血液透析患者高血压机制及相关危险因素

目的 :　对血液透析患者高血压相关危险因素进行分析 ,探讨高血压的发生机制。方法 :　将 4 0例患者分成正常血压组、高血压组 (再分为透后血压升高组及透后血压未升高组 ) ,用放射免疫法测透析前、后的ANP、PRA、Ang -II及ET - 1,并计算它们的Kt/V和心胸比例。结果 :　高血压组的Kt/V显著低于正常血压组 (P <0 .0 5 ) ;透后血压未升高组的透前、透后ANP均显著高于透后血压升高组 (P <0 .0 1) ;透后血压升高组的透前、透后PRA、Ang -II均显著高于透后血压未升高组 (P<0 .0 1) ;高血压组的透前ET - 1显著高于正常血压组 (P <0 .0 5 )。结论 :　透析不充分是引起血压升高的原因之一 ;血透患者Kt/V达 1.7以上者血压控制较好 ;水钠潴留仍为血透患者高血压形成和维持的主要因素 ;透后血压升高者与RAS有关 ;内皮素系统过度表达亦是血透患者高血压的发病机制之一

A Prospective Study of Relevant Factors in Hemodialysis Patients with Hypertension

Objective:To investigate the mechanisms of hemodialysis patients with hypertension. Methods:40 patients with hemodialysis were classified into two groups,normotensive group and hypertensive group,according to blood pressure level;then hypertensive group was divided into two subgroups,group C whose blood pressure rised after dialysis and group D whose blood pressure did not rise after dialysis.Atrial natriuretic peptide(ANP),Plasma renin activation(PRA),Angiotension-II(Ang-II) and Endothelin-1(ET-1) were measured before and after dialysis respectively,calculated the Kt /V and the ratio of thorax-heart. Results:The Kt /V of hypertension group was significantly lower than that of normotensive group(P< 0.05). The plasm concentrations of ANP of before and after dialysis of group D were remarkably increased than that of group C(P<0.01);PRA and plasm levels of Ang-II before and after dialysis of group C were significantly higher than that of group D(P<0.01);The plasm concentrations of ET-1 of predialysis of hypertensive group was remarkably greater than that of normotensive group. Conclusion:On multivariate analysis,hemodialysis inadequacy,sodium and water retention,excitation of renin-angiotension system(RAS) and high ET-1 are independently associated with higher blood pressure;Control of hypertension becomes more easily when the Kt /V is more than 1.7.