Chinese Journal of Blood Purification

12 November 2008, Volume 7 Issue 11 Previous Issue    Next Issue

专家述评

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Simple analysis of applications of extracorporeal membrane oxygenation in critical and severe cases WANG Zhi-gang 2008, 7 (11):  581-584.  Abstract ( 501 )   HTML ( 0 )   PDF (297KB) ( 436 )   Metrics

论著

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The relationship between peritoneal charge barrier and peritoneal protein loss in continuous ambulatory peritoneal dialysis patients YU Guo-qing;WEN wen;CHEN Jian;ZHUANG Yong-ze 2008, 7 (11):  585-587.  Abstract ( 636 )   HTML ( 0 )   PDF (301KB) ( 239 )   Objective To investigate the relationship between peritoneal charge barrier and peritoneal protein loss in continuous ambulatory peritoneal dialysis (CAPD) patients, we determined the peritoneal charge barrier and then compared the charge barrier and peritoneal protein loss between CAPD patients with the primary disease of diabetes nephropathy (DN group) and those with the primary disease of chronic glomerulonephritis (CGN group). Method Blood sample and peritoneal fluid were collected. Peritoneal charge barrier was evaluated by the ratio of clearance of pancreatic isoamylase (Cpam) to clearance of salivary isoamylase (Csam) (Cpam/Csam). Protein loss in peritoneal fluid was measured as well. Result ① In the 32 CAPD patients we investigated, Cpam/Csam was 6.296±21.514 and protein in peritoneal fluids was 4.14±1.91g. ② Protein in peritoneal fluid was higher in DN group than in CGN group (5.61±0.86g vs. 4.35±1.88g,P＝0.011), but charge barrier was lower in DN group than in CGN group (0.68±0.86 vs. 9.94±28.35, P＝0.017). ③ Cpam/Csam was negatively correlated with peritoneal protein loss (r = -0.584, P＜0.01), and the natural logarithm of Cpam/Csam was also linearly correlated with the protein loss. Conclusion In CAPD patients, the loss of charge barrier on peritoneum promotes the loss of protein in peritoneal fluid. In these patients, the peritoneal microvascular damage, the decrease of peritoneal charge barrier and the loss of peritoneal protein are proportionately correlated. Metrics

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Causes and prognosis of patients transferring from peritoneal dialysis to hemodialysis YANG Li;MAO Zhi-guo;SUN Lin-lin 2008, 7 (11):  588-590.  Abstract ( 973 )   HTML ( 3 )   PDF (310KB) ( 559 )   Objective To analyze the causes and prognosis of patients transferring from peritoneal dialysis to hemodialysis. Methods We retrospectively investigated the causes of transferring from peritoneal dialysis to hemodialysis in 39 patients between 1999 and 2008, and analyzed the prognosis of 23 patients transferred in our hospital. Results In the 39 peritoneal dialysis patients transferred from peritoneal dialysis to hemodialysis, the average peritoneal dialysis time was 14.4±16.3 months, and the reasons for the transfer were dialysis insufficiency (30.8%), mechanical complications (28.2%), peritoneal dialysis related infection (25.6%) and ultrafiltration failure (10.3%). Twenty-three patients were transferred to hemodialysis in our hospital, of which 12 patients died and hemodialysis continued in 11 patients. The major causes of death were cardiocerebrovascular events and infection. Diabetic patients had worse prognosis than patients with glomerulonepthritis. Conclusion The main causes of transferring to hemodialysis were dialysis insufficiency, mechanical complications and peritoneal dialysis related infection. Primary disease leading to renal failure affects the prognosis of patients transferred from peritoneal dialysis to hemodialysis. Patients with diabetic nephropathy have worse prognosis than patients with glomerulonepthritis. Metrics

