不同血液净化模式对维持性血液透析患者蛋白结合类毒素的清除效果
发布时间：2018-12-12 01:09
【摘要】：目的:探讨不同血液净化方式对维持性血液透析(MHD)患者蛋白结合类毒素清除的效果。方法:选取符合入选标准的MHD患者136例,经4周洗脱期,随机分成4组:低通量血液透析(LFHD)组、高通量血液透析(HFHD)组,血液透析滤过(HDF)组和血液透析联合血液灌流(HD+HP)组,采用高效液相色谱串联质谱法(HPLC-MS/MS)方法测定不同血液净化方法治疗前后血清、透析废液和血液灌流器中马尿酸(HA)、硫酸对甲酚(PCS)、硫酸吲哚酚(IS)、3-羧基-4-甲基-5-丙基-2-呋喃丙酸(CMPF)的浓度,观察对蛋白结合类毒素的清除效果。结果:四种模式皆能有效清除HA,各组之间无差异。对血清PCS的清除,HDF组和HD+HP组的下降率高于LFHD组(P0.01)和HFHD组(P0.05,P0.01)。对血清IS的清除,HDF组和HD+HP组高于LFHD组、HFHD组(均P0.05)。对于血清CMPF的清除,HD+HP组和HDF组明显高于LFHD组、HFHD组(P0.01),HD+HP组高于HDF组(P0.01),LFHD组与HFHD组相比无差别(P0.05)。结论:四种方式对于蛋白结合力较低的蛋白结合类毒素清除效率接近于小分子毒素的清除效果;HDF、HD+HP对中等蛋白结合力的蛋白结合类毒素的清除能力优于HFHD、LFHD;HD+HP清除高蛋白结合力的蛋白结合毒素的能力最佳,HDF次之,LFHD和HFHD几乎无效。
[Abstract]:Objective: to investigate the effect of different blood purification methods on the clearance of protein-binding toxoid in (MHD) patients with maintenance hemodialysis. Methods: one hundred and thirty-six patients with MHD were randomly divided into four groups: low flux hemodialysis (LFHD) group, high throughput hemodialysis (HFHD) group, low flux hemodialysis (LFHD) group, and high throughput hemodialysis (HFHD) group. High performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) was used to determine serum before and after treatment in (HDF) group and hemodialysis combined with hemoperfusion (HD HP) group. The concentration of hippuric acid (HA), sulfuric acid p-cresol (PCS), sulfate indole phenol (IS), 3-carboxylic 4-methyl-5-propyl-2-furanolpropionic acid (CMPF) in dialysis waste liquor and hemoperfusion apparatus, To observe the clearance effect of protein-binding toxoid. Results: all the four models could effectively eliminate the difference between the HA, groups. The decrease rate of serum PCS in HDF group and HD HP group was higher than that in LFHD group (P0.01) and HFHD group (P0.05 P0.01). The clearance of serum IS in HDF group and HD HP group was higher than that in LFHD group and HFHD group (P0.05). The clearance of serum CMPF in, HD HP group and HDF group was significantly higher than that in LFHD group and HFHD group (P0.01), HD HP group was higher than HDF group (P0.01), LFHD group and HFHD group had no difference (P0.05). Conclusion: the clearance efficiency of four ways for protein-binding toxoid with low protein binding ability is close to that of small molecular toxin, and that of HDF,HD HP is superior to that of HFHD,LFHD; for medium protein binding ability. HD HP had the best ability to clear the protein-binding toxin with high protein binding ability, followed by HDF, and LFHD and HFHD were almost ineffective.
【作者单位】： 中国人民解放军空军总医院肾病科;
【分类号】：R692
本文编号：2373595
[Abstract]:Objective: to investigate the effect of different blood purification methods on the clearance of protein-binding toxoid in (MHD) patients with maintenance hemodialysis. Methods: one hundred and thirty-six patients with MHD were randomly divided into four groups: low flux hemodialysis (LFHD) group, high throughput hemodialysis (HFHD) group, low flux hemodialysis (LFHD) group, and high throughput hemodialysis (HFHD) group. High performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) was used to determine serum before and after treatment in (HDF) group and hemodialysis combined with hemoperfusion (HD HP) group. The concentration of hippuric acid (HA), sulfuric acid p-cresol (PCS), sulfate indole phenol (IS), 3-carboxylic 4-methyl-5-propyl-2-furanolpropionic acid (CMPF) in dialysis waste liquor and hemoperfusion apparatus, To observe the clearance effect of protein-binding toxoid. Results: all the four models could effectively eliminate the difference between the HA, groups. The decrease rate of serum PCS in HDF group and HD HP group was higher than that in LFHD group (P0.01) and HFHD group (P0.05 P0.01). The clearance of serum IS in HDF group and HD HP group was higher than that in LFHD group and HFHD group (P0.05). The clearance of serum CMPF in, HD HP group and HDF group was significantly higher than that in LFHD group and HFHD group (P0.01), HD HP group was higher than HDF group (P0.01), LFHD group and HFHD group had no difference (P0.05). Conclusion: the clearance efficiency of four ways for protein-binding toxoid with low protein binding ability is close to that of small molecular toxin, and that of HDF,HD HP is superior to that of HFHD,LFHD; for medium protein binding ability. HD HP had the best ability to clear the protein-binding toxin with high protein binding ability, followed by HDF, and LFHD and HFHD were almost ineffective.
【作者单位】： 中国人民解放军空军总医院肾病科;
【分类号】：R692
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