高通量血液透析对尿毒症病人心脏舒缩功能及内皮素-1的影响

目的 研究高通量血液透析对尿毒症病人心脏舒缩功能及内皮素-1(ET-1)的影响。方法 选取2015年1月至2017年3月在江陵县人民医院肾内科行维持性血液透析的病人68例,采用随机数字表法分为高通量血液透析(HFHD)组和普通血液透析(HD)组,每组34例,HFHD组男性15例,HD组男性18例。HFHD组行高通量血液透析,普通HD组行普通血液透析,每周3次,治疗6个月,比较两组病人治疗后血清ET-1和彩色多普勒心动图数据,包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD),左室舒张期末容积(LVEDV)、左室收缩期末容积(LVESV)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、舒张早期及晚期最大血流比(E/A)、等容舒张时间(IRT)、左心室射血分数(EF)以及左心室心肌重量指数(LVMI)。结果 经过6个月的治疗后,HFHD组的ET-1水平下降至(53.2±12.4)ng/L,而普通HD组的ET-1水平略有上升,为(87.3±23.2)ng/L,两组相比差异有统计学意义(t=7.559,P=0.000)。HFHD组的LVEDD,LVESD,LVEDV,LVESV明显小于普通HD组(均P<0.05)。HFHD组的E/A和IRT也较普通HD组明显改善(均P<0.05)。结论 HFHD组能更好的保护尿毒症病人的心脏功能,降低ET-1水平。

Effects of high flow hemodialysis on cardiac diastolic and systolic function and endothelin-1 (ET-1) in patients with uremia

Objective To study the effects of high flow hemodialysis (HFHD) on cardiac diastolic and systolic function and endothelin-1 (ET-1) in patients with uremia.Methods Sixty-eight patients who underwent maintenance hemodialysis (MHD) in Department of Nephrology,Jiangling County People''s Hospital from January 2015 to March 2017 were selected and randomly assigned into high-flux hemodialysis (HFHD) group and general hemodialysis (HD) group,and 34 cases in each group,according to the random number table method.There were 15 males in HFHD group and 18 males in HD group.HFHD group received high flow hemodialysis while HD group underwent the routine hemodialysis,3 times a week,6 months of treatment.Serum ET-1 and color Doppler echocardiography data,including left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),left ventricular posterior wall thickness (LVPWT),interventricular septal thickness (IVST),early diastolic and late diastolic peak ratio (E/A),isovolumic relaxation time (IRT),left ventricular ejection fraction (EF) and the left ventricular mass index (LVMI) were compared between two groups after treatment.Results After 6 months,The level of ET-1 in HFHD group decreased to (53.2±12.4) ng/L,while that in HD group increased slightly to (87.3±23.2) ng/L.There was a significant difference between the two groups (t=7.559,P=0.000).The LVEDD,LVESD,LVEDV,and LVESV in HFHD group were significantly lower than those in normal HD group(all P<0.05).E/A and IRT in HFHD group were also significantly improved compared with those in HD group(all P<0.05).Conclusion HFHD can better improve cardiac function and reduce the level of ET-1 of patients with uremia.