慢性肾功能衰竭患者血液透析前后血管活性因子的变化及临床意义

The changes and significance of the plasma levels of nitric oxide,endothelin,atrial natriuretic peptide and angiotensinⅡ in chronic renal failure patients receiving hemodialysis therapy

目的 :了解血液透析患者血浆一氧化氮 (NO)、内皮素 (ET)、心房利钠多肽 (ANP)、肾素 (PRA)及血管紧张素 (AT )在透析前后的水平变化及临床意义。方法 :设正常对照、慢性肾功能不全失代偿期患者及慢性肾功能衰竭 (CRF)患者各 30例。用比色法测定 NO,放射免疫法测定 ANP、ET、PRA及 AT 水平。结果 :CRF组 NO、ANP、ET、PRA、AT 浓度明显高于对照组 (P<0 .0 5或 P<0 .0 1) ;透析后 NO和 ANP显著下降 (P<0 .0 5和 P<0 .0 1) ,PRA和 AT 浓度明显升高 (P均 <0 .0 1) ,ET透析前后无明显变化 (P>0 .0 5 )。结论 :血液透析可使 CRF患者血浆 NO、ANP降低 ,PRA、AT 升高 ,提示 ET升高可增加 ANP和PRA水平 ,ANP浓度可抑制 AT 的分泌。

Objective:To investigate the changes and clinical significance of plasma levels of nitric oxide (NO),endothelin(ET),atrial natriuretic peptide(ANP),plasma renin activity(PRA) and angiotensinⅡ(ATⅡ) before and after hemodialysis in patients with chronic renal failure(CRF).Methods:Sixty patients with CRF(30 patients with uncompensated chronic renal dysfunction and the other 30 patients with chronic renal failure) were included in the study.Thirty healthy volunteer were chosen as normal control.Blood samples were collected before and after hemodialysis.The plasma NO was assayed using colorimetry and the plasma ET,ANP,PRA and ATⅡ were determined by radioimmunoassay.Results:The plasma levels of NO,ET,ANP,PRA and ATⅡ in the group of CRF were significant higher than those of control ( P <0 05 or P <0 01).After hemodialysis,plasma NO and ANP decreased significantly ( P <0 05 and P <0 01) while PRA and ATⅡ increased (both P <0 01).No significant change was observed in plasma ET before and after hemodialysis.Conclusions:Plasma levels of NO and ANP can be lowered by hemodialysis therapy in CRF patients while the plasma levels of PRA and ATⅡ elevated at the same time.It's suggsted that the increase in ET may cause the rise of the concentration of ANP and PRA,and increase in concentration of ANP may inhibit the secretion of ATⅡ.