中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
1期
25-30
,共6页
杜邱娜%高嘉元%朱铭力%陆任华%戴慧莉%张伟明%蒋蓉%王咏梅%钱家麒%倪兆慧%严玉澄
杜邱娜%高嘉元%硃銘力%陸任華%戴慧莉%張偉明%蔣蓉%王詠梅%錢傢麒%倪兆慧%嚴玉澄
두구나%고가원%주명력%륙임화%대혜리%장위명%장용%왕영매%전가기%예조혜%엄옥징
肾透析%心血管疾病%高通量%蛋白结合毒素
腎透析%心血管疾病%高通量%蛋白結閤毒素
신투석%심혈관질병%고통량%단백결합독소
Renal dialysis%Cardiovascular disease%High-flux%protein-bound toxin
目的 探讨终末期肾病患者高通量血液透析对体内心血管疾病相关蛋白结合毒素的清除情况.方法 选择应用高通量透析器进行维持性血液透析的患者23例.HPLC-MS-MS(高效液相色谱-串联质谱)法测定透析前后血浆内的对甲酚硫酸盐(PCS)、吲哚硫酸盐(IS)和同型半胱氨酸( Hcy)浓度,计算这些物质的下降率.连续部分透析液收集法收集透析过程中的透析废液,测定透析废液中相应溶质的清除总量(TR)作为血透中溶质清除的金标准.分析这些溶质的清除情况与尿素氮、肌酐清除率及透前溶质血浆水平的关系.结果透后PCS、IS和Hcy的总体血浆浓度较透前有所下降,下降率分别为(32.43± 11.41)％、( 37.38±10.99)％和(57.16±10.43)％,明显低于BUN或Scr的下降率(均P＜0.05),且与BUN和Scr的下降率之间无相关性.游离PCS、IS和Hcy的血浆下降率分别为(55.54±20.75)％、( 55.33± 19.49)％和(74.63±11.45)％,较总体部分略高(均P＜0.05).游离PCS和IS的下降率仍不及BUN或Scr的下降率(均P＜ 0.05).清除后进人透析废液中的总体和游离PCS的TR分别是(60.58±39.41) mg和(34.87±23.64) mg；总体和游离IS的TR分别为(72.47±45.18)mg和(33.82±24.28 )mg;总体和游离Hcy的TR分别为(5.27±3.31) mg和(3.73±1.68) mg.透前血浆PCS、IS和Hcy浓度与清除后进入透析废液中溶质TR均呈正相关(均P＜0.05).结论 高通量血液透析可以部分清除心血管疾病相关蛋白结合毒素,其透前血浆浓度与透析 清除总量呈正相关,但其清除行为不同于小分子水溶性物质,仍需进一步探索更为有效的蛋白结合毒素的清除方式.
目的 探討終末期腎病患者高通量血液透析對體內心血管疾病相關蛋白結閤毒素的清除情況.方法 選擇應用高通量透析器進行維持性血液透析的患者23例.HPLC-MS-MS(高效液相色譜-串聯質譜)法測定透析前後血漿內的對甲酚硫痠鹽(PCS)、吲哚硫痠鹽(IS)和同型半胱氨痠( Hcy)濃度,計算這些物質的下降率.連續部分透析液收集法收集透析過程中的透析廢液,測定透析廢液中相應溶質的清除總量(TR)作為血透中溶質清除的金標準.分析這些溶質的清除情況與尿素氮、肌酐清除率及透前溶質血漿水平的關繫.結果透後PCS、IS和Hcy的總體血漿濃度較透前有所下降,下降率分彆為(32.43± 11.41)％、( 37.38±10.99)％和(57.16±10.43)％,明顯低于BUN或Scr的下降率(均P＜0.05),且與BUN和Scr的下降率之間無相關性.遊離PCS、IS和Hcy的血漿下降率分彆為(55.54±20.75)％、( 55.33± 19.49)％和(74.63±11.45)％,較總體部分略高(均P＜0.05).遊離PCS和IS的下降率仍不及BUN或Scr的下降率(均P＜ 0.05).清除後進人透析廢液中的總體和遊離PCS的TR分彆是(60.58±39.41) mg和(34.87±23.64) mg；總體和遊離IS的TR分彆為(72.47±45.18)mg和(33.82±24.28 )mg;總體和遊離Hcy的TR分彆為(5.27±3.31) mg和(3.73±1.68) mg.透前血漿PCS、IS和Hcy濃度與清除後進入透析廢液中溶質TR均呈正相關(均P＜0.05).結論 高通量血液透析可以部分清除心血管疾病相關蛋白結閤毒素,其透前血漿濃度與透析 清除總量呈正相關,但其清除行為不同于小分子水溶性物質,仍需進一步探索更為有效的蛋白結閤毒素的清除方式.
