目的 探讨树脂吸附对维持性血液透析(maintenance hemodialysis,MHD)难治性高血压患者肾素-血管紧张素-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4 h);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2 h HP+2 h HD).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(AT Ⅱ)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(tSBP=-0.615、tDBP=-0.660,tPRA=-0.473,tATⅡ=-0.644,tPTH=-0.170,P值均＞0.05)；②HD+HP组治疗后血压、血清PRA、AT Ⅱ及PTH水平均较治疗前明显下降(tSBP=-11.018,tDBP=-25.773,P值均＜0.01; tPRA=-8.267,tATⅡ =-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(tSBP=-8.566、tDBP=-24.257,P值均＜0.01;tPRA=-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-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.%Objective To investigate the effect of resin-absorbed hemoperfusion on renin-angiotensinaldosterone 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 ① 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).② In HD+HF group after the treatment for 8 weeks,BP,PRA,ATⅡ and PTH were lower than those before the treatment (tSBP=-1 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,tAT Ⅱ=-25.967,tpTH=-2.383,P ＜ 0.05).Conclusion 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.
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