ABNORMAL HEMODYNAMICS AND ELEVATED ANGIOTENSIN-II PLASMA-LEVELS IN POLYDIPSIC PATIENTS ON REGULAR HEMODIALYSIS-TREATMENT
ABNORMAL HEMODYNAMICS AND ELEVATED ANGIOTENSIN-II PLASMA-LEVELS IN POLYDIPSIC PATIENTS ON REGULAR HEMODIALYSIS-TREATMENT
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DOI：
10.1038/ki.1993.219
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发表时间：
1993-07-01
影响因子：
19.6
通讯作者：
MORGANTI, A
中科院分区：
文献类型：
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作者：
GRAZIANI, G;BADALAMENTI, S;MORGANTI, A
为了探讨慢性透析患者强迫性口渴和液体摄入过多的原因和机制，我们测量了7例多饮患者和6例正常血液透析患者的血浆抗利尿激素（ADH）、血管紧张素II （Ang II）和一些血液动力学参数，这些患者在血液透析前、透析结束时和透析间期多次。透析前，我们发现两组ADH均升高（多囊组和对照组分别为6.9 +/- 1.9和6.9 +/- 1.3 pg/ml），而Ang II仅在多囊组异常升高（51 +/- 12和11 +/- 3 pg/ml， P < 0.01）；这些患者的心率和心脏指数也明显高于对照组，总外周阻力也明显低于对照组。总体而言，这些血流动力学指标与Ang II相关，但与ADH无关。在透析后的多囊患者中，Ang II显著升高，在透析结束后的第4小时达到峰值（136 +/- 12 pg/ml），并在整个透析间期持续升高，而在对照组中，Ang II相对于基线几乎没有变化。相比之下，ADH在两组中都有轻微的相似的改变，血流动力学的改变也是重叠的。在透析间期Ang II的绝对值和百分比变化与血浆容量变化之间存在显著相关性（P < 0.001），整个研究期间测量的Ang II的个体值与透析间期体重增加之间存在显著相关性（P < 0.05）。这些结果表明，多饮患者在血液透析引起的容量耗竭之前和之后都有异常高水平的Ang II。这种肽的高循环水平是肾素系统的高反应性的表达，显然，它代表了高运动循环的体液对应物，它与Ang II的致病作用相结合，可能是这些患者抱怨的强迫性口渴的原因。
To investigate the cause and the mechanisms responsible of the compulsive thirst and excessive fluid intake observed in many patients on chronic dailysis treatment, we measured plasma antidiuretic hormone (ADH), angiotensin II (Ang II) and some hemodynamic parameters in seven polydipsic and in six normodipsic patients before hemodialysis, at the end of it and several times during the interdialytic interval. Before dialysis we found that ADH was elevated in both groups (6.9 +/- 1.9 vs. 6.9 +/- 1.3 pg/ml, respectively in polydipsics and controls), whereas Ang II was abnormally high only in polydipsics (51 +/- 12 vs. 11 +/- 3 pg/ml, P < 0.01); these patients also had significantly higher heart rate and cardiac indices and lower total peripheral resistances than control patients. Overall these hemodynamic indices were related with Ang II but not with ADH. Ang Il rose markedly in polydipsics after dialysis, reaching a peak at the fourth hour after its termination (136 +/- 12 pg/ml) and remained consistently elevated throughout the interdialytic period, whereas in controls Ang II was practically unchanged with respect to baseline. In contrast, ADH had minor and similar modifications in both groups, in whom also the hemodynamic changes were superimposable. Significant correlations were found between the absolute and percent changes of Ang II and those of plasma volume during the interdialytic interval (P < 0.001 for both), and between the individual values of Ang II measured during the whole study and the interdialytic weight gain (P < 0.05). These results demonstrate that polydipsic patients have abnormally high levels of Ang II before and after the hemodialysis-induced volume depletion. The high circulating levels of this peptide are expression of the hyperreactivity of the renin system that, apparently, represents the humoral counterpart of an hyperkinetic circulation which, in conjunction with the dipsogenic effect of Ang II, may be the cause of the compulsive thirst complained by these patients.