목적 탐토종말기신병환자고통량혈액투석대체내심혈관질병상관단백결합독소적청제정황.방법 선택응용고통량투석기진행유지성혈액투석적환자23례.HPLC-MS-MS(고효액상색보-천련질보)법측정투석전후혈장내적대갑분류산염(PCS)、신타류산염(IS)화동형반광안산( Hcy)농도,계산저사물질적하강솔.련속부분투석액수집법수집투석과정중적투석폐액,측정투석폐액중상응용질적청제총량(TR)작위혈투중용질청제적금표준.분석저사용질적청제정황여뇨소담、기항청제솔급투전용질혈장수평적관계.결과투후PCS、IS화Hcy적총체혈장농도교투전유소하강,하강솔분별위(32.43± 11.41)％、( 37.38±10.99)％화(57.16±10.43)％,명현저우BUN혹Scr적하강솔(균P＜0.05),차여BUN화Scr적하강솔지간무상관성.유리PCS、IS화Hcy적혈장하강솔분별위(55.54±20.75)％、( 55.33± 19.49)％화(74.63±11.45)％,교총체부분략고(균P＜0.05).유리PCS화IS적하강솔잉불급BUN혹Scr적하강솔(균P＜ 0.05).청제후진인투석폐액중적총체화유리PCS적TR분별시(60.58±39.41) mg화(34.87±23.64) mg；총체화유리IS적TR분별위(72.47±45.18)mg화(33.82±24.28 )mg;총체화유리Hcy적TR분별위(5.27±3.31) mg화(3.73±1.68) mg.투전혈장PCS、IS화Hcy농도여청제후진입투석폐액중용질TR균정정상관(균P＜0.05).결론 고통량혈액투석가이부분청제심혈관질병상관단백결합독소,기투전혈장농도여투석 청제총량정정상관,단기청제행위불동우소분자수용성물질,잉수진일보탐색경위유효적단백결합독소적청제방식.
Objective To investigate protein-bound uremic toxins clearance in high-flux hemodialysis patients. Methods Twenty-three high-flux hemodialysis patients from Renji Hospital,Shanghai Jiaotong University School of Medicine were enrolled.Concentrations of p-cresyl sulfate (PCS),indoxylsulfate (IS) and homocysteine (Hcy) were tested by HPLC-MS-MS.Reduction ratios (RRs) and the amount of these toxins in drained dialysate were determined.The relationship of clearance of PCS,IS and Hcy with BUN or Scr was analyzed. Results Plasma levels of the protein-bound toxins were decreased in high-flux hemodialysis.The RRs of total PCS,IS and Hcy were (32.43 ±11.41)％, (37.38 ±10.99)％ and (57.16 ±10.43)％,respectively,which were significantly lower than those of BUN or Scr (all P＜0.05).Moreover,no correlation was found between the RRs of the total protein-bound compounds and BUN or Scr.The RRs of free PCS,IS and Hcy were (55.54±20.75)％,(55.33±19.49)％ and (74.63±11.45)％,respectively.Although RRs of free protein-bound toxins were slightly higher than that of their total,RRs of free PCS and free IS were still inferior to those of BUN or Scr (all P＜0.05).Elimination of protein-bound toxins assessed by their mass in dialysate was (60.58±39.41) mg,(34.87±23.64)mg for total and free PCS; (72.47±45.18) mg,(33.82±24.28) mg for total and free IS; (5.27±3.31) mg,(3.73±1.68) mg for total and free Hcy,respectively.The total and free protein-bound uremic toxins mass in dialysate were positively correlated with the pre-treatment plasma concentrations (all P＜0.05).Conclusions Protein-bound toxins PCS,IS and Hcy can be partly removed by high-flux hemodialysis,and the elimination of these compounds into dialysate can be predicted by the levels of pre-treatment plasma concentrations.Additionally,the behavior of the protein-bound toxins under study during hemodialysis may be different from water-soluble substances like BUN and Cr.Alternative efficient therapy forms should be explored.