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The effect of interdialytic weight gain on pulse wave velocity in hemodialysis patients CHENG Li-tao;FENG Jing-xi;CHEN Hui-min 2008, 7 (11):  591-594.  Abstract ( 693 )   HTML ( 0 )   PDF (344KB) ( 196 )   Objective To identify the effect of interdialytic weight gain (IDWG) on pulse wave velocity (PWV) in hemodialysis patients. Methods We recruited 27 hemodialysis patients (thrice per week) in this study. Their body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), extracellular water (ECW) by bioimpedance method, and carotid-femoral PWV were measured after a hemodialysis session and before the next session. Results In the 27 patients we tested, 12 were male, 15 were female, and the mean age was 61±12 years. After a hemodialysis session, their body weight increased from 62.5±11.2 kg to 64.1±11.9 kg (P＜0.001), their ECW increased from 14.0±2.5L to 15.5±3.1L (P＜0.001), but their SBP, DBP and PWV (11.0±1.8 m/s to 10.4±2.0 m/s, P>0.05) did not show any significant changes. These patients were then divided into low IDWG group (n=14) and high IDWG group (n=13) based on the median value of IDWG. In high IDWG group, patients had higher increases of weight, ECW and SBP but without significant change in PWV, as compared with those in low IDWG group. Pearson’s correlation analysis showed that SBP and DBP elevations were positively correlated with the increase of PWV (r=0.554, P＜0.01 and r=0.537, P＜0.01, respectively). Multiple regression analysis revealed that SBP was the single and independent determinant of PWV change (B=0.039, P＜0.005; adjusted R2=0.268), while age, diabetes, weight and DBP were excluded from this model. Conclusion During the interdialytic period, IDWG did not cause significant PWV change. Among the factors of age, diabetic status, SBP and IDWG, SBP change was the most important one which affected PWV change. Metrics

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The correlation of serum resistin to microinflammatory state and dyslipidemia in patients with maintaince hemodialysis ZHANG Rui;WANG Li;LI Gui-sen 2008, 7 (11):  595-598.  Abstract ( 638 )   HTML ( 0 )   PDF (359KB) ( 276 )   Objective To investigate serum resistin in maintenance hemodialysis (MHD) patients and to explore its correlation to microinflammatory state and lipid metabolism． Methods Serum resistin, biochemical parameters and related inflammatory factors were determined by ELISA in 30 MHD patients before and after hemodialysis and in 30 healthy individuals. Clinical data were collected, and the relationship between serum resistin and the parameters was investigated. Results Serum resistin increased significantly (5.88±2.54ng/ml vs. 1.94±0.95ng/ml, P＜0.01) in MHD patients, especially in those complicated with cardiovascular diseases. In MHD group, serum triglyceride (TG) increased (P＜0.05), high density lipoprotein-cholesterol (HDL-C) decreased (P＜0.05), but serum cholesterol and low-density lipoprotein cholesterol (LDL-C) remained unchanged, as compared with those in control group. Serum C-reactive protein (CRP), IL-6 and vascular cell adhesion molecule-1 (VCAM-1) also increased significantly. In MHD group, serum resistin correlated positively with CRP (r=0.387, P＜0.05), IL-6 (r=0.432, P＜0.05), LDL-C (r=0.428, P＜0.05) and subjective general assessment (r=0.517, P＜0.05), and negatively with HDL-C (r=-0.451, P＜0.05). Conclusions MHD patients had higher serum resistin, which may relate to their dyslipidemia, microinflammatory status and cardiovascular diseases Metrics

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Clinical trail on asymmetric dimethylarginine clearance by hemodialysis and its correlation with nitric oxide production ZHANG Dong-liang;ZHANG Yu;WEI Yuan-yuan;LIU Wen-hu. 2008, 7 (11):  599-602.  Abstract ( 272 )   HTML ( 0 )   【Abstract】 Objective To study the correlation between clearance of asymmetric dimethylarginine (ADMA) by hemodialysis and nitric oxide (NO) production in maintenance hemodialysis patients (MHD). Methods Serum ADMA and NO productions (NOx) were measured in 159 MHD patients before and after the dialysis, from which the clearance of ADMA and NOx after the 4-hour dialysis treatment can be calculated. Samples from 20 healthy individuals were used as the controls. Serum ADMA and NOx before and after dialysis were compared. The comparison was also made in MHD patients and normal controls, MHD patients older than 65 years and those less than 65 years, MHD patients with diabetes and those without diabetes, and MHD patients with hypertension, hypotension, and stable blood pressure. Correlation analysis was performed to serum ADMA and NOx before and after the dialysis. Results In MHD patients after the dialysis, serum ADMA decreased[ (1.05±0.67)umol/L vs (0.83±0.53) umol/L, P＜0.001], and serum NOx increased [(61.1±38.5) umol/L vs (96.1±58.1) umol/L, P＜0.001]. The clearance of ADMA and NOx after 4-hour dialysis ranged (9.15±4.70) umol and (448.62±58.59) umol, respectively. MHD patients had higher serum ADMA before dialysis [(1.05±0.67) umol/L, P =0.002] and after dialysis [(0.83 ±0.53 umol/L, P = 0.004], as compared with serum ADMA of normal controls (0.35±0.06umol/L). However, MHD patients had relatively unchanged serum NOx before dialysis [(61.1±38.5) umol /L, P = 0.596] and after dialysis [(96.1±58.1) umol/L, P = 0.166], as compared with that of the normal controls [(68.1±13.6) umol/L]. Among the subgroups of HMD patients, no significant differences in serum ADMA and NOx were detected before dialysis, but negative correlation was found between serum ADMA and NOx before the dialysis (r = -0.344, P = 0.047) and after dialysis (r = -0.612，P = 0.001). Conclusion In HMD patients before dialysis, serum ADMA increased, and serum NOx was similar to the value of normal controls. Hemodialyis is capable to remove ADMA and NOx, although the clearance of ADMA is insufficient. The increase of serum NOx after dialysis may result from the removal of ADMA. Metrics

