胱抑素C下降率在终末期肾病患者中分子物质清除评估中的应用  

Cystatin C reduction ratio in evaluation of clearance of middle molecules in patients with end-stage renal disease

作　　者：苏海华[1] 张家隆[1] 张婷[1] 王永红[1] 滕佳琪[1] 舒全莲 

机构地区：[1]海洋石油总医院肾内科,天津300452

出　　处：《国际移植与血液净化杂志》2015年第3期22-25,共4页International Journal of Transplantation and Hemopurification

基　　金：中海油能源发展基金资助项目（HFKJ-ZYYl202）

摘　　要：目的 探讨胱抑素C下降率（cystatin Creductionratio,CyCRR）在终末期肾病（ESRD）患者中分子物质清除评估中的作用.方法 选择终末期肾病患者90例,按透析方式不同分为血液透析滤过（hemodiafitration,HDF）组和血液透析（hemodialysis,HD）组,每组各45例,于治疗前、后分别测定血清胱抑素C（CyC）、β2-微球蛋白（β2-MG）、全段甲状旁腺激素（iPTH）、瘦素（LP）、尿素氮（BUN）、肌酐（Cr）等指标,并根据上述指标计算胱抑素C下降率（CyCRR）、β2-微球蛋白下降率（β2-MGRR）、全段甲状旁腺激素下降率（iPTHRR）、瘦素下降率（LPRR）以及尿素清除指数（eKt/Vurea）.对两组治疗前后血清CyC、β2-MG、iPTH、LP水平及下降率分别进行比较,同时对HDF组上述物质下降率进行相关性分析.结果 两组治疗前各项指标差异无统计学意义（P＞0.05）.HDF组治疗后CyCRR 、β2-MGRR、iPTHRR、LPRR较HD组提高（P＜0.05）,两组KT/V未见明显差异（P＞0.05）.HDF组相关性分析显示,CyCRR不仅与β2-MGRR、iPFHRR、LPRR相关（P＜0.05）,且与eKt/Vurea相关（P＜0.05）.结论 HDF与HD相比较能有效提高CyC、β2-MG、iPTH、LP等中分子物质的清除率,而CyCRR可作为一种较准确反映终末期肾病患者中分子物质清除的评估指标.Objective To investigate the role of cystatin C reduction ratio（CyCRR） in evaluation of the clearance of middle molecules in patients with end-stage renal disease （ESRD）.Methods Ninety patients with maintenance hemodialysis （MHD） were randomly divided into two groups,45 cases with hemodiafitration treatment （HDF group）,and 45 cases with hemodialysis treatment （HD group）.Cystatin C （CyC）,β2-microglobulin （β2-MG）,leptin （Lp）,intact parathormone （iPTH）,creatinine （Cr）,urea nitrogen （BUN） were detected before and after the treatment.Cystatin C reduction ratio （CyCRR）,β2-microglobulin reduction ratio （β2-MGRR）,leptin reduction ratio （LpRR）,intact parathormone reduction ratio （iPTHRR） and equilibrated Kt/Vurea （eKt/Vurea） were calculated as the results of above indexes after treatment.Above reduction ratio of the two groups after treatment were compared respectively.Also,correlation analyse were utilized to assess the relationship of CyCRR and some other reduction ratio.Results There were no significant difference in all parameters between HDF group and HD group before the treatment.CyCRR,β2-MGRR,iPTHRR and LPRR in the HDF group were significantly increased after the treatment compared to those in the HD group（P 〈 0.01 or P 〈 0.05）.However,the eKt/Vurea did not differ between the two groups.CyCRR was significantly related to β2-MGRR,iPTHRR,LPRR and eKt/Vurea in the HDF group by Pearson relativity analysis （P 〈 0.01 or P 〈 0.05）.Conclusion Compared to HD,HDF can elevate the clearance of middle molecules,including CyC,β2-MG,iPTH and LP more efficiently.As a alternative evaluation indicator,CyCRR can more accurately reflect of the clearance of middle molecules in patients with ESRD undergoing MHD.

关 键 词：胱抑素C下降率 肾透析 中分子物质 评估 

分 类 号：R692.5[医药卫生—泌尿科学]