老年血液透析患者血压升高的机制及促红细胞生成素的影响

The role of recombinant human erythropoietin on the blood pressure in aged patients for maintenance hemodialysis

目的 探讨老年血液透析患者血压升高的机制以及基因重组促红细胞生成素(rHuEPO ,EPO)对维持性血液透析患者血管活性介质的影响。 方法 5 2例老年血液透析患者 ,合并高血压者 2 3例 (HBP组 ) ,正常血压者 2 9例 (NBP组 )。检测血中血管活性介质 :内皮素 (ET)、肾素活性 (PRA)、醛固酮 (PA)、血管紧张素Ⅰ (AⅠ )、血管紧张素Ⅱ (AⅡ )、多巴胺 (DA)、肾上腺素 (E)和去甲肾上腺素 (NE)。NBP组中 15例静脉 1次注射EPO 30 0 0U(EPO组 ) ,14例作为对照 (NS组 )静脉注射生理盐水。均于注射后第 1、3、6、9、12、18、2 4、30、4 4h动态检测血中EPO和上述血管活性介质。 结果 (1)与NBP组较比 ,HBP组DA (346 0 6± 137 12 )pmol/L、E (6 0 0 0 0± 4 36 36 )pmol/L和NE(4789 90± 1892 31)pmol/L明显增加 (P <0 0 5 ) ;(2 )与NS组相比 ,EPO组ET一过性升高 ,而DA、E和NE进行性升高 (P >0 0 5 )。 结论 老年血液透析患者血压升高和EPO引起的血压升高的机制可能与血中DA、E和NE增多有关。

Objective To study the effect of recombinant human erythropoietin (rHuEPO) on in aged patients undergoing maintenance hemodialysis. Methods Blood pressure and its mechanism 52 elderly patients undergoing maintenance hemodialysis divided into two groups, HBP group (23 cases with hypertension) and NBP group(29 cases without hypertension). The plasma vasoactive substances were measured by radioimmunological methods. Fifteen cases in NBP group as EPO group were given a bolus of venous injection of rHuEPO (3 000 IU), others in NBP group (14 cases) were injected 0.9% saline as control group. The plasma vasoactive substances were assayed before and 1, 3, 6, 9, 12, 18, 24, 30, 44 hours after therapy with or without rHuEPO. Results (1) The plasma dopamine (DA) in HBP group were significantly higher than that of NBP group. (2) Endothelin levels increased transiently but DA levels increased steadily in EPO group. Conclusions The study suggests that the effect of rHuEPO induced on hypertension in the elderly patients undergoing maintenance hemodialysis is associated with the increasing plasma DA.