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Effects of fosinopril combined with simvastatin on inflammatory parameters and nutritional status in maintenance hemodialysis patients TANG Qi;ZHANG Li-ming;WU Bi-bo 2008, 7 (11):  603-606.  Abstract ( 596 )   HTML ( 0 )   PDF (355KB) ( 350 )   Objective To investigate the effects of fosinopril combined with simvastatin on inflammatory parameters and nutritional status in maintenance hemodialysis (MHD) patients. Methods 127 MHD patients and 26 controls were enrolled. All MHD patients were randomly divided into four groups and followed up for six months. 32 patients of them were treated with fosinopril combined with simvastain (group A), 32 patients of them were treated with fosinopril (group B), 31 patients of them were treated with simvastain (group C), and 32 patients were not given ACEI, ARB and statins (group D). The serum levels of c-reactive protein (CRP), interleukin (IL)-1 , IL-6, tumor necrosis factor- (TNF- ) and nutrition were measured at the experiment onset, three months and six months later.Twenty-six normal medical examination adults who took no medicines were selected as healthy control group. Results At the initiation of the investigation, the serum levels of CRP, IL-1 , IL-6 and TNF- in MHD patients were obviously higher than those in the control group (P＜0.01). After treatment for three months, the scores of CRP, IL-6, TNF- were obviously decreased in group A ,B and C, compared with group D and before treatment (P＜0.05). Six months later, the levels of IL-1 in group A , B and C were also significantly lower than those in group D and baseline (P＜0.05). The serum levels of albumin (Alb) and pre-albumin (PA) in group A and B were increased remarkably (P＜0.05). Except for group C, the longer the duration of the experiment, the more significantly changes of the levels of inflammatory parameters, Alb and PA (P＜0.05). The degree of serum CRP, IL-1 , IL-6 and TNF- in group A were decreased greatly after treatment for six months (P＜0.05), while the degree of serum Alb and PA were increased remarkably (P＜0.05), compared with those in group B and C. Conclusion Using fosinopril combined with simvastain may significantly improved microinflammation parameters and nutrition states in MHD patients than that of using fosinopril or simvastain only. Metrics

基础研究

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Determination of blood atropine by HPLC and experimental study on the clearance of atropine by hemoperfusion ZHAO Yan-xia;KONG Xiang-qing;ZHANG Jian-ping 2008, 7 (11):  607-609.  Abstract ( 678 )   HTML ( 1 )   PDF (358KB) ( 255 )   Object To establish the rapid determination of blood atropine and to study the clearance rate of blood atropine by hemoperfusion. Method We performed perfusion and adsorption for healthy sheep blood mixed with atropine through an extracorporeal closed circulating perfusion apparatus loaded with membrane-coated activated charcoal, similar to that for clinical use. Blood atropine was determined by high performance liquid chromatography (HPLC). Result The recovery rate of low, middle and high concentrations of blood atropine ranged 107.0 ~ 110.7%, with the relative standard deviation (RSD) of 0.95 ~ 7.8%. Blood atropine was 74.51μg/ml before hemoperfusion. After perfusion for 1.0h, 2.0h and 3.0h, blood atropine was 16.00μg/ml, 3.85μg/ml and 1.51μg/ml, respectively, in the 0.5g group, decreased to 6.45μg/ml, 0.81μg/ml, 0.21μg/ml, respectively, in the 1.0g group, and was 4.50μg/ml, 0.43μg/ml, 0.32μg/ml, respectively, in the 1.5g group. Conclusion Blood atropine can be quickly and accurately determined by HPLC. Hemoperfusion with membrane-coated activated charcoal can also remove atropine sulfate efficiently. Therefore, blood atropine must be monitored, and appropriate dose of atropine must be supplemented in time in clinical hemoperfusion. Metrics

