不同生物相容性透析膜对维持性血液透析患者血管内皮细胞的影响  

Effect of the hemodialysis membrane on vascular endothelial cell in patients on hemodialysis

作　　者：孟娟[1] 王质刚[2] 孙倩美[1] 彭立人[1] 周亦伦[1] 李忠心[1] 范连成[3] 刘禹庚[4] 

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020 [2]首都医科大学附属北京友谊医院肾内科,北京100050 [3]首都医科大学附属北京朝阳医院检验科,北京100020 [4]首都医科大学附属北京朝阳医院急诊科,北京100020

出　　处：《中国实用内科杂志》2008年第8期673-675,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨不同生物相容性透析膜对维持性血液透析(MHD)患者血管内皮细胞的影响。方法选取首都医科大学附属北京朝阳医院肾内科透析室2006年5月至10月32例MHD患者作为研究对象,并随机分为2组:血仿膜组和聚砜膜组,每组各16例。分别于透析前后采集血样,Percoll密度梯度离心法测定血循环内皮细胞(CEC)数量,血浆一氧化氮(NO)的测定用硝酸盐还原酶法,血浆不对称二甲基精氨酸(ADMA)用高效液相色谱法(HPLC)。并采集健康对照组血样12例。结果MHD患者透析前CEC数量高于正常对照组,两实验组之间透析前比较差异无统计学意义。血仿膜组和聚砜膜组透析后CEC数量均较透析前明显增高,透析后和透析前比较差异有统计学意义(P<0.01);透析后血仿膜组CEC数量高于聚砜膜组,组间比较差异有统计学意义(P<0.01)。血浆两组NO、ADMA浓度透析后较透析前均有显著下降(P<0.01)。两组间透析后,NO浓度差异无统计学意义。血仿膜组CEC数量与血浆NO、ADMA浓度呈显著负相关(分别为r=-0.532和r=-0.432,P<0.05);而聚砜膜组CEC数量与血浆NO、ADMA浓度虽然也呈负相关,但无统计学意义。结论MHD患者血管内皮细胞受生物相容性的影响,合成膜对血管内皮细胞的影响较小。不同生物相容性透析膜对血管内皮细胞的损伤有可能是通过抑制内皮细胞NO合成酶通路而导致的。Objective To observe biocompatibility on vascular endothelial cell in hemodialysis, in order to explore the mechanism of biocompatibility on vascular endothelial cell. Methods Two kinds of dialyzer membranes （ hemophan and polysulfone） were randomly used on two groups of 32 MHD patients： A group（ hemophan group ）and B group （polysulfone group）. Blood samples were collected before hemodialysis and after hemodialysis. The CECs were separated by using isopyknic centrifugation method. The plasma NO and ADMA were measured by Griess method and HPLC method respec- tively. Results The CEC numbers of before-hemodialysis in two groups were higher than that of control group （ P 〈 0. 01 ）. The CEC numbers of after-hemodialysis in two groups were significantly higher than that of before hemodialysis （P 〈 0. 01 ）. The number of CECs in A group was higher than that of B group after hemodialysis （ P 〈 0. 01 ）. Serum NO and ADMA in A group and B group all decreased. Serum ADMA of A group was higher than that of B group after hemodi- alysis （P 〈 0.01 ）. A significant correlation was found between plasma level of CEC and serum NO, ADMA after hemodial- ysis in A group （ r = - 0. 532 and r = - 0. 432,P 〈 0. 05 ） respectively. Conclusion The effect of synthetic membrane on vascular endothelial cell in patients on hemodialysis is less than hemophan membrane. The mechanism of biocompati- bility on vascular endothelial cell in hemodialysis may be caused by dysfunction of NO synthase pathway.

关 键 词：血液透析 生物相容性 循环内皮细胞 一氧化氮 不对称二甲基精氨酸 

分 类 号：R5[医药卫生—内科学]