血液透析联合血液灌流清除维持性血液透析患者蛋白结合类毒素的长期临床研究

发布时间：2018-03-17 06:21

本文选题：蛋白结合类毒素　切入点：中大分子毒素　出处：《河北北方学院》2017年硕士论文　论文类型：学位论文

【摘要】：蛋白结合类毒素(Protein-bound uremic toxins,PBUTs)因其与白蛋白结合以及多室分布的特点难以被常规血液透析清除,血液透析(Hemodialysis,HD)联合血液灌流(Hemoperfusion,HP)治疗较常规血液透析增加对PBUTs的清除,但PBUTs在体内分布容积远大于血浆室容积,长期HD+HP治疗能否将PBUTs维持在较低水平尚未可知,因此本研究旨在探讨长期应用HD+HP治疗对PBUTs的清除效果,同时观察对生活质量的影响。本研究选取46例维持性血液透析(Maintenance hemodialysis,MHD)患者,分为HD+HP组及HD组。HD+HP组(n=22例)采取HD(2次/周)和HD+HP(1次/周)治疗;HD组(n=24例)采取HD治疗(3次/周),随访观察36周。测定试验前、12、24、36周透前PBUTs、β2-MG,同时监测治疗前、后临床指标,并行KDQOL-SF1.3量表评估生活质量。PBUTs包括马尿酸(hippuric acid,HA)、硫酸吲哚酚(indoxyl sulfate,IS)、硫酸对甲酚(p-cresyl sulphate,PCS),测定方法为高效液相色谱-串联质谱方法(High-performance liquid chromatography/tandem mass spectrometry,HPLC-MS/MS)。临床指标包括血清钙、血清磷、全段甲状旁腺激素、血红蛋白、血清白蛋白、血清铁蛋白、血清转铁蛋白饱和度、透析充分性(Kt/V)。经36周治疗后,1.HD组和HD+HP组各临床指标与治疗前相比差异均无统计学意义(P0.05),治疗后两组间比较差异均无统计学意义(P0.05);2.HD+HP组血清β2-MG水平在整个研究期间均低于HD组。结束时,HD+HP组下降约15.6%,显著低于治疗前(P0.01);HD组下降约1.2%,治疗前、后差异无统计学意义(P0.05);HD+HP组血清β2-MG下降大于HD组(P0.05);3.HD+HP组的PBUTs在整个研究期间均低于HD组。结束时,HD+HP组HA、IS、PCS分别下降33.5%、12.8%、24.2%。HD组分别上升2.3%、21.8%、2.8%。血清HA、PCS、IS浓度下降HD+HP组大于HD组(P0.05)。4.HD组生活质量评分(躯体疼痛、精力)较治疗前明显降低(P0.05),HD+HP组生活质量评分(症状与不适、肾病影响、精力)较治疗前明显改善(P0.05)。HD+HP组治疗后生活质量评分(肾病影响、认知功能、睡眠质量、生理机能、躯体疼痛、总体健康、社会功能、精力)明显高于HD组(P0.05)。综上所述,长期应用血液透析联合血液灌流(1次/周)治疗对中大分子及蛋白结合类毒素的清除优于常规血液透析,同时显著改善MHD患者生活质量。
[Abstract]:Protein-bound uremic toxin (PBUTs) is difficult to be cleared by routine hemodialysis because of its characteristics of binding to albumin and multicompartment distribution. Hemodialysis combined with hemoperfusion is more effective than routine hemodialysis in the treatment of PBUTs. However, the volume distribution of PBUTs in vivo is much larger than that of plasma ventricular volume. It is not known whether long-term HD HP treatment can maintain PBUTs at a lower level. Therefore, the purpose of this study was to investigate the effect of long-term HD HP therapy on PBUTs clearance. In this study, 46 patients with maintenance hemodialysis and maintenance hemodialysis (MHD) were studied. The patients were divided into HD HP group and HD HP group (n = 22) received HD(2 times / week) and HD HP(1 group (n = 24) were treated with HD three times a week, followed up for 36 weeks. The quality of life. PBUTs including hippuric acid, indoxyl sulfate sulfate, p-cresyl sulphate were evaluated by high performance liquid chromatography/tandem mass spectrometric HPLC-MS-MSP. The clinical parameters included serum calcium, serum phosphorus, and P-cresyl sulphate. Whole parathyroid hormone, hemoglobin, serum albumin, serum ferritin, serum transferrin saturation, After 36 weeks of treatment, there was no significant difference in the clinical indexes of HD group and HD HP group compared with that before treatment. There was no significant difference in serum 尾 2-MG level between the two groups after treatment. 2. The serum 尾 2-MG level in HD HP group was not significantly different from that in HD HP group during the whole study period. At the end of treatment, the decrease of HP group was about 15.6g, which was significantly lower than that of P0.01U HD group before treatment, about 1.2%, before treatment, and before treatment, there was no significant difference between HD group and HD group. There was no significant difference in serum 尾 2-MG between HD HP group and HD HP group. The PBUTs of HD group was lower than that of HD group during the whole study period. Quality of life score (body pain) in HD group (P 0.05). Energy) significantly decreased the scores of quality of life (symptoms and discomfort, the influence of nephropathy, energy) before and after treatment. The scores of quality of life (influence of nephropathy, cognitive function, sleep quality, physiological function) were significantly improved after treatment. Somatic pain, overall health, social function and energy) were significantly higher than those in HD group (P 0.05). In conclusion, long-term hemodialysis combined with hemoperfusion once a week was superior to routine hemodialysis in the clearance of medium and large molecules and protein-binding toxoid. At the same time, the quality of life of MHD patients was improved significantly.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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