血液透析中C型利钠肽、心脏扩张肽的连续动态观察

目的通过对血液透析过程中CNP(c-type natriuretic peptide)、CDN(cardiodilatin)的连续动态观测,对单次血液透析的影响作出评估.方法选取2000年6月～2001年8月在我中心长期维持性血液透析全部患者18例,透析前血肌酐>500μmol/L,其中男14例,女4例,年龄29～74岁(平均48.4岁),血液透析时间2个月～55个月(平均17个月),每次血液透析5小时,每周2～3次;血液透析器为德国Braun HE1400,血液透析液为碳酸氢盐透析液.随机观测30次血液透析过程,选取血液透析开始前、血液透析治疗第1、2、3、4小时及血液透析结束时(第5小时)共6个时间,记录血压及采取血标本.用放免法检测CNP及CDN.数据按血液透析中标本采取时间分为6个组进行自身组间对照,因素间行直线相关分析.结果①CNP正常参考值14.40～25.52ng/L[(19.96±5.56)ng/L].血液透析前较血液透析中各组均低,有显著性差异;血液透析过程中及血液透析后各组间无显著性差异.各组均数均明显高于正常参考值.②CDN正常参考值210～260ng/L.从均数上显示血液透析前、透析后较高,超出正常参考值上限,透析中降低,透析中各组均数均在正常参考值内,各组间两两比较无显著性差异.③相关分析显示CNP与收缩压、CNP与舒张压呈正相关.结论慢性肾衰竭及血液透析影响了血浆内多种血管活性肽的变化.CNP值高于正常参考值,血液透析过程中浓度逐渐升高;CDN血液透析前、透析后较高,超出正常参考值上限,透析中降低,透析中各组均数均在正常参考值内.CNP与收缩压、CNP与舒张压呈正相关.

A continuous and development observation of c-type natriuretic peptide and cardiodilatin during hemodialysis

Objective To evaluate the influence of single HD on c-type natriuretic peptide(CNP) and cardiodilatin(CDN). Methods Eighteen maintenance hemodialysis patients were studied. Blood samples were collected and blood pressure were measuredbefore hemodialysis, 1,2,3,4 hours duning hemodialysis and post hemodialysis. CNP and CDN were measured with radioimmunoassay(RIA).Results The value of CNP before HD is significantly lower than all the others; There was no significant difference between the other 5 groups. the means of all the 6 groups were higher than the normal referenle ralue (NRV). 2, The NRV of CDN is from 210 to 260ng/L. The means of the before and after HD group were higher than the other 4 groups during HD and NRV. The means of the 4 groups during HD were within the NRV. There was no significant difference between all the 6 groups. 3, There were positive correlations befween CNP and systolic pressure and CNP and diastotic pressure.Conclusion Many angio-bioactive peptide are influenced by chronic renal failure and HD. The CNP value in maintenance hemodialysis patients are higher than NRV and increase gradually during hemodialysis. The CDN value before and after hemodialysis are highention NRV while decreases and are with in NRV during HD. There are positive correlation between CNP and systolic pressure and CNP and diastolic pressure.