中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (04): 244-247.doi: 10.3969/j.issn.1671-4091.2021.04.007

• 临床研究 • 上一篇    下一篇

不同透析器膜材料对维持性血液透析患者体内双酚A 暴露情况的影响

王兆星1,许焱1,史航2,史振伟3   

  1. 1应急总医院肾内科
    2北京师范大学附属中学国际部
    3北京华信医院(清华大学第一附属医院)肾内科
  • 收稿日期:2020-10-22 修回日期:2021-01-14 出版日期:2021-04-12 发布日期:2021-04-12
  • 通讯作者: 史振伟 shizhenwei2008@126.com E-mail:shizhenwei2008@126.com

The influence of different dialysis membrane composition on bisphenol A exposure in maintenance hemodialysis patients

  1. 1Department of Nephrology, Emergency General Hospital, Beijing 100028, China; 2International Department of The High School Affiliated to Beijing Normal University, Beijing 100052, China; 3Department of Nephrology, The First Hospital of Tsinghua University, Beijing 100016, China
  • Received:2020-10-22 Revised:2021-01-14 Online:2021-04-12 Published:2021-04-12

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摘要： 【摘要】目的评估维持性血液透析(maintenance hemodialysis,MHD)患者体内双酚A(bisphenol A，BPA)的暴露情况以及不同透析器膜材料对BPA 暴露情况的影响。方法选取健康人群15 例作为对照组。选取MHD 的慢性肾脏病患者共66 例，随机分为A、B 2 组，A 组应用聚砜(polysulfone,PS)膜透析器、B组应用聚醚砜(polyethersulfone,PES)膜透析器治疗3 个月，随后2 组交换透析器类型继续治疗3 个月。用酶联免疫吸附测定检测健康人群以及MHD 患者第1 次透析前后、治疗3 个月以及治疗6 个月后的血清BPA 进行对比分析。结果2 组MHD 患者的血清BPA 均高于健康人群(t=9.378，P＜0.001;t=8.784，P＜0.001)。A 组在第1 次血液透析后血清BPA 较前升高(t=2.794，P=0.009)。B 组在第1 次血液透析后血清BPA 同前无明显变化(t=-0.631，P=0.533)。A 组应用PS 膜透析器血液透析治疗3 个月后血清BPA 较基线无显著变化(t=1.721，P=0.095)，换用PES 膜透析器血液透析治疗3 个月后血清BPA 较基线及治疗3 个月时均下降(t=-4.690, P＜0.001；t=-6.378, P＜0.001)。B 组应用PES 膜透析器血液透析治疗3 个月后血清BPA 较基线下降(t=-3.604, P=0.001)，换用PS 膜透析器血液透析治疗3个月后血清BPA 较3个月时回升(t=4.412, P＜0.001)，与基线水平无显著差异(t=-0.679, P=0.502)。治疗3个月时2组间血清BPA差异有统计学意义(t=3.367, P=0.002)。相关性分析提示血清BPA与透析龄(r=0.391, P= 0.001)、体质量指数(r=0.355, P=0.003)、糖尿病(r=0.364, P=0.003)、高脂血症(r=0.405, P=0.001)呈正相关，与残余尿量(r= -0.721, P＜0.001)呈负相关。结论MHD 患者存在较高的体内BPA 蓄积风险，可能导致多系统的潜在损害，影响远期预后。长期应用PS 膜透析滤器进行血液透析可加重BPA 体内蓄积，而应用PES 膜透析器进行血液透析不会加重BPA体内蓄积。

关键词: 双酚A, 血液透析, 慢性肾脏病, 透析器, 聚砜膜, 聚醚砜膜

Abstract: 【Abstract】Objective To evaluate the exposure of bisphenol A (BPA) and the influence of different dialysis membrane composition on BPA exposure in maintenance hemodialysis (MHD) patients. Methods A total of 66 chronic kidney disease patients with MHD were recruited and randomly divided into group A or group B. Group A was treated with polysulfone (PS) membrane dialyzer, and group B was treated with polyethersulfone (PES) membrane dialyzer for hemodialysis for 3 months. The dialyzer types for the two groups were then exchanged and used for hemodialysis for another 3 months. Fifteen healthy people were selected as the control group. EnzymElinked immunosorbent assay was used to measure serum BPA before and after the first dialysis, 3 months and 6 months after the treatment as well as serum BPA in healthy people for comparison. Results Serum BPA of the two MHD patient groups was significantly higher than that of healthy people (t=9.378, P＜0.001; t=8.784, P＜0.001). In group A after the first hemodialysis, serum BPA was significantly higher than that before hemodialysis (t=2.794, P=0.009); while in group B after the first hemodialysis, serum level did not change significantly as compared with the level before hemodialysis (t=- 0.631, P=0.533). In
group A after hemodialysis using PS membrane dialyzer for 3 months, serum level did not change significantly as compared with that of the value (t=1.721, P=0.095); after switching to hemodialysis using PES membrane dialyzer for 3 months, serum level decreased significantly as compared with that of the value and the value at the third month of the treatment (t=-4.690, P＜0.001; t=-6.378, P＜0.001). In group B after hemodialysis using PES membrane dialyzer for 3 months, serum level decreased significantly as compared with that of the value (t=-3.604, P=0.001); after switching to hemodialysis using PS membrane dialyzer for 3months, serum level increased significantly as compared with that before 3 months (t=4.412, P＜0.001) and similar to that of the baseline level (t=-0.679, P=0.502). After the treatment for 3 months, serum BPA was statistically different between the two groups (t= 3.367, P=0.002). Correlation analysis showed that serum BPA was positively correlated with dialysis age (r=0.391, P=0.001), body mass index (r=0.355, P=0.003), diabetes (r=0.364, P=0.003), and hyperlipidemia (r=0.405, P=0.001), and negatively correlated with residual urine volume (r=-0.721, P<0.001). Conclusions MHD patients are at the high risk of BPA accumulation, potentially
causing damage to multiple systems and affecting long- term prognosis. Long-term application of PS membrane dialyzer for hemodialysis increases the accumulation of BPA, while the application of PES membrane dialyzer for hemodialysis decreases this risk.

Key words: Bisphenol A, Hemodialysis, Chronic kidney disease, Dialyzer, Polysulfone membrane, Polyethersulfone membrane

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