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Expression of matrix metalloproteinases in glomerulosclerosis in rats ZHAO Hui-ying;HUANG Wen;HUANG Hai-chang 2008, 7 (11):  610-614.  Abstract ( 610 )   HTML ( 0 )   PDF (453KB) ( 292 )   Objective To assay the expression change of matrix metalloproteinasea-2 (MMP-2) and matrix metalloproteinasea-9 (MMP-9) in focal segmental glomerulosclerosis in rats, and to investigate the relationship between the expression of MMP-2 and MMP-9 and the accumulation of extracellular matrix (ECM) in the kidney in these rats. Materials and methods We divided 12 Wistar rats into test group and control group. The model of focal segmental glomerursclerosis (n = 7) was made by intravenous injection of puromycin aminonucleoside (PAN) 9mg/100g-1 body weight. Rats in control group (n = 5) were injected with 3ml 0.9% sodium chloride. Proteinuria and serum creatinine, lipids and protein were examined. Twenty weeks after the injection rats were sacrificed and their kidneys were taken for examination. Renal MMP-2, MMP-9 and fibronectin (FN) were examined by Immunohistochemistry. Positive immunohistochemical signals were quantitatively analysed using the Image-pro software. Results Rats in the test group had prominent protienuria and the increase of serum lipids. Pathologically, the kidney showed focal segmental sclerosis or sclerosis of the whole glomerulus in a part of glomeruli. ECM was segmentally accumulated in the kidney. MMP-9 normally expresses in glomerular endothelial and epithelial cells at a low level, but the expression decreased significantly in glomeruli of the rats in test group (P<0.05). There was no significant relationship between the MMP-9 expression and proteinuia. MMP-2 normally expresses in small renal arteries and the interstitium around renal tubules at a low level, but the expression decreased insignificantly in kidney of the rats in test group (P>0.05). FN normally expresses in glomeruli mesangial areas, glomerular basement membrane and renal interstitium, and the expression increased significantly in kidney of the rats in test group (P<0.05). FN expression negatively correlated with MMP-9 expression, but had no relationship with MMP-2 expression and proteinuria. Conclusion In the pathogenesis of focal segmental glomerulosclerosis, MMP-9 expression is down-regulated, resulting in the decrease of FN catabolism and the ECM accumulation. Metrics

人工肝

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The effect of BL-300 perfusion column on plasma purification for patients with chronic severe hepatitis GAO Lei;JI Fu-hong;SHEN Yun-feng 2008, 7 (11):  615-617.  Abstract ( 696 )   HTML ( 0 )   PDF (356KB) ( 235 )   Objective To observe the effect of BL-300 perfusion column on clearance of biochemical substances in plasma for patients with chronic severe hepatitis. Methods Mixed plasma collected from patients with chronic severe hepatitis flowed through BL-300 perfusion column in cycles. Serum biochemical substances including total bilirubin (TBIL), direct bilirubin (DBIL), bile acid (TBA), albumin (ALB) and globulin (GLB) were tested before the perfusion and after the pass-through reached 32.0 liters. The clearance rate of TBIL and DBIL was calculated when the total amount of pass-through was 0, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0 and 32.0 liters, respectively. We also observed the changes of these serum biochemical parameters in 65 patients with chronic severe hepatitis treated with hemoperfusion using the BL-300 perfusion column. Results When the total amount of pass-through reached 32.0 liters, TBIL, DBIL and TBA in the mixed plasma decreased significantly (P＜0.01, as compared with those in the plasma prior to perfusion), and ALB and GLB decreased slightly (P＜0.05). TBIL concentration decreased by 58.1%, DBIL by 54.9%, TBA by 86.9%, ALB by 7.5% and GLB by 11.7%, corresponding to the total adsorbed amount of 342.2μmol, 292.3μmol, 263.5μmol, 7.0g and 9.5g, respectively. The clearance rate of TBIL and DBIL of the mixed plasma decreased gradually with the increase of total amount of pass-through. In patients with chronic severe hepatitis after perfusion with BL-300 perfusion column, serum biochemical parameters showed the same changes as those of the mixed plasma. No other abnormal changes were found in this study. Conclusion BL-300 perfusion column is effective in adsorption of serum TBIL, DBIL and TBA in patients with chronic severe hepatitis. Supplement of ALB and GLB is necessary to the patients treated with artificial liver of this column. Metrics