中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (02): 77-81.doi: 10.3969/j.issn.1671-4091.2016.02.005

• 临床研究 • 上一篇    下一篇

血液灌流对血液透析患者体内蛋白结合类毒素的清除效果

张宏1,2,李新伦2,高卓2,李红霞2,伦立德1   

  1. 1. 中国人民解放军空军总医院肾病科
    2. 安徽医科大学空军临床学院
  • 收稿日期:2015-10-10 修回日期:2015-12-14 出版日期:2016-02-12 发布日期:2016-02-19
  • 通讯作者: 伦立德 lunlideldm@163.com E-mail:lunlideldm@163.com

Effect of hemoperfusion on the clearance of protein-bound uremic toxins in maintenance hemodialysis patients

  • Received:2015-10-10 Revised:2015-12-14 Online:2016-02-12 Published:2016-02-19

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摘要： 目的 观察血液灌流(hemoperfusion，HP)联合血液透析(hemodialysis，HD)对维持性血液透析(maintenance hemodialysis，MHD)患者体内蛋白结合尿毒症毒素的清除效果。方法选取60 例MHD患者，随机分为2 组。HD+HP 组(n=30 例)采取低通量血液透析(2 次/周)和HD+HP(1 次/周)治疗；HD 组(n=30 例)采取低通量血液透析治疗(3 次/周)。采用高效液相色谱-串联质谱(high-performance liquid chromatography/tandem mass spectrometry，HPLC-MS/MS)方法测定HD 组透析前、后及HD+HP 组血液灌流前、后血清马尿酸(hippuric acid，HA)、硫酸吲哚酚(indoxyl sulphate，IS)、硫酸对甲酚(p-cresyl sulphate，PCS)和3-羧基-4-甲基-5-丙基-2-呋喃丙酸(3-carboxy-4-methyl-5-propyl-2-furanpropionic acid，CMPF)浓度，并计算其下降率，同时测定HD 组透析废液及HD+HP 组血液灌流器中这4 种毒素的含量。结果两组患者治疗后血清HA 的浓度较治疗前显著下降[HD 组:(11.63±9.48)mg/L 比(31.68 ± 19.41)mg/L，t=6.652,P=0.000；HP + HD 组:(12.60 ± 8.42)mg/L 比(32.34 ± 25.60)mg/L，t=6.114,P=0.000]，HD+HP 组灌流后2h 的HA 下降率高于HD 组治疗4h 的HA 下降率[(62.21±10.01)%比 (57.03±18.79)%，t=-1.155,P=0.025]。两组患者治疗后血清PCS 的浓度较治疗前显著下降[HD 组:(19.05 ± 7.50)mg/L 比(28.87 ± 10.51)mg/L，t=8.175,P=0.000；HP + HD 组:(15.61 ± 10.85)mg/L 比(31.04±18.93)mg/L，t=7.738,P=0.000]，HD+HP 组灌流后2h 的PCS 下降率高于HD 组治疗4h 的PCS 下降率[(49.92±10.42)%比(34.13±10.13)%，t=-5.302,P=0.003]。两组患者治疗后血清IS 的浓度较治疗前显著下降[HD 组:(19.98±11.97)mg/L 比(31.96±16.30)mg/L,t=8.175,P=0.000；HP+HD 组：(16.72±
8.02)mg/L 比(32.89±16.66)mg/L,t=7.864,P=0.000]，HD+HP 组灌流后2h 的IS 下降率高于HD 组治疗4h的IS 下降率[(47.67±11.37)%比(37.58±15.13)%，t=-2.754, P=0.008]。HD 组患者治疗后血清CMPF 的浓度较治疗前无显著变化[(28.97±14.40)mg/L 比(26.86±19.93)mg/L，t=-2.013,P＞0.05),HP+HD 组治疗后血清CMPF 的浓度较治疗前显著下降[(15.54±12.07)mg/L 比(23.03±18.33)mg/L，t=5.324,P=0.001],HD + HP 组灌流后2h 的CMPF 下降率显著高于HD 组治疗4h 的CMPF 下降率(31.18±11.79)%比(- 4.79 ± 23.44)% ，t=- 3.384,P=0.002]。HP + HD 组血液灌流器中HA、PCS、IS 和CMPF 的含量为别为(126.14±76.61)mg、(74.95± 28.67)mg、(82.36±26.96)mg 和(10.96±6.70)mg；HD 组透析废液中HA、PCS 和IS 的含量为别为(93.05±61.87)mg、(30.57±10.93)mg 和(27.18±15.55)mg，CMPF在透析废液中未测出，两组比较具有显著性差异(P＜0.01)。结论血液灌流对MHD 患者体内蛋白结合类毒素的清除效果明显优于常规血液透析。

