Heintz B, Königs F, Dakshinamurty K V, Kierdorf H, Gladziwa U, Kirsten R, Nelson K, Wieland D, Riehl J, Mann H
2nd Medical Clinic, Technical University of Aachen, FRG.
Nephron. 1993;65(2):266-72. doi: 10.1159/000187486.
The changes in blood volume (BV), atrial natriuretic peptide (ANP), plasma renin activity (PRA), aldosterone (Aldo), norepinephrine (NE), epinephrine (Epi), parathyroid hormone (PTH), arginine vasopressin (AVP) and the cyclic nucleotides cAMP and cGMP were measured during a fluctuating BV cycle in 15 patients with end-stage renal failure maintained on chronic hemodialysis (HD). HD consisted of 4 periods of about 60 min each. The first half of each HD period consisted of ultrafiltration (UF) greater than 1,000 ml/h, and the second half consisted of no UF. Changes in relative BV were measured using continuous hemoglobinometry. Total BV at the end of treatment was 74.3 +/- 6.9% of the pretreatment volume. A significant positive correlation between BV and the levels of ANP, PTH, Epi and cGMP and an inverse correlation between BV and PRA, Aldo, AVP and NE were demonstrated. While mean values of NE and AVP levels were directly related to actual changes in BV, individual values did not homogeneously reflect this relationship. The cyclic nucleotides cGMP and cAMP did not follow immediate BV changes, but showed a significant decrease correlated with diminished BV. Based on a pre-postdialysis analysis, significant changes in PRA and Aldo were missing. It seems possible that vascular stability in dialysis patients may be maintained by the response of NE and AVP, and not by the renin-aldosterone system. The changes in ANP and cGMP values correlated most significantly (r = 0.38 and r = 0.51, p < 0.005) with the changes in BV, but no single variable could explain the blood pressure regulation during HD with intermittent rapid UF.
在15例维持性慢性血液透析（HD）的终末期肾衰竭患者的血容量（BV）波动周期中，测量了血容量、心房利钠肽（ANP）、血浆肾素活性（PRA）、醛固酮（Aldo）、去甲肾上腺素（NE）、肾上腺素（Epi）、甲状旁腺激素（PTH）、精氨酸加压素（AVP）以及环核苷酸cAMP和cGMP的变化。HD由4个各约60分钟的时段组成。每个HD时段的前半段为超滤（UF）大于1000 ml/h，后半段无超滤。使用连续血红蛋白测定法测量相对BV的变化。治疗结束时的总BV为治疗前体积的74.3±6.9%。结果显示BV与ANP、PTH、Epi和cGMP水平呈显著正相关，与PRA、Aldo、AVP和NE呈负相关。虽然NE和AVP水平的平均值与BV实际变化直接相关，但个体值并未均匀反映这种关系。环核苷酸cGMP和cAMP并未随BV立即变化，而是显示出与BV减少相关的显著下降。基于透析前后分析，PRA和Aldo无显著变化。透析患者的血管稳定性似乎可能由NE和AVP的反应维持，而非肾素 - 醛固酮系统。ANP和cGMP值的变化与BV变化的相关性最为显著（r = 0.38和r = 0.51，p < 0.005），但没有单一变量能够解释间歇性快速超滤HD期间的血压调节。
