高通量血液透析对尿毒症病人心脏舒缩功能及内皮素-1的影响
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摘要
目的研究高通量血液透析对尿毒症病人心脏舒缩功能及内皮素-1(ET-1)的影响。方法选取2015年1月至2017年3月在江陵县人民医院肾内科行维持性血液透析的病人68例,采用随机数字表法分为高通量血液透析(HFHD)组和普通血液透析(HD)组,每组34例,HFHD组男性15例,HD组男性18例。HFHD组行高通量血液透析,普通HD组行普通血液透析,每周3次,治疗6个月,比较两组病人治疗后血清ET-1和彩色多普勒心动图数据,包括左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD),左室舒张期末容积(LVEDV)、左室收缩期末容积(LVESV)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、舒张早期及晚期最大血流比(E/A)、等容舒张时间(IRT)、左心室射血分数(EF)以及左心室心肌重量指数(LVMI)。结果经过6个月的治疗后,HFHD组的ET-1水平下降至(53.2±12.4)ng/L,而普通HD组的ET-1水平略有上升,为(87.3±23.2)ng/L,两组相比差异有统计学意义(t=7.559,P=0.000)。HFHD组的LVEDD,LVESD,LVEDV,LVESV明显小于普通HD组(均P<0.05)。HFHD组的E/A和IRT也较普通HD组明显改善(均P<0.05)。结论 HFHD组能更好的保护尿毒症病人的心脏功能,降低ET-1水平。
Objective To study the effects of high flow hemodialysis(HFHD) on cardiac diastolic and systolic function and endothelin-1(ET-1) in patients with uremia.Methods Sixty-eight patients who underwent maintenance hemodialysis(MHD) in Department of Nephrology,Jiangling County People's Hospital from January 2015 to March 2017 were selected and randomly assigned into high-flux hemodialysis(HFHD) group and general hemodialysis(HD) group,and 34 cases in each group,according to the random number table method.There were 15 males in HFHD group and 18 males in HD group.HFHD group received high flow hemodialysis while HD group underwent the routine hemodialysis,3 times a week,6 months of treatment.Serum ET-1 and color Doppler echocardiography data,including left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST),early diastolic and late diastolic peak ratio(E/A),isovolumic relaxation time(IRT),left ventricular ejection fraction(EF) and the left ventricular mass index(LVMI) were compared between two groups after treatment.Results After 6 months,The level of ET-1 in HFHD group decreased to(53.2±12.4) ng/L,while that in HD group increased slightly to(87.3±23.2) ng/L.There was a significant difference between the two groups(t=7.559,P=0.000).The LVEDD,LVESD,LVEDV,and LVESV in HFHD group were significantly lower than those in normal HD group(all P<0.05).E/A and IRT in HFHD group were also significantly improved compared with those in HD group(all P<0.05).Conclusion HFHD can better improve cardiac function and reduce the level of ET-1 of patients with uremia.
Objective To study the effects of high flow hemodialysis(HFHD) on cardiac diastolic and systolic function and endothelin-1(ET-1) in patients with uremia.Methods Sixty-eight patients who underwent maintenance hemodialysis(MHD) in Department of Nephrology,Jiangling County People's Hospital from January 2015 to March 2017 were selected and randomly assigned into high-flux hemodialysis(HFHD) group and general hemodialysis(HD) group,and 34 cases in each group,according to the random number table method.There were 15 males in HFHD group and 18 males in HD group.HFHD group received high flow hemodialysis while HD group underwent the routine hemodialysis,3 times a week,6 months of treatment.Serum ET-1 and color Doppler echocardiography data,including left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST),early diastolic and late diastolic peak ratio(E/A),isovolumic relaxation time(IRT),left ventricular ejection fraction(EF) and the left ventricular mass index(LVMI) were compared between two groups after treatment.Results After 6 months,The level of ET-1 in HFHD group decreased to(53.2±12.4) ng/L,while that in HD group increased slightly to(87.3±23.2) ng/L.There was a significant difference between the two groups(t=7.559,P=0.000).The LVEDD,LVESD,LVEDV,and LVESV in HFHD group were significantly lower than those in normal HD group(all P<0.05).E/A and IRT in HFHD group were also significantly improved compared with those in HD group(all P<0.05).Conclusion HFHD can better improve cardiac function and reduce the level of ET-1 of patients with uremia.