关键词: 血液灌流, 血液透析, 蛋白结合类毒素, 溶质清除总量

Abstract: Objective To observe the clearance of protein-bound uremic toxins in maintenance hemodialysis (MHD) patients by combination of hemodialysis (HD) and hemoperfusion (HP). Methods A total of 60 MHD patients were randomly divided into 2 groups: HD+HP group (low-flux hemodialysis two times a week and the combined treatment of HD and HP once a week, n=30) and HD group (low-flux hemodialysis three times a week, n=30). High performance liquid chromatography tandem mass spectrometry (HPLC-MS/ MS) method was used to determine the serum concentrations of hippuric acid (HA), indoxyl sulfate (IS), pcresyl sulphate (PCS), and 3-carboxyl-4-methyl-5-2-methyl propyl furfuryl propionate (CMPF) before and after treatment, and the clearance rates of these toxins were calculated. These toxins were also determined in dialysate in HD group and in hemoperfusion apparatus in HD+HP group. Results After the treatment, serum HA decreased from 31.68±19.41mg/L to 11.63±9.48mg/L (t=6.652, P=0.000) in HD group, and from 32.34± 25.60mg/L to 12.60±8.42mg/L (t=6.114, P=0.000) in HD+HP group, with the HA clearance rate of 62.21± 10.01% in HD+HP group and 57.03±18.79% in HD group (t=-1.155, P=0.025). Serum PCS decreased from 28.87±10.51mg/L to 19.05±7.50mg/L (t=8.175, P=0.000) in HD group, and from 31.04±18.93mg/L to 15.61± 10.85mg/L (t=7.738, P=0.000) in HP+HD group, with the PCS clearance rate of 49.92±10.42% in HD+HP group and 34.13±10.13% in HD group (t=-5.302, P=0.003). Serum IS decreased from 31.96±16.30mg/L to 19.98±11.97mg/L (t=8.175, P=0.000) in HD group and from 32.89±16.66mg/L to 16.72±8.02mg/L (t=7.864, P=0.000) in HP+HD group, with the IS clearance rate of 47.67±11.37% in HD+HP group and 37.58±15.13% in HD group (t = -2.754, P = 0.008). Serum CMPF was unchanged in HD group (26.86 ± 19.93mg/L before HD and 28.97±14.40mg/L after HD; t=-2.013, P＞0.05), but decreased from 23.03±18.33mg/L to 11.79±12.07mg/L (t=5.324, P= 0.001) in HP+HD group, with the CMPF clearance rate of -4.79±23.44% in HD group and31.18±11.79% in HD+HP group (t=-3.384, P=0.002). The total solute clearance of HA, PCS, IS, and CMPF were 93.05 ± 61.87mg, 30.57 ± 10.93mg, 27.18 ± 15.55mg, and 0mg, respectively, in HD group, and were 126.14 ± 76.61 mg, 74.95±28.67mg, 82.36±26.96mg and 10.96±6.70mg, respectively, in HD+HP group, higher in HD+HP group than in HD group (P＜0.01). Conclusion HD + HP is better than HD in clearance of proteinbound uremic toxins.

Key words: Hemoperfusion, hemodialysis, protein-bound toxins, total solute removal