高通量透析对慢性肾病患者生物活性物质的影响

目的血清肌酐(Scr)、血管紧张素Ⅱ(Ang Ⅱ)、内皮素-1(ET-1)和一氧化氮(NO)水平升高是慢性肾病的主要标志。机体淋巴细胞和血管内皮细胞均可通过分泌上述活性分子,参与慢性肾病的发病过程。本实验通过观察高通量透析(HFHD)对维持性血液透析(MHD)患者血管活性物质的影响,从而探讨HFHD改善MHD患者体内这些生物活性物质分泌的作用,为临床治疗提供理论依据及新思路,也为进一步研究机体免疫系统参与慢性肾病的发生机制奠定基础。方法将MHD患者20例随机分为低通量血液透析(LFHD)组和高通量血液透析(HFHD)组各10例。选取尿毒症非透析患者20例,另选取20例正常健康体检者作为健康对照组。HFHD组改用可重复使用高通量透析器Polyflux17R,LFHD组继续采用可重复使用透析器Polyflux8LR。分别检测HFHD组及LFHD组患者单次治疗前后及3个月透析前检测的Scr、Ang Ⅱ、ET-1和NO;另抽取尿毒症非透析组和健康对照组各20例的清晨空腹肘静脉血标本同时检验。NO测定用硝酸还原酶法,ET-1、Ang Ⅱ检测均采用放免法。Cr的测定采用常规生化法。透析组患者同时监测血压变化。结果两组患者单次透析后HFHD组Ang Ⅱ、ET-1水平较LFHD组显著降低(P<0.05)。治疗3个月后,HFHD组患者NO、ET-1、平均动脉压与治疗前显著下降(P<0.05)。结论高通量血液透析可以提高上述生物活性物质的清除,使MHD患者高血压得到改善;本实验结果为将来进一步研究淋巴细胞和内皮细胞参与慢性肾病发病的机制提供临床实验依据。

Effects of high flux hemodialysis on the blood levels of bioactive molecules in chronic nephrosis patients

This study was designed to observe the effects of high flux hemodialysis(HFHD) on the secretion of the above bioactive molecules in patients with maintenance hemodialysis(MHD).Total of 20 patients were randomly divided into HFHD treatment group(10 patients) and low flux hemodialysis(LFHD) treatment group(10 patients).20 uremic patients without dialysis,and the other 20 healthy volunteers were selected into control groups.Reusable high flux dialyzers Polyflux17R were used in HFHD group,and reusable dialyzers Polyflux8LR in LFHD.The serum levels of Scr,Ang Ⅱ,ET-1 and NO were detected before and just after hemodialysis and 3 months after hemodialysis in HFHD group and LFHD group.Moreover,fasting elbow venous blood samples of 20 nondialysis uremic patients and 20 health persons were collected and analyzed.NO was determined by nitrate reductase,creatinine was determined by conventional biochemical methods,while ET-1 and Ang II were determined by radioimmunoassay.By the time,the changes of blood pressure were observed in dialysis patients.The results showed that the levels of Ang Ⅱ and ET-1 after hemodialysis in HFHD group were lower than those of LFHD group(P < 0.05) and the levels of ET-1,NO and MAP in HFHD group after 3 months’ treatment were decreased significantly than before(P < 0.05).These results suggest that HFHD could improve the clearance of the above bioactive molecules and ameliorate the high blood pressure of patients.These results provide the experimental basis for further clarification of the mechanisms that how lymphocytes and endothelial cells involve in the pathogenesis of chronic nephrosis.