中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (09): 639-642.doi: 10.3969/j.issn.1671-4091.2014.09.008

• 临床研究 • 上一篇    下一篇

不同血液净化方法清除维持性血液透析患者血清蛋白结合类尿毒症毒素的效果比较

邓岱,李新伦,李红霞,高卓,窦桂芳,伦立德   

  1. 北京，中国人民解放军空军总医院肾病科(窦桂芳军事医学科学院药代动力学实验室)
  • 收稿日期:2014-04-02 修回日期:2014-05-21 出版日期:2014-09-12 发布日期:2014-09-02
  • 通讯作者: 伦立德 lynlidldm@163.com E-mail:lunlideldm@163.com

Comparison of different blood purification modalities for removal of serum protein-bound uremic toxins in maintenance hemodialysis patients

  • Received:2014-04-02 Revised:2014-05-21 Online:2014-09-12 Published:2014-09-02

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摘要： 目的探讨血液透析(HD)、血液透析滤过(HDF)和血液灌流联合血液透析(HP+HD)治疗方法对维持性血液透析(MHD)患者血清蛋白结合类毒素--硫酸吲哚酚(indoxyl sulphate，IS)、硫酸对甲酚(pcresylsulphate，PCS)和马尿酸(hippuric acid，HA)的清除效果。方法将入选的48 例患者随机分为HD 组、HDF 组和HP+HD 组，采用高效液相色谱-电喷雾电离-串联质谱(high-performance liquid chromatographyelectrospray ionization tandem mass spectrometry，HPLC-ESI-MS/MS)方法测定不同血液净化方法治疗前后血清IS、PCS 和HA 浓度，以比较不同治疗方式对蛋白结合类尿毒症毒素的清除效果。结果对血清IS 的清除，HD 组从(30.96±12.55)μg/ml 降至(21.03±10.42)μg/ml(P＜0.05),下降率为(33.10±12.87)%；HDF 组从(32.24±17.11)μg/ml 降至(17.11±8.94)μg/ml(P＜0.01),下降率为(43.96±14.96)%；HP+HD 组从(33.52±19.30)μg/ml 降至(14.33±9.81)μg/ml(P＜0.01),下降率为(57.96±11.95)%；HP+HD 组下降率显著高于同期HDF 组和HD 组(P＜0.05，P＜0.01)，HDF 组下降率显著高于HD 组(P＜0.05)。对血清PCS 的清除，HD 组从(24.87±13.64)μg/ml 降至(16.80±8.48)μg/ml(P＜0.05),下降率为(30.24±9.27)%；HDF 组从(30.60±19.18)μg/ml 降至(15.59±12.39)μg/ml(P＜0.05),下降率为(43.20±11.87)%；HP+HD 组从(38.92±17.24)μg/ml 降至(17.71±10.22)μg/ml(P＜0.01), 下降率为(54.22±14.37)%。HP+HD 组下降率显著高于同期HDF 组和HD 组(P＜0.01，P＜0.01)，HDF 组治疗血清PCS 水平下降率高于HD 组(P＜0.05)。对血清HA 清除,HD 组从(18.65±14.24)μg/ml 降至(7.38±5.27)μg/ml(P＜0.01),下降率为(59.36±7.46)%；HDF 组从(27.62±16.07)μg/ml 降至(7.75±4.56)μg/ml(P＜0.01),下降率为(69.70±11.93)%；HP+HD 组从(20.48±11.02)μg/ml 降至(6.33±4.78)μg/ml(P＜0.01),下降率为(71.20±10.28)%；HP+HD 组下降率显著高于同期HD 组(P＜
0.01)，HDF 组降率显著高于HD 组(P＜0.01)，但HP+HD 组与HDF 组之间的下降率相比无统计学差异(P>0.05)。结论HD、HDF 和HP+HD 血液净化治疗方法对蛋白结合类毒素均有清除作用，HP+HD 的清除效果优于HDF和HD。

关键词: 蛋白结合类尿毒症毒素, 血液透析, 血液透析滤过, 血液灌流

Abstract: Objective To compare the removal efficiencies of protein-bound uremic toxins including indoxyl sulphate (IS), p-cresyl sulphate (PCS) and hippuric acid (HA) by hemodialysis (HD), hemodiafiltration (HDF) and hemoperfusion associated with hemodialysis (HP + HD). Methods Forty- eight MHD patients were enrolled in this study. They were randomly assigned into HD group, HDF group or HP+HD group. IS, PCS and HA in serum samples before and after the treatment were determined using high-performance liquid chromatography electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS), to compare the removal
of protein-bound uremic toxins by the three dialysis modalities. Results ①Serum IS decreased from 30.96±12.55 μg/ml to 21.03±10.42 μg/ml (reduction rate [RR]=33.10±12.87%, P＜0.05) in HD group, from 32.24±17.11 μg/ml to 17.11±8.94 μg/ml (RR=43.96±14.96%, P＜0.01) in HDF group, and from 33.52±19.30 μg/ml to 14.33±9.81 μg/ml (RR=57.96±11.95%, P＜0.01) in HP+HD group. Therefore, HDF and HP+HD are more effective than HD (P＜0.05 and ＜0.01, respectively), and HP+HD is more effective than HDF (P＜ 0.05) in IS clearance. ②Serum PCS decreased from 24.87±13.64 μg/ml to 16.80±8.48 μg/ml (RR = 30.24 ± 9.27%, P＜0.05) in HD group, from 30.60±19.18 μg/ml to 15.59±12.39 μg/ml (RR=43.20±11.87%, P＜0.05) in HDF group, and from 38.92±17.24 μg/ml to 17.71±10.22 μg/ml (RR=54.22±14.37%, P＜0.01) in HP+HD group. Therefore, HDF and HP+HD are more effective than HD (P＜0.01), and HP+HD is more effective than HDF (P＜0.05) in PCS clearance. ③Serum HA decreased from 18.65±14.24 μg/ml to 7.38±5.27 μg/ml (RR=59.36±7.46%, P＜0.01) in HD group, from 27.62±16.07 μg/ml to 7.75±4.56 μg/ml (RR=69.70±11.93%, P＜0.01) in HDF group, and from 20.48±11.02 μg/ml to 6.33±4.78 μg/ml (RR= 71.20 ± 10.28%, P＜0.01) in HP+HD group. Consequently, HDF and HP+HD are more effective than HD (P＜0.01), but HP+HD and HDF are similar in HA clearance (P>0.05). Conclusion HD, HDF and HP+HD can partially remove proteinbound uremic toxins. HP+HD is better than HDF and HD in removal of these uremic toxins.

Key words: Protein-bound uremic toxins, Hemodialysis, Hemodiafiltration, Hemoperfusion