树脂吸附对维持性血液透析难治性高血压患者肾素-血管紧张素-醛固酮系统的影响

目的探讨树脂吸附对维持性血液透析（maintenancehemodialysiS，MHD）难治性高血压患者肾素一血管紧张素一醛固酮（RAS）系统的影响。方法将64例MHD患者随机分成2组，每组32人，即血液透析（HD）组：每例患者每周2～3次HD治疗（每次4h）；HD＋血液灌流（HP）组：每例患者在HD治疗基础上，每周1次HD＋HP治疗（每次2hHP＋2hHD）。观察治疗前和治疗后8周末血压、血清肾素（PRA）、血管紧张素II（ATII）的变化情况。结果①HD组治疗前后血压、PRA、ATII及甲状旁腺激素（PTH）水平变化不明显，无统计学差异（tsw=-0．615、tDBP==0．660，tPPA=-473，tATⅡ=-0．644，tpTH=-0．170，P值均〉0．05）；②HD＋HP组治疗后血压、血清PRA、ATII及PTH水平均较治疗前明显下降（tsBp：--ii．018，tDBP------25．773，P值均〈0．01：tpRA=-8．267，tAII=-26．593，tPTH=3．061，P值均〈0．05），且各指标均较HD组治疗后明显下降，差异均有统计学意义（tSRP=-8．566、tDBP=-24．257，P值均〈0．01；tm=-8．406，tATⅡ=-25．967，tpTH=-2．383，P值均〈0．05）。结论树脂吸附联合血液透析较单纯血液透析能明显降低MHD患者血浆肾素一血管紧张素的水平，可使MHD难治性高血压患者的血压得到有效控制。

The effect of resin-absorbed hemoperfusion on the renin-angiotensin-aldosterone system in hemodialysis patients with intractable hypertension

Objective To investigate the effect of resin-absorbed hemoperfusion on renin-angiotensin- aldosterone system in maintenance hemodialysis （MHD） patients with intractable hypertension. Methods A total of 64 patients in our hospital were randomly and equally divided into 2 groups. In HD group, patients were treated with hemodialysis （HD） 2 or 3 times a week. In HD＋ hemoperfusion （HF） group, patients were treated with resin-absorbed hemoperfusion once a week on the basis of conventional HD. Blood pressure （BP）, rennin （PRA）, angiotensin II （ATII） and parathyroid hormone （PTH） were measured before treatment and after the treatment for 8 weeks. Result （D In HD group, the changes of BP, PRA, ATII and PTH were statistically insignificant before and after the treatment （tSBP=-0.615, tDBP=-0.660, tpRA=-0.473, tAT ii= -0.644, tpTH=-0.170, P 〉 0.05）. ~） In HD＋HF group after the treatment for 8 weeks, BP, PRA, ATII and PTH were lower than those before the treatment （tSBP=-I 1.018, tDBP=-25.773, P 〈 0.01 ; tpRA=-8.267, tAT Ⅱ=-26.593, tpTH=-3.061, P 〈 0.05）, and were also lower than those in HD group after HD for 8 weeks （tSBP =-8.566, tDBP =-24.257, P 〈 0.01; tpRA=-8.406, tATⅡ=-25.967, tpTH=-2.383, P 〈 0.05）. Con- clusion Resin-absorbed HF combined with HD was more effective than HD in blood pressure control and lowering renin and angiotensin II in MHD patients with intractable hypertension.