma renin （RA）, angiotensin Ⅱ（AngⅡ）, mean arterial pressure. Result B patients iPTH, plasma renin （RA）, angiotensin Ⅱ（AngⅡ） than the A group were significantly decreased mean arterial blood pressure also dropped significantly more. Conclusion Hemodiafiltration can effectively remove plasma RA, AngⅡ, parathyroid hormone （iPTH）, and other elements of toxins, the treatment of refractory high blood pressure is more effective than hemodialysis, worthy to be popularized.