不同血液净化方式对β2微球蛋白清除效果的比较  

Comparison of efficiency of different blood purification approached in clearance of β2-microglobulin

作　　者：林小洁[1] 王铠[1] 

机构地区：[1]民航总医院透析中心,北京100123

出　　处：《北京医学》2016年第8期829-832,共4页Beijing Medical Journal

摘　　要：目的比较不同血液净化方式对β2微球蛋白的清除效果。方法选取98例长期血液透析患者,分为3组。A组34例,接受后置换血液透析滤过[HDF,膜表面积2.2 m^2,超滤系数为75 ml/(h·mm Hg)];B组54例,行高通量透析(HFHD),并分为两亚组,HFHD1组34例,接受高通量透析器[膜表面积2.2 m^2,超滤系数为73 ml/(h·mm Hg)]进行HFHD,HFHD 2组20例,应用高通量透析器[膜表面积1.8 m^2,超滤系数为54 ml/(h·mm Hg)]进行HFHD;C组10例,应用低通量透析器[膜表面积1.4 m^2,超滤系数为12 ml/(h·mm Hg)]进行低通量透析(LFHD),作为基础对照。于单次治疗前、治疗结束时取血检测β2微球蛋白水平,计算β2微球蛋白下降率。结果 C组患者透后β2微球蛋白水平较透析前无明显下降,甚至较透前略有升高。而血液透析滤过使β2微球蛋白的下降率明显高于相同膜面积透析器的高通量血液透析(A组vs.HFHD1组,77%vs.69%,P<0.001)。高通量透析的透析器超滤系数越大、膜面积越大对β2微球蛋白的清除越多(HFHD1组vs.HFHD2组,69%vs.64%,P<0.05)。结论低通量血液透析无法清除血β2微球蛋白。血液透析滤过对β2微球蛋白的清除效果优于高通量血液透析。高通量透析器的超滤系数及膜表面积越大,对血β2微球蛋白的清除越多,可接近血液透析滤过的效果。Objective To compare the efficiency of different blood purifications approaches in the clearance of β2- microglobulin （β2-MG）. Methods Ninety-eight long-term stable hemodialysis patients were divided into three groups. Thirty-four patients （Group A） were given hemodiafiltration （HDF, post-dilution, 2.2m2,Kuf 75ml/h/mmHg）; 34 patients （Group B） received high-flux dialysis （HFHD 1 ）and 20 patients of the HFHD2 group were respectively treated with highflux dilyzerl （2.2 m2, Kuf 73ml/h/mmHg） and high-flux dilyzer2 （1.8 m2, Kuf 54ml/h/mmHg）. The other 10 patients （Group C） were treated with low-flux dialysis（LFHD, 1.4 m2 ,Kuf 12ml/h/mmHg）.The values of blood β2-MG were measured before and after single therapy. Results Blood β2-MG level wasn＇ t decreased or even increased aRer dialysis in the LFHD group. The reduction ratio of β2-MG in the HDF group was higher than the HFHD with the same dilyzer surface area （HDF group vs. HFHD1 group, 77% vs. 69%, P 〈 0.001）. HFHD1 group could remove more β2-MG than the HFHD2 group（69% vs. 64%, P 〈 0.05）. Conclusion The clearance of β2-MG is much higher by HFHD and HDF as compared to LFHD. The β2-MG reduction ratio of HFHD is lower than HDF, but with higher dilyzer surface area and higher Kuf, the reduction ratio is nearly comparable with HDF.

关 键 词：低通量透析 高通量透析 血液透析滤过 Β2微球蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]