目的  探讨血液透析联合血液灌流中长期治疗维持性血液透析患者合并难治性高血压的疗效。方法选择75 例透析龄≥6 个月的存在难治性高血压的稳定的MHD 患者，随机分为血液灌流治疗组(45 例)和对照组(30 例)。对照组每周血液透析3 次，每2 周1 次血液透析滤过；血液灌流治疗组每周血液透析3 次，每2 周1 次血液透析滤过，再予每2 周1 次血液灌流，随访1 年。2 组分别在治疗首次(即0 月)、3月、6 月和12 月，于治疗前后采用放射免疫法测定卧位血浆肾素(RA)、血管紧张素Ⅱ(angiotensinⅡ,AngII)和醛固酮浓度，并测定血压共3 次，取其平均值。结果①对照组首次(即0 月)、3 月、6 月和12月治疗前后血浆RA、AngII 和醛固酮浓度比较无统计学差异(P＞0.05)。②HP 治疗前后的RA 和收缩压(systolic blood pressure,SBP)、治疗前的舒张压(diastolic blood pressure, DBP)、治疗后的AngII和醛固酮浓度，随着治疗时间的持续均出现明显下降(P＜0.01 或0.05)，6 月和12 月治疗前的AngII和醛固酮浓度均比0 月和3 月明显下降(P＜0.01)。③治疗6 月和12 月血浆RA、AngII、醛固酮浓度以及血压和降压药使用量，HP 治疗组比对照组均有下降(P＜0.05 或0.01)；HP 治疗组3 月、6 月和12 月降压药物使用量比0 月明显减少(P＜0.01)。④血浆RA、AngII 和醛固酮浓度与平均动脉压(mean arterialpressure, MAP)的相关性分析表明，三者与治疗前后的MAP 有不同程度的相关。结论合并难治性高血压的MHD 患者，血压难以控制与RAAS 兴奋密切相关，中长期、一定频率的血液透析联合血液灌流治疗，提供了安全、简便、有效、平稳的治疗途径.

Objective To assess the medium and long term efficacy of hemodialysis combined with hemoperfusion in the treatment of maintenance hemodialysis (MHD) patients with refractory hypertension. Methods Seventy- five MHD patients with persistent and refractory hypertension for more than 6 months were randomly divided into two groups: hemoperfusion (HP) group (n=45) and control group (n=30). In control group, hemodialysis was performed 3 times a week and hemodiafiltration was performed once every 2 weeks. In HP group, hemoperfusion was performed once every 2 weeks in addition to the therapeutic protocol
in control group. Plasma rennin, angiotensinⅡ (ATⅡ) and aldosterone were measured by radioimmunoassay. Blood pressure was measured before and after the treatment. Result ①Plasma rennin, ATⅡ and aldosterone changed insignificantly after the treatment for 0, 3, 6 and 12 months in control group. ②With continuing the treatment, plasma rennin and systolic blood pressure (values before and after the treatment), diastolic blood pressure (value before the treatment), plasma AT Ⅱ and aldosterone (values after the treatment) decreased gradually in HP group (P＜0.01 or 0.05). Plasma ATⅡ and aldosterone after the treatment for 6 months and 12 months were significantly lower than those at the beginning and after the treatment for 3 months (P＜0.01). ③After the treatment for 6 months and 12 months, plasma rennin, ATⅡ, aldosterone and blood pressure were lower in HP group than in control group (P＜0.01 or 0.05). ④Plasma rennin, ATⅡ and aldosterone correlated with mean arterial pressure before and after the treatment. Conclusion Hemodialysis combined with hemoperfusion with an appropriate frequency and for a medium or long period is a safe, convenient, and effective approach for MHD patients with refractory hypertension.