引文
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[11] 唐玲,邓晓风,代青,等.高通量血液透析对尿毒症患者心肌损伤标志物和心功能指标的影响[J].中华危重病急救医学,2017,29(6):547-550.
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[14] 温玉.高通量血液透析联合低钙透析液与普通透析对尿毒症病人皮肤瘙痒评分及血生化指标的影响对比[J].安徽医药,2017,21(3):496-500.
[15] LI X,XU H,XIAO XC,et al.Prognostic effect of high-flux hemodialysis in patients with chronickidney disease[J].Braz J Med Biol Res,2016,49(1):e4708.DOI:10.1590/1414-431X20154708.
[2] LAVEBORN E,LINDMARK K,SKAGERLIND M,et al.NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane[J].Int J Artif Organs,2015,38(2):69-75.
[3] TSAI SH,LU G,XU X,et al.Enhanced endothelin-1/rho-kinase signaling and coronary microvascular dysfunction in hypertensive myocardial hypertrophy[J].Cardiovasc Res,2017,113(11):1329-1337.
[4] COZZOLINO M,GALASSI A,PIVARI F,et al.The cardiovascular burden in end-stage renal disease[J].Contrib Nephrol,2017,191:44-57.
[5] TONELLI M,KARUMANCHI SA,THADHANI R.Epidemiology and mechanisms of uremia-related cardiovascular disease[J].Circulation,2016,133(5):518-536.
[6] 王学森.长期高通量透析对维持性血液透析患者心脏结构与功能的影响研究[J].现代诊断与治疗,2017,28(9):1693-1694.
[7] STUBBS JR,HOUSE JA,OCQUE AJ,et al.Serum trimethylamine-n-oxide is elevated in CKD and correlates with coronary atherosclerosis burden[J].JASN,2016,27(1):305-313.
[8] TOBE S,KOHAN DE,SINGARAYER R.Endothelin receptor antagonists:new hope for renal protection?[J].Curr Hypertens Rep,2015,17(7):57.
[9] GUO B,LI Y,JIN X,et al.Nitric oxide/cyclic GMP pathway mediates the endothelin-1-upregulation of adiponectin expression in rat cardiomyocytes[J].Biomed Rep,2017,7(3):267-271.
[10] 黄鹤宁,谢小洪.高通量血液透析对维持性血液透析中慢性心力衰竭患者的内皮素-1水平的影响[J].中国现代药物应用,2014(24):69-70.
[11] 唐玲,邓晓风,代青,等.高通量血液透析对尿毒症患者心肌损伤标志物和心功能指标的影响[J].中华危重病急救医学,2017,29(6):547-550.
[12] GEBERTH S,NOWACK R.Praxis der Dialyse[M].Berlin Heidelberg:Springer,2014.
[13] MEDOW JE,SANGHVI SR,HOFMANN RM.Use of high-flow continuous renal replacement therapy with citrate anticoagulation to control intracranial pressure by maintaining hypernatremia in a patient with acute brain injury and renal failure[J].Clinical Medicine & Research,2015,13(2):89-93.
[14] 温玉.高通量血液透析联合低钙透析液与普通透析对尿毒症病人皮肤瘙痒评分及血生化指标的影响对比[J].安徽医药,2017,21(3):496-500.
[15] LI X,XU H,XIAO XC,et al.Prognostic effect of high-flux hemodialysis in patients with chronickidney disease[J].Braz J Med Biol Res,2016,49(1):e4708.DOI:10.1590/1414-431X20154708.