摘要
目的 观察低钠透析液高通量透析对伴发高血压的维持性透析患者血压恢复及外周血血管紧张素(Ang)Ⅱ、肾素水平的影响.方法 前瞻性选取2022年2月至2024年2月在秦皇岛市第一医院进行维持性透析的100例伴发高血压患者为对象,按照信封法分为正常组(n=50)和低钠组(n=50).正常组给予140 mmol/L正常钠透析液进行高通量透析,低钠组给予135 mmol/L低钠透析液进行高通量透析.检测两组治疗前、治疗12周后的24 h动态血压(24 h收缩压和舒张压、日间平均收缩压和舒张压、夜间平均收缩压和舒张压、血压负荷)、肾素-血管紧张素-醛固酮系统(RAAS)相关因子(AngⅠ、AngⅡ、肾素、醛固酮)、内皮素-1、甲状旁腺激素(PTH)、同型半胱氨酸(Hey)、一氧化氮(NO)水平,并记录两组不良反应发生情况.结果 治疗12周后,两组24 h收缩压和舒张压、日间收缩压和舒张压、夜间收缩压和舒张压、血压负荷均较治疗前降低,且低钠组的24 h收缩压和舒张压、日间收缩压和舒张压、夜间收缩压和舒张压、血压负荷分别为(131.12±6.58)mmHg、(74.47±3.95)mmHg、(140.25±6.95)mmHg、(81.25±4.06)mmHg、(132.52±6.71)mmHg、(77.11±4.69)mmHg、(25.65±5.94)％,均低于正常组[(138.25±7.15)mmHg、(79.14±4.23)mmHg、(151.25±8.22)mmHg、(89.96±4.44)mmHg、(139.96±6.77)mmHg、(87.41±5.07)mmHg、(32.32±6.15)％],差异均有统计学意义(P＜0.05).治疗12周后,两组Ang Ⅰ、AngⅡ、肾素、醛固酮水平均较治疗前降低,且低钠组的 Ang Ⅰ、AngⅡ、肾素、醛固酮水平分别为(2.74±0.67)ng/mL、(97.33±18.14)pg/mL、(2.04±0.67)ng/(mL·h)、(137.14±26.95)pg/mL,均低于正常组[(3.23±0.89)ng/mL、(126.21±20.44)pg/mL、(2.56±0.78)ng/(mL·h)、(189.54±32.25)pg/mL],差异均有统计学意义(P＜0.05).治疗12周后,两组PTH、Hcy、内皮素-1水平均较治疗前降低,NO水平均较治疗前升高,且低钠组的PTH、Hcy、内皮素-1水平分别为(134.75±18.62)pg/mL、(14.45±2.67)μmol/L、(64.03±5.11)µmol/L,均低于正常组[(167.54±20.44)pg/mL、(19.04±3.54)μmol/L、(71.14±5.82)μmol/L],NO 水平为(16.88±2.89)μg/mL,高于正常组[(13.54±2.27)µg/mL],差异均有统计学意义(P＜0.05).两组总不良反应发生率比较,差异无统计学意义(P＞0.05).结论 低钠透析液高通量透析可降低伴发高血压的维持性透析患者血压水平,可能与调节肾素-血管紧张素-醛固酮系统与血管内皮功能有关.
Abstract
Objective To observe the effect of high flux dialysis with low sodium dialysate on blood pressure recovery and peripheral blood angiotensin(Ang)Ⅱ and renin levels in maintenance dialysis patients with concomitant hypertension.Methods A total of 100 patients with hy-pertension who underwent maintenance dialysis in Qinhuangdao First Hospital from February 2022 to February 2024 were prospectively selected and divided into the normal group(n=50)and the low sodium group(n=50)according to the envelope method.The normal group was given 140 mmol/L normal sodium dialysate for high-throughput dialysis,and the low-sodium group was given 135 mmol/L low-sodium dialysate for high-throughput dialysis.The levels of 24 h ambulatory blood pressure[24 h systolic and diastolic blood pressure,daytime mean systolic and diastolic blood pressure,nighttime mean systolic and diastolic blood pressure,and blood pressure load],renin-angiotensin-aldosterone system(RAAS)-related factors(Ang Ⅰ,Ang Ⅱ,renin,aldosterone),endothelin-1,parathyroid hormone(PTH),homocysteine(Hey),and nitric oxide(NO)were detected before the treatment and at 12 weeks of the treatment,and adverse reactions in both groups were recorded.Results After 12 weeks of treatment,24 h systolic blood pressure and diastolic blood pressure,daytime systolic blood pressure and diastolic blood pressure,night-time systolic blood pressure and diastolic blood pressure,and blood pressure load were lower in the two groups before treatment,the 24 h systolic blood pressure and diastolic blood pressure,daytime systolic blood pressure and diastolic blood pressure,nighttime systolic blood pressure and di-astolic blood pressure,and blood pressure load in the low sodium group were(131.12±6.58)mmHg,(74.47±3.95)mmHg,(140.25±6.95)mmHg,(81.25±4.06)mmHg,(132.52±6.71)mmHg,(77.11±4.69)mmHg,(25.65±5.94)％,respectively,which were lower than those in the normal group[(138.25±7.15)mmHg,(79.14±4.23)mmHg,(151.25±8.22)mmHg,(89.96±4.44)mmHg,(139.96±6.77)mmHg,(87.41±5.07)mmHg,(32.32±6.15)％],and the differences were statistically significant(P＜0.05).After 12 weeks of treat-ment,the levels of Ang Ⅰ,Ang Ⅱ,renin and aldosterone in the two groups were lower than those before treatment,and the levels of Ang Ⅰ,AngⅡ,renin and aldosterone in the low sodium group were(2.74±0.67)ng/mL,(97.33±18.14)pg/mL,(2.04±0.67)ng/(mL·h),(137.14±26.95)pg/mL,respectively,which were all lower than those in the normal group[(3.23±0.89)ng/mL,(126.21±20.44)pg/mL,(2.56±0.78)ng/(mL·h),(189.54±32.25)pg/mL],and the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the levels of PTH,Hey and endothelin-1 in the two groups were lower than those before treatment,and the levels of NO were higher than those before treatment,the levels of PTH,Hcy and endothelin-1 in the low sodium group were(134.75±18.62)pg/mL,(14.45±2.67)μmol/L and(64.03±5.11)µmol/L,respectively,which were lower than those in the normal group[(167.54±20.44)pg/mL,(19.04±3.54)μmol/L,(71.14±5.82)μmol/L],the level of NO was(16.88±2.89)μg/mL,which was higher than that in the normal group[(13.54±2.27)μg/mL],and the difference was statistically significant(P＜0.05).There was no statistically significant difference in the incidence of total adverse reactions between the two groups(P＞0.05).Conclusion High flux dialysis with low sodium dialysate reduces blood pressure levels in maintenance dialysis patients with concomitant hypertension and may be related to the regulation of the renin-angiotensin-aldosterone system with endothelial function.
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