CAJ | 학술논문

背景：维持性血液透析人群中有10%-49%的患者合并顽固性高血压，常规药物治疗效果差。连续性肾脏替代治疗可较好地清除患者血浆中的中、大分子毒素，理论上可通过降低相关毒素水平干预顽固性高血压形成机制。 　　目的：观察连续性肾脏替代治疗对维持性血液透析患者顽固性高血压的影响。 　　方法：45例维持性血液透析合并顽固性高血压患者，随机分为血液透析组22例与连续性血液净化组23例，血液透析组则行常规血液透析治疗，连续性肾脏替代治疗组在常规血液透析治疗基础上每周行连续性肾脏替代治疗1次。 　　结果与结论：治疗3个月后，连续性血液净化组肾素、内皮素、血管紧张素Ⅱ、C-反应蛋白、白细胞介素6、肿瘤坏死因子α水平均低于试验前水平，24 h平均血压下降，且差异均有显著性意义(P<0.05)，血液透析组上述各指标较试验前无变化(P>0.05)；试验后连续性血液净化组上述各指标均低于血液透析组，差异有显著性意义(P<0.05)。结果显示在常规血液透析基础上行连续性肾脏替代治疗可明显降低合并顽固性高血压维持性血液透析患者的血压，其机制可能是降低了患者血浆中的中、大分子毒素以及炎症因子水平。
배경：유지성혈액투석인군중유10%-49%적환자합병완고성고혈압，상규약물치료효과차。련속성신장체대치료가교호지청제환자혈장중적중、대분자독소，이론상가통과강저상관독소수평간예완고성고혈압형성궤제。 　　목적：관찰련속성신장체대치료대유지성혈액투석환자완고성고혈압적영향。 　　방법：45례유지성혈액투석합병완고성고혈압환자，수궤분위혈액투석조22례여련속성혈액정화조23례，혈액투석조칙행상규혈액투석치료，련속성신장체대치료조재상규혈액투석치료기출상매주행련속성신장체대치료1차。 　　결과여결론：치료3개월후，련속성혈액정화조신소、내피소、혈관긴장소Ⅱ、C-반응단백、백세포개소6、종류배사인자α수평균저우시험전수평，24 h평균혈압하강，차차이균유현저성의의(P<0.05)，혈액투석조상술각지표교시험전무변화(P>0.05)；시험후련속성혈액정화조상술각지표균저우혈액투석조，차이유현저성의의(P<0.05)。결과현시재상규혈액투석기출상행련속성신장체대치료가명현강저합병완고성고혈압유지성혈액투석환자적혈압，기궤제가능시강저료환자혈장중적중、대분자독소이급염증인자수평。
BACKGROUND:About 10%-49%of maintenance hemodialysis patients are accompanied by refractory hypertension and common drug therapy is ineffective. Continuous renal replacement therapy could clear the middle and giant molecule toxins in the blood plasma of patients, it is theoretical y treat refractory hypertension through reducing the toxin levels. OBJECTIVE:To observe the effect of continuous renal replacement therapy on maintenance hemodialysis patients with refractory hypertension. METHODS:A total of 45 maintenance hemodialysis patients with refractory hypertension were randomly divided into two groups, hemodialysis group (n=22) and continuous blood purification group (n=23). Hemodialysis group underwent conventional hemodialysis treatment. Continuous blood purification group underwent conventional hemodialysis therapy, and treatment of continuous blood purification weekly. RESULTS AND CONCLUSION:After 3 months of treatment, the renin activity, endothelin, angiotensin II, C-reactive protein, interleukin-6, and tumor necrosis factor-αlevels in continuous blood purification group were significantly lower than the levels before the experiment, while 24-hour mean blood pressure levels were significantly decreased (P<0.05). In hemodialysis group, renin activity, endothelin, angiotensin II, C-reactive protein, interleukin-6, and tumor necrosis factor-αlevels and 24-hour mean blood pressure did not change (P>0.05). After the test, continuous blood purification group showed significantly lower levels of the above index than the hemodialysis group (P<0.05). Continuous renal replacement therapy plus hemodialysis significantly reduce the blood pressure in maintenance hemodialysis patients with refractory hypertension, the potential mechanisms are mediated by lowering the middle and giant molecule toxin as wel as inflammatory factor in plasma.