中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (05): 300-303.doi: 10.3969/j.issn.1671-4091.2019.05.003

• 临床研究 • 上一篇    下一篇

一种新的估算Kt/Vurea值的方法

刘昕1,2,甘良英1,檀敏1,管红杰1,左力 1   

  1. 1. 北京大学人民医院肾内科
    2. 北京医院肾内科 国家老年医学中心
  • 收稿日期:2018-12-13 修回日期:2019-02-25 出版日期:2019-05-12 发布日期:2019-05-15
  • 通讯作者: 左力 zuoli@bjmu.edu.cn E-mail:lox_352@163.com
  • 基金资助:

    卫计委公益行业基金--优化尿毒症患者管理模式的研究，基金号201502010

A new method for estimating Kt/Vurea

  • Received:2018-12-13 Revised:2019-02-25 Online:2019-05-12 Published:2019-05-15

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摘要： 【摘要】目的Kt/Vurea是目前测定透析计量的首选方法。Kt/Vurea采用单室模型或近似双室模型得出。本研究目的是将采用药代动力学软件多参数方法获得Kt/Vurea，并与既往计算方法相比较，阐明其可行性。方法选取长期稳定的维持性血液透析患者30例，分别进行单次高通量透析(Fresenius FX60或FX80)，于
治疗前及治疗过程中第15、30、60、90、120、180及240min治疗结束时各抽血1次，采用脲酶法测定血清尿素浓度。采用第二代Daugirdas 公式、eKt/V 公式(Daugirdas 及Tattersall 公式)分别获得spKt/Vurea、eKt/VureaD及eKt/VureaT，与药动学分析软件(WinNonlin 软件)在单室及双室模型下所得的Kt/VureaW- 1 室与Kt/VureaW-2 室进行比较。结果单次高通量透析血尿素浓度水平可下降至治疗前的30.0%±6.0%。所有受试者在WinNonlin 软件双室模型下拟合的AIC 值均小于单室模型，说明透析过程中血尿素动力学改变更符合双室模型。WinNonlin 软件双室模型下所获得的Kt/VureaW- 2 室(1.23±0.21)明显低于spKt/Vurea(1.48±0.21)，有统计学意义(t=4.784,P＜0.001)，但2 者有较好的相关性(R 2=0.911，P＜0.001)；而Kt/VureaW- 2 室分别与eKt/VureaD(1.28±0.18) (t=0.935, P=0.352)及eKt/VureaT(1.31±0.19) (t=1.578, P=0.117)之间的差异均无统计学意义。结论利用药代动力学软件证明透析过程中血尿素动力学更符合双室模型；该方法可较为准确的获得eKt/Vurea值。

关键词: 尿素, 双室模型, 药代动力学, 高通量透析

Abstract: 【Abstract】Objective Kt/Vurea is currently a preferential method for measuring dialysis dose. The calculation of Kt/Vurea is based on the single-compartment kinetic model or the approximate two-compartment kinetic model. The aim of this study is to compare theKt/Vurea value from pharmacokinetic software and multiparameter method with that from traditional method and to prove the feasibility of the new method. Methods Thirty long-term hemodialysis patients with stable status were treated with one session of high-flux dialysis using FX60 or FX80 high-flux dialyzer. Blood samples were collected at the beginning, after 15, 30, 60, 90, 120, 180 and 240 minutes at the end of the session. Urease method was used to measure the concentration of blood urea. SpKt/Vurea, eKt/VureaD and eKt/VureaT were calculated by the second generation of Daugirdas formula and equilibrated Kt/Vurea equations of Daugirdas and Tattersall, respectively. They were compared with Kt/Vurea W-single pool and Kt/Vurea W-two pools fitted by pharmacokinetic software (WinNonlin software). Results After one session of high-flux dialysis, blood urea concentrations could be reduced to 30.0±6.0% of the value before the session. The AIC values fitted by WinNonlin software with two-compartment model were lower than those with singlecompartment model, indicating that the dynamic changes of blood urea during dialysis were better in line with the two-compartment model. The value of Kt/Vurea W-two pools (1.23±0.21) was significantly lower than that of sp-Kt/Vurea (1.48±0.21) (t=4.784, P＜0.001). In addition, the two values were statistically correlated (R2=0.911, P＜0.001). The difference betweenKt/Vurea W- two pools and eKt/Vurea D (1.28 ± 0.18) was not significant (t=0.935, P=0.352), so wasn’t the difference between Kt/Vurea W-two pools and eKt/Vurea T (1.31±0.19) (t=1.578, P=0.117). Conclusions By using the pharmacokinetic software, we identified that the dynamics of blood urea during dialysis
was better in line with the two-compartment model and that the eKt/Vurea value could be accurately obtained by this method.

Key words: urea, two-compartment model, pharmacokinetics, high-flux dialysis