膜式血浆置换对维持性血透患者血清全段甲状旁腺激素及β_2微球蛋白的影响  

The removal of iPTH and β_2-MG in patients with maintenance hemodialysis by therapeutic plasma exchange.

作　　者：俞香宝[1] 毛慧娟[1] 胡建明[1] 沈霞[1] 黄桂英[1] 邢昌赢[1] 

机构地区：[1]南京医科大学一附院肾科,江苏南京210029

出　　处：《临床和实验医学杂志》2007年第12期21-23,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的观察治疗性血浆置换(PP)前后血清甲状旁腺激素(PTH)及β2微球蛋白(β2-MG)浓度的变化,探讨PP对两者的清除效果。方法17例维持性血透(MHD)患者,行37例次单滤法PP,于PP前、后分别取血标本及废弃血浆检测全段PTH(iPTH)、β2-MG、钾、钠、氯、钙离子,同时抽查补充液4%人白蛋白复方氯化钠溶液内钙离子等浓度,比较PP前、后其浓度改变,分析影响因素。结果PP治疗前、后iPTH分别为391.24±329.76 pg/ml、681.92±584.42 pg/ml,治疗后iPTH明显增高(P<0.005),废弃血浆中浓度为116.00±62.72 pg/ml;治疗前后血钙分别为2.3025±0.18mmol/L、2.15±0.13 mmol/L,PP治疗后明显降低(P<0.05);PP治疗前、后β2-MG分别为15.56±9.03 mg/ml、13.44±8.73 mg/ml,治疗后明显下降(P<0.001),废弃的血浆中浓度为13.48±10.13 mg/ml。结论单滤法PP后血清iPTH显著升高,可能与补充液中低钙刺激储存的甲状旁腺素快速分泌有关;单滤法PP能有效清除β2-MG,其清除下降率约为17.19%。Objective To observe the changes in serum levels of parathyroid hormone （ PTH ） and beta - 2 - microglobulin （ β2 - MG） in maintenance hemodialysis patients treated by therapeutic plasma exchange, and to explore its mechanisms. Methods Thirty - seven procedures were performed in 17 patients with maintenance hemodialysis. The plasma concentrations of PTH, β2 -MG, total calcium, ionized sodium, potassium and chloride were determined before and after treatment. The same tests were randomly taken in samples of replacement fluid used for exchanging and in samples of discarded fluid respectively. Results The reduction in serum concentrations of total calcium and β2 - MG during plasma ex- change was significant （ P 〈 0.05 ）, and the concentration of PTH raised distinctly （ P 〈 0. 005 ）. However, after three consecutive procedures in 6 patients, the concentration of PTH was significantly reduced. The concentrations of PTH and β2 - MG in discarded fluid were 116.00 ± 62. 72 pg/ml and 13.48 ± 10.13 mg/ml respectively. Conclusion Above - mentioned data demonstrate that a rapid compensatory response in PTH to the reduction of serum concentration of total calcium. The concentration of β2 - MG could be reduced approximately 17.19% by means of therapeutic plasma exchange.

关 键 词：血浆置换 尿毒症 甲状旁腺激素 Β2-微球蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]