RAAS对血液透析患者透析过程中血压波动的影响及相关因素分析
Chinese Journal of Blood Purification(2016)
Abstract
目的 研究维持性血液透析患者肾素-血管紧张素-醛固酮系统(Renin-angiotensin-aldosterone system,RAAS)水平与透析过程中血压波动的关系及相关影响因素的分析. 方法 选择上海市同济医院维持性血液透析的患者,根据透析过程中血压变化分为透析低血压组,透析高血压组及透析血压稳定组,比较各组患者生化、RAAS及内皮系统相关指标的变化及其相关性分析.结果 透析高血压组较血压稳定组的血管紧张素转化酶(angiotensin-converting enzyme,ACE)(37.022±9.482) U/L比(25.415±10.215)U/L(t=-3.618,P=0.023)、血管紧张素Ⅱ(angiotensin Ⅱ,AngⅡ) (97.269±47.256) ng/L比(75.334±27.205)ng/L(t=-1.727,p=0.018)及醛固酮(aldosterone,ALD) (176.469±67.070) ng/L比(124.093±42.642) ng/L(t=-2.901,p=0.007)均明显升高,透析低血压组的ACE、AngⅡ及ALD较透析血压稳定组有升高趋势,但ALD水平较透析血压稳定组明显降低(163.034±53.266) ng/L比(124.093±42.642) ng/L(t=2.286,P=0.030).血清一氧化氮(Nitric oxide,NO)水平变化趋势透析血压稳定组高于透析低血压组高于透析高血压组(74.371±27.650)μ mol/L比(65.566±16.785)u mol/L比(60.430±17.906)u mol/L(F=2.024,P=0.143).然而血清血管内皮素-1(endothelin-1,ET-1)水平与血清NO水平趋势相反[(3.650±1.291) pg/ml比(4.313±1.414) pg/ml比(4.819±1.938) pg/ml,(F=2.539,P=0.089),其中血压稳定组较透析高血压组降低明显(t=-2.208,P=0.034).NO/ET-1比值透析低血压组及透析高血压组均低于透析血压稳定组[(15.756±3.257)及(14.035±4.845)比(20.614±7.485)],且存在统计学差异(t=-2.486,P=0.026:t=3.178,P=0.003).通过多元逐步线性回归分析显示除RAAS及内皮功能外透析间期体质量增长(interdialysis weight gain,IDWG) (B=1.482,P=0.001)、心血管合并症(B=4.578,P=0.001)、糖尿病(B=3.038,p=0.024)、性别(B=-2.183,P=0.035)、透龄(B=-0.167,P=-0.018)与透析血压变化相关.结论 ①RAAS激活及内皮功能紊乱与透析患者透析过程血压波动密切相关.②透析间期容量负荷增加为导致透析高血压的原因之一.③IDWG、透龄、心血管并发症、糖尿病为影响透析过程血压波动的独立危险因素.
MoreKey words
Hemodialysis,Variation of intradialytic blood pressure,Renin-angiotensin-aldosterone system
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