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目的探讨高通量血液透析(high-flux hemodialysis,HFHD)和低通量血液透析(low-flux hemodialysis,LFHD)对慢性肾功能衰竭尿毒症患者血清内皮素-l(endothelin-l,ET-1)、血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、一氧化氮(nitric oxide,NO)的影响及临床意义。方法40例行维持性血液透析治疗慢性肾功能衰竭尿毒症患者随机分为HFHD组和LFHD组各20例,尿毒症未行血液透析患者20例为非透析组,同期体检健康者20例为对照组。检测HFHD组和LFHD组透析治疗前及治疗3个月血清肌酐(serum creatinine,SCr)、ET-1、AngⅡ、NO水平,并与非透析组、对照组进行比较。结果 (1)HFHD组及LFHD组治疗前ET-1[(181.22±24.36)、(180.14±25.91)ng/L]、AngⅡ[(80.54±19.37)、(81.47±18.27)ng/L]、肌酐[(900.45±148.73)、(901.31±147.89)μmol/L]以及非透析组以上指标[(130.55±33.27)ng/L、(66.51±13.11)ng/L、(904.71±156.25)μmol/L]均高于对照组[(55.24±13.72)ng/L、(40.77±21.42)ng/L、(75.54±16.27)μmol/L](P<0.05),而NO水平[(178.41±21.39)、(179.42±22.51)、(172.49±29.18)μmol/L]均低于对照组[(263.55±12.33)μmol/L](P<0.05);HFHD组及LFHD组治疗前ET-1、AngⅡ均高于非透析组,NO、肌酐与非透析组比较差异无统计学意义(P>0.05);(2)透析治疗3个月,HFHD组ET-1[(116.13±10.09)ng/L]、AngⅡ[(50.49±20.07)ng/L]较治疗前下降(P<0.05),NO[(179.14±19.05)μmol/L]较治疗前略有升高,但差异无统计学意义(P>0.05);LFHD组治疗3个月后ET-1[(179.22±24.56)ng/L、AngⅡ(78.44±19.10)ng/L、NO(181.28±23.14)μmol/L]与治疗前比较差异无统计学意义(P>0.05);HFHD组与LFHD组AngⅡ、ET-1水平比较差异有统计学意义(P<0.05),NO、肌酐水平比较差异无统计学意义(P>0.05)。结论 HFHD可提高肾功能衰竭尿毒症患者血管活性物质的清除率,改善其内皮细胞分泌功能,减少血管活性物质的释放。
Objective To investigate the effects of high-flux hemodialysis (HFHD) and low-flux hemodialysis (LFHD) on the levels of endothelin-1 (ET-1) in patients with uremia of chronic renal failure ), Angiotensin Ⅱ (AngⅡ), nitric oxide (NO) in serum and its clinical significance. Methods Forty patients with chronic renal failure who underwent maintenance hemodialysis were randomly divided into HFHD group and LFHD group. Twenty patients without hemodialysis were enrolled in this study. Twenty patients with healthy hemodialysis during the same period were selected as control group group. The levels of serum creatinine (SCr), ET-1, AngⅡ and NO in HFHD group and LFHD group before dialysis treatment and 3 months after treatment were compared with those in non-dialysis group and control group. Results (1) The levels of ET-1 [(181.22 ± 24.36), (180.14 ± 25.91) ng / L], AngⅡ [(80.54 ± 19.37), (81.47 ± 18.27) [(900.45 ± 148.73), (901.31 ± 147.89) μmol / L], and the above indexes in non-dialysis group [(130.55 ± 33.27) ng / L, (66.51 ± 13.11) ng / L and (904.71 ± 156.25) μmol / Were significantly higher than those in the control group (55.24 ± 13.72 ng / L, 40.77 ± 21.42 ng / L, 75.54 ± 16.27 μmol / L, respectively) 179.42 ± 22.51 and 172.49 ± 29.18 μmol / L, respectively, compared with those in the control group [(263.55 ± 12.33) μmol / L] (P <0.05) There was no significant difference between non-dialysis group, NO, creatinine and non-dialysis group (P> 0.05); (2) ET-1 [(116.13 ± 10.09) ng / L] (50.49 ± 20.07) ng / L] before treatment was significantly lower than that before treatment (P <0.05), NO [(179.14 ± 19.05) μmol / L] There was no significant difference in ET-1 [(179.22 ± 24.56) ng / L, Ang Ⅱ (78.44 ± 19.10) ng / L, NO (181.28 ± 23.14) μmol / L vs > 0.05); Ang II, ET-1 water in HFHD group and LFHD group There was significant difference between the two groups (P <0.05). NO and creatinine levels had no significant difference (P> 0.05). Conclusion HFHD can improve the clearance rate of vasoactive substances in uremic patients with renal failure, improve the secretion function of endothelial cells and reduce the release of vasoactive substances.