人尾加压素Ⅱ和花生四烯酸乙醇胺在腹膜透析患者容量抵抗和高血压中的作用

Roles of arachidonoylethanolamine and human urotensin Ⅱ on volume resistance and hypertension in peritoneal dialysis patients

目的人尾加压素Ⅱ(human urotensinⅡ,hUⅡ)和花生四烯酸乙醇胺(arachidonoylet-hanolamine,AEA)是近年来新发现的舒张血管的降压物质。我们既往研究发现有一定比例的腹膜透析患者尽管出现容量超负荷,但却能维持正常血压,提示这部分患者具有容量抵抗。本研究探讨AEA、hUⅡ在腹膜透析患者高血压中的作用,并初步探讨其是否在容量抵抗中发挥作用。方法回顾性研究纳入2009年7月至2010年1月年在北京大学第三医院肾内科腹膜透析门诊随诊的腹膜透析患者105例,患者均采用标准的持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)方式。应用生物电阻抗测定出的OH值为衡量患者容量负荷的主要指标。患者在随访过程中多次测量OH取平均值。OH<2为正常容量组,OH≥2为高容量组;收缩压<130mm Hg(1mm Hg=0.133kPa)为正常收缩压组,收缩压≥130mm Hg为高收缩压组。将患者分为4组:①正常收缩压正常容量组(NT-NV组);②正常收缩压高容量组(NT-HV组);③高收缩压正常容量组(HT-NV组);④高收缩压高容量组(HT-HV组)。血浆hUⅡ水平采用放射免疫测定法,AEA水平采用高效液相色谱-串联质谱(UPLC-MS)测定。结果收缩压组<130mm Hg患者血浆hUⅡ水平显著高于高收缩压组(P<0.05),AEA水平也有高于收缩压组的趋势,但差异无统计学意义(P=0.13)。NT-HV组hUⅡ水平高于HT-HV组(P<0.05),NT-HV组AEA水平高于HT-NV组(P<0.05)。结论 hUⅡ水平高可能是腹膜透析患者容量抵抗的原因之一,而AEA亦可能参与容量抵抗腹膜透析患者的血压调节。

Objective Arachidonoylethanolamine （AEA） and human urotensin Ⅱ （hUⅡ） are newly discovered substances which can dilate vessels to decrease blood pressure. Our previous studies show that some volume overloaded peritoneal dialysis patients can maintain normal blood pressure, suggesting that these patients may have volume resistance capacity. This study was to investigate ifAEA and UIl played important roles in volume resistance and hypertension in peritoneal dialysis patients. Methods A total of 105 patients on continuous ambulatory perito- neal dialysis （CAPD） were enrolled in this retrospective study. Volume load was judged by mean OH from series OH values by bioimpedance assay （BIA） method. Patients with OH 〈2 were assigned to normal volume （NV） group, and those with OH ≥ 2 to high volume （HV） group. Patients with systolic blood pressure 〈130mmHg were assigned to normal tension （NT） group, and those with systolic blood pressure ≥ 130mmHg to hypertension （HT） group. Patients could also be divided into four groups： （a） normal tension with normal volume （NT-NV）, （b） normal tension with high volume （NT-HV）, （c） hypertension with normal volume （HT-NV）, and （d） hypertension with high-volume （HT-HV）. hUII was measured by radioimmunoassay method, and AEA by ultra performance liquid chromatography- tandem mass spectrometry （UPLC-MS） method. Results hUII was significantly higher in NT group than in HT group （P 〈0.05）. AEA tended to be higher in NT group than in HT group, but without statistical significance （P = 0.13）. Both hUⅡ and AEA were higher in NT-HV group than in HT-HV group （P〈0.05）. Conclusions Our study suggests that hUⅡand AEA may be involved in the volume resistance processes in peritoneal dialysis patients.