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1、优秀毕业论文本学位论文在导师(或指导小组)的指导下，由本人独立完成。 本学位论文研究所获得的研究成果，其知识产权归河北医科大学所 有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表 与学位论文主要内容相关的论文，第一署名单位为河北医科大学，试 验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。 否则，承担相应的法律责任。研究生签名：桶彳导师签章：锹二级毒院领导盖章：“。：jn幽，年多月7日河北医科大学 研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了 文中特别加以标注等内容外，文中不包含其他人已发表或撰写的研究 成果，指导教师对此进行了审定。
2、本论文由本人独立撰写，文责自负。研究生躲桶首翩鳞焉联沙，年莎月7日精品参考文献资料目录中文摘要l英文摘要一3研究论文高通量透析对血管活性物质和透析患者血压的影响前言HIJ吾66材料与方法7结果lO附图12附表1 6讨论l 8结论23参考文献24综述高通量血液透析的研究进展29 致谢40个人简历4 1中文摘要高通量透析对血管活性物质和透析患者血压的影响摘要目的：近期国内外报道低通量透析(10w flux hemodialysis，LFHD)患 者改为高通量透析(high flux hemodialysis，HFHD)有利于血管内皮细胞 的保护，可以获得较好的血压控制，但其机制尚不明确。高通量透析
3、是目前清除尿毒症毒素中大分子物质的重要手段。本实验通过检测维持性血液 透析(MHD)患者单次透析前后及治疗3个月后血管紧张素II (angiotensinll，AngII)、内皮素一1(endothelin1，ET-1)、一氧化氮(nitric oxide，NO)的变化，及MHD患者血压变化情况，观察高通量透析对血管活性物质的影响，从而探讨HFHD改善MHD患者内皮细胞功能及血压的机制，为临床提治疗提供理论依据及新思路。方法：选取201 0年1 O月至201 1年2月在河北医科大学第二医院血 液透析中心维持性血液透析的患者20例，男12例，女8例，已透析时间 均超过3个月，KtV值1214，病
4、情稳定。随机分为低通量血液透析 (LFHD)组和高通量血液透析(HFHD)组各10例。选取尿毒症非透析 患者20例，另选取20例正常健康体检者作为健康对照组。尿毒症透析组、 非透析组及健康对照组性别构成、年龄差异无统计学意义。所有透析组患 者每周透析3次，每次4小时，HFHD组改用可重复使用高通量透析器 Polyfluxl7R，LFHD组继续采用可重复使用透析器Polyflux8LR。分别检测HFHD组及LFHD组患者单次治疗前后及3个月透析前检测的血清肌酐(Scr)、血管紧张素II(Ang II)、内皮素1(ET-1)、一氧化氮(NO)， 另抽取尿毒症非透析组和健康对照组各20例的清晨空腹肘
5、静脉血标本同 时检验。NO测定用硝酸还原酶法，ET-1、Ang II检测均采用放免法。Cr 的测定采用常规生化法。透析组患者同时监测血压变化。所有数据均以均数标准差(x土s)表示，对各组数据进行正态性检验和方差齐性检验。符 合正态性检验和方差齐性检验，两组间比较用独立样本t检验，自身前后 变化比较用配对t检验。PO05认为统计学差异有显著性，采用SPSSl70 软件包进行数据分析。结果：中文摘要1尿毒症透析组、尿毒症非透析组患者ET-1、Ang II、Cr、NO水平 均高于健康对照组(PO01)。尿毒症透析组(透前值)、非透析组之间Cr、 NO无差异，ET-1、Ang II升高，比较有统计学差
6、异(P005)，提示两组患者具有可比性。 3单次透析前后，HFHD组患者NO降低，有统计学差异(P005)，ET-1、Ang II降低，无统计学差异。LFHD组ET-l略升高，但无统计学差异，Ang II升高，有统计学差异(PO05)，NO水平下降，有统计学差异 (P001)。两组患者单次透析后比较Ang II、ET-1水平HFHD组较LFHD 低，有统计学差异(PO05)，NO、Cr水平比较无统计学差异，单次透析 后平均动脉压两组间无差异。4治疗3个月后，HFHD组患者NO、ET-I、平均动脉压与治疗前相 比下降，有统计学差异(P005)。LFHD组患者ET-1、Ang II、NO、血压水平
7、与治 疗前相比无统计学差异(P005)。两组患者Cr水平与治疗前相比无统计学 差异(PO05)。两组问比较NO、ET-1水平HFHD组较LFHD组下降，有 统计平均血压 析患高血英文摘要Influence of high flux hemodialysis on vasoactive substances and blood pressure in hemodialysis patientsABSTRACTObj ective：Recent reports indicated that the iateria of patients change from low flux hemodialy
8、sis(LFHD)to high flux hemodialysis(HFHD)is conducive to the protection of endothelial cells，can get better blood pressure contr01But the mechanism remains unclearHigh flux hemodialysis iS an important method to remove macromolecules of uremic toxinsBy observing the changes of angiotensinII(AnglI)，en
9、dothelinl(ET-1)，nitric oxide(NO)andblood pressure in patients on maintenance hemodialysis(MHD)，who have been given treatment for 3 months，and the influence of high flux hemodialysis on vasoactive substances，we discussed the mechanism of HFHD improving the function of endothelial cells and blood pres
10、sure in MHD patients，to provide a theoretical basis and new ideas for clinical treatmentMethods：To selected 20 patients who were treated in the bloodpurification center of the second hospital of Hebei medical university from October in 20 1 0 tO February in 20 1 1，8 patients were male，1 2 paitients
11、were femaleThey have been treated with maintenance hemodialysis for more thanthree months，the value of KtV is 12 to 14They were in stable statusThepatients were randomly divided into two groups1 0 cases were treated with LFHD and 1 0 cases were treated with HFHDSelected 20 uremic patients without di
12、alysis，and to selected the other 20 healthy volunteers as control groupThe sex and age in the three groups were no significant difference HFHD and LFHD were used three times every weekIt was continued 4 hours every dialysisWe used reusable high flux dialyzer Polyflux l 7R in HFHD group，however,in LF
13、HD group，we continued using reusable dialyzer Polyflux8LRTo observe the serum levels of Scr,AnglI，ET-1 and NO before and just after hemodialysis and 3 months after hemodialysis in HFHD groupand LFHD groupMoreover,20 nondialysis uremic patients and 20 health3英文摘要一一一一persons，fasting elbow venous blood
14、 sample were selectedNO was determined by nitrate reductase，ET-1 and Angll were determined bv radioimmunoassayCr w as determi ned by conventional biochemical methods By the time，we must observe the vhanges of blood nressure in dialysis patients。All metric Qa：qvas expre。；std as aver口2z-standard deviationto check up the data of all groups with normal test and anova testTo accord withnormal test and anova test，the compare between two groups withindependentsample t test，the compare between before and after oneself with Pairedsample t testP005 was signi ficantly d
