血液灌流在维持性血液透析并发难治性高血压治疗中的临床疗效观察

Clinical effectiveness of blood perfusion in the treatment of maintenance hemodialysis complicated with refractory hypertension in uremia

目的观察血液灌流（hemoperfusion，HP）对维持性血液透析（hemodiaIysis，HD）患者并发难治性高血压的治疗作用并探讨其可能的致病机制。方法将58例符合难治性高血压的维持性HD患者随机分为治疗组30例及对照组28例，治疗组在HD基础上进行HP治疗，每2周1次，每次2．5h，持续12周，对照组仅行HD治疗。观察两组治疗前、后血压变化，降压药使用种类以及血浆肾素活性（plasmareninactivity，PRA）、血管紧张素（angiotensin，Ang）Ⅱ、醛固酮（aldosterone，Ald）、内皮素（endothelin，ET）、全段甲状旁腺素（intactparathyroidhormone，i-PTH）等物质的水平。结果维持性HD并发难治性高血压患者体内存在较高水平的PRA、AngⅡ、Ald、ET、i-PTH，12周后治疗组PRA、AngⅡ、Aid、ET、i-PTH较治疗前以及对照组明显下降，差异有统计学意义（P〈0．05），而对照组治疗前、后各项指标无明显变化（P〉0．05），治疗组血压下降，使用降压药种类减少，与治疗前及对照组比较，差异有统计学意义（P〈0．05），而对照组治疗前、后血压无明显变化（P〉0．05）。结论HP对维持性HD伴难治性高血压患者有显著的治疗作用。这与HP有效的清除尿毒症患者体内PRA、AngⅡ、Ald、ET、i-PTH等中、大分子物质有关。

Objective To observe the effect of hemoperfusion（HP）on maintenance hemodialysis （HD） patients with refractory ＂hypertension and discuss the possible pathogenesis of HP. Methods Fifty-eight cases of refractory hypertension during maintenance HD were randomly divided into treatment group （n = 30） and control group （n = 28）. On the basis of HD, the patients in treatment group were subjected to HP （2. 5 h every time, twice every week for 12 weeks）,and those in control group to HD treatment alone. Changes in blood pressure before and after treatment, use of antihyper- tensive drugs,and plasma renin activity （PRA）, angiotensinⅡ（Ang Ⅱ ）,aldosterone（Ald） ,endothe- lin （ET） and intact parathyroid hormone （i-PTH） were observed. Results The maintenance HD pa- tients with refractory hypertension had higher levels of PRA, AngⅡ, Ald, ET, and i-PTH. Twelve weeks after treatment,PRA, Ang Ⅱ ,Ald, ET and i-PTH levels in treatment group had significantly decreased as compared with those before treatment and control group （P〈0. 05）, but there was no sig- nificant difference in control group before and after treatment （P〈0. 05）. In treatment group blood pressure,and use of antihypertensive drugs had significantly declined as compared with those before treatment and control group （P〈0. 05）, but there was no significant change in blood pressure of con- trol group before and after treatment （P〉0. 05）. Conclusions HP on maintenance HD patients with refractory hypertension has a significant therapeutic effect probably by effectively removing PRA,AngⅡ ,Ald, ET, i-PTH and other macromolecular substances in uremic patients.