血液灌流对维持性血液透析患者同型半胱氨酸精氨酸加压素及内皮素的影响

目的检测维持性血液透析患者血清同型半胱氨酸(Hcy)、精氨酸加压素(AVP)及内皮素的水平,并观察血液灌流对三者的影响。方法选择维持性血液透析患者60例,随机分为血液灌流串联血液透析组(HP+HD组)和单纯血液透析组(HD组),每组30例,分别于治疗前、后采静脉血;健康人25名为对照组;成批检测血中Hcy、AVP和内皮素的水平。采用单因素方差分析进行数据分析。结果①HP+HD组治疗前血Hcy、AVP和内皮素水平分别为:(13.4±1.0)μmol/L,(354±49)ng/L,(142±16)ng/L;HD组分别为:(14.0±1.3)μmol/L,(348±43)ng/L,(142±14)ng/L;均明显高于对照组分别为:(7.2±0.9)μmol/L,(256±41)ng/L,(115±10)ng/L],差异均有统计学意义(P<0.05);HP+HD组和HD组治疗前各因子水平差异无统计学意义。②HP+HD组在治疗后血Hcy、AVP和内皮素水平分别为:(8.7±0.9)μmol/L,(265±39)ng/L,(119±12)ng/L,较治疗前显著下降,差异均有统计学意义(P<0.05);而HD组在治疗前后各因子水平差异无统计学意义。结论维持性血液透析患者血清Hcy、AVP和内皮素水平较健康人明显升高,血液灌流串联血液透析可以有效降低其在体内的水平。

Effects of hemoperfusion on homocysteine,arginine vasopressin and endothelin in patients with maintenance hemodialysis

Objective To determine the levels of serum homocysteine（Hcy）,arginine vasopressin（AVP） and endothelin in patients with maintenance hemodialysis（MHD） and how hemoperfusion affects these three biomarkers.Methods Sixty patients with MHD were randomized into two groups：hemoperfusion/hemodialysis combination group（HP＋HD group,n=30） and simple hemodialysis group（HD group,n=30）.The both groups underwent venous blood sampling before and after treatment.Twenty-five healthy subjects were selected as normal controls（control group）.And the levels of Hcy,AVP and endothelin in serum were measured.Comparison among groups was performed using oneway ANOVA.Results The levels of Hcy,AVP and endothelin were（13.4±1.0）μmol/L,（354±49）ng/L and（142±16） ng/L in the serum in HP＋HD group,and were（14.0±1.3）μmol/L,（348±43）ng/L and（142±14）ng/L in the serum in HD group.Both levels were significantly higher than those of control group （7.2±0.9）μmol/L,（256±41）ng/L,（115± 10）ng/L,respectively]（P〈0.05）.There was no significance of Hcy,AVP and endothelin in HP＋HD group and HD group before treatment.There was a significant decrease in the level of Hcy,AVP and endothelin（8.7±0.9）μmol/L,（265±39）ng/L,（119±12）ng/L,respectively] in HP＋HD group after treatment（P〈0.05）,whereas there was no significance among each parameter in HD group before and after treatment.Conclusion Compared with the control group,the levels of serum Hcy,AVP and endothelin were significantly increased in the patients with MHD.The hemoperfusion/hemodialysis combination may be an effective approach to reduce the level of Hcy,AVP and endothelin in patients with MHD.