CAJ | 학술논문

目的观察4种不同膜材料透析器临床应用过程中的生物相容性.方法 60例维持性血液透析(MHD)患者入选,进行前瞻、随机、对照、队列研究.在基线水平所有患者均应用聚砜(PS)膜透析器透析至少3个月,随后患者按随机数字法分配入3个不同膜材质透析器组:聚醚砜膜(PES)组、三醋酸纤维素膜(CTA)组和聚甲基内烯酸甲酯膜(PMMA)组,观察6个月.透析器无复用,在不同的时间点测定生物相容性指标进行比较.结果血超敏C反应蛋白(hsCRP)、白细胞介素(IL)1β、IL-13、红细胞计数、血小板计数在不同组之间及分组前(0)、3、6个月透析前后进行比较,差异均无统计学意义.透析过程中,血补体C3a、C5a水平均先升后降.PMMA组在0个月时透析0 min、15 min、240 min补体C3a为(117.92±35.99)、(183.09±57.02)、(135.20±43.08)μg/L;在3个月时分别为(96.11±30.84)、(141.48±50.70)、(115.38±37.49)μg/L;在6个月时分别为(85.05±17.28)、(146.31±41.07)、(116.69±32.95)μg/L,0个月分别与3个月、6个月间C3a水平差异有统计学意义(均P＜0.05).3个月时PMMA组透析0 min、15 min、240 min C5a为(60.59±19.07)、(85.30±23.50)、(72.74±28.97)μg/L,PES组透析0 min、15 min、240 min C5a为(74.70±18.70)、(98.85±27.78)、(83.96±27.87)μg/L,两组间差异有统计学意义(P＜0.05).白细胞计数(WBC,×109/L)在透析过程中先降后升.PMMA组WBC 0个月、3个月、6个月的透析0 min为(5.60±1.42)、(6.02±1.36)、(6.45 ±1.29)(均P＜0.05);15 min为(4.44±0.98)、(2.32±1.11)、(2.20±1.42)(均P＜0.01);0个月、6个月的透析30 min为(5.64±1.22)、(4.74±1.35)(P=0.026);60 min为(5.97±0.82)、(6.82±1.58)(P=0.39);240 min为(7.41±1.87)、(8.44±1.61)(P:0.001);3个月、6个月的透析240 min为(7.53±2.31)、(8.44±1.61)(P=0.004).差异均有统计学意义.结论 4种膜材料透析器生物相容性存在一定的差异.
목적 관찰4충불동막재료투석기림상응용과정중적생물상용성.방법 60례유지성혈액투석(MHD)환자입선,진행전첨、수궤、대조、대렬연구.재기선수평소유환자균응용취풍(PS)막투석기투석지소3개월,수후환자안수궤수자법분배입3개불동막재질투석기조:취미풍막(PES)조、삼작산섬유소막(CTA)조화취갑기내희산갑지막(PMMA)조,관찰6개월.투석기무복용,재불동적시간점측정생물상용성지표진행비교.결과 혈초민C반응단백(hsCRP)、백세포개소(IL)1β、IL-13、홍세포계수、혈소판계수재불동조지간급분조전(0)、3、6개월투석전후진행비교,차이균무통계학의의.투석과정중,혈보체C3a、C5a수평균선승후강.PMMA조재0개월시투석0 min、15 min、240 min보체C3a위(117.92±35.99)、(183.09±57.02)、(135.20±43.08)μg/L;재3개월시분별위(96.11±30.84)、(141.48±50.70)、(115.38±37.49)μg/L;재6개월시분별위(85.05±17.28)、(146.31±41.07)、(116.69±32.95)μg/L,0개월분별여3개월、6개월간C3a수평차이유통계학의의(균P＜0.05).3개월시PMMA조투석0 min、15 min、240 min C5a위(60.59±19.07)、(85.30±23.50)、(72.74±28.97)μg/L,PES조투석0 min、15 min、240 min C5a위(74.70±18.70)、(98.85±27.78)、(83.96±27.87)μg/L,량조간차이유통계학의의(P＜0.05).백세포계수(WBC,×109/L)재투석과정중선강후승.PMMA조WBC 0개월、3개월、6개월적투석0 min위(5.60±1.42)、(6.02±1.36)、(6.45 ±1.29)(균P＜0.05);15 min위(4.44±0.98)、(2.32±1.11)、(2.20±1.42)(균P＜0.01);0개월、6개월적투석30 min위(5.64±1.22)、(4.74±1.35)(P=0.026);60 min위(5.97±0.82)、(6.82±1.58)(P=0.39);240 min위(7.41±1.87)、(8.44±1.61)(P:0.001);3개월、6개월적투석240 min위(7.53±2.31)、(8.44±1.61)(P=0.004).차이균유통계학의의.결론 4충막재료투석기생물상용성존재일정적차이.
Objective To elucidate the biocompatibility differences of 4 dialyzers with different membranes in maintenance hemodialysis (MHD)patients. Methods A total of 60 MHD patients were enrolled in the prospective,randomized,control,cohort study.In baseline,synthetic polysulfone(PS)membrane dialyzer was used in all the patients for at least 3 months.Then the patients were randomly divided into three groups:ployethersulfone(PES)membrane group,cellulose triacetate (CTA)membrane group,and synthetic polymethylmethacrylate(PMMA)membrane group.Study duration was 6 months.No dialyzer was reused.The biocompatibility markers were detected repeatedly at different time points and compared with each other in different dialyzer groups. Results The blood levels of high sensitive C reactive protein,interleukin-1β and interleukin-13 were not significantly different among different groups on every time point.However,the blood complements levels and WBC count were significantly different among four kinds of dialyzer.When the dialyzers changed from PS to PMMA membrane,C3a levels and WBC count changed significantly(P＜0.05).Moreover,the change of C5a level was significantly different between PES group and PMMA group on month 3(P＜0.05). Conclusion There are some differences of biocompatibiliy among different dialyzer membranes.