国产新型血液灌流器清除蛋白结合类毒素的临床疗效研究  

A clinic study of removing protein-bound toxins by using a noval hemoperfusion apparatus

作　　者：张豫[1] 刘园园[1] 肖观清[1] 邵咏红[1] 梅长林[2] 孔耀中[1] 

机构地区：[1]广东省佛山市第一人民医院肾内科,528000 [2]上海长征医院肾内科,上海200003

出　　处：《临床肾脏病杂志》2017年第6期345-348,共4页Journal Of Clinical Nephrology

基　　金：2012年广东省科技计划项目[粤科规划字(2012)145号-4];2013年佛山市科技创新专项资金项目(No.2013AG10008)

摘　　要：目的研究国产新型血液灌流器MG150对蛋白结合类毒素晚期糖基化终产物(advanced glycation end products,AGEs)和硫酸吲哚酚(indoxyl sulfate,IS)的清除效果。方法选择上海长征医院和佛山市第一人民医院长期血液透析(hemodialysis,HD)患者共88例,根据南方医科大学统计研究室提供随机化数据表分配,使用二阶段交叉实验对照研究方法,选用广泛使用的健帆HA130灌流器作为对照,A组患者先使用HA130血液灌流(hemoperfusion,HP)+HD串联治疗一次,中间经过洗脱期1周,再使用MG150 HP串联治疗一次;B组患者先使用MG150 HP+HD串联治疗一次,洗脱期后1周再使用HA130 HP+HD串联治疗。分别在2次治疗前后检测血清AGEs和IS浓度,并记录不良事件发生情况,观察比较新型血液灌流器对蛋白结合类毒素的清除效果及安全性。结果 (1)2个医院各入组44例患者;A组(n=44)和B组(n=44)两组患者治疗前除了AGEs[(285.77±107.03)ng/L比(456.89±129.10)ng/L)]和C反应蛋白(C-reactive protein,CRP)[(2.67±2.58)mg/L比(6.38±8.83)mg/L)]差异有统计学意义(P均<0.01),其他基线资料如性别、年龄、体质量、收缩压、舒张压、尿素清除指数(Kt/V)、β_2微球蛋白(β_2-microglobulin,β_2-MG)、IS、血红蛋白(hemoglobin,Hb)、血白蛋白(albumin,Alb)和肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)的比较差异均无统计学意义。(2)MG150和HA130 HP联合HD治疗2 h后血AGEs下降率分别26.0%为4.7%,差异有统计学意义(F=14.323,P<0.01);IS的下降率分别为51.7%和9.6%,差异有统计学意义(F=117.247,P<0.01);β_2-MG下降率分别14.9%、2.7%,差异有统计学意义(F=45.190,P<0.01)。(3)共7例发生轻度不良事件,在2种灌流器治疗过程中发生的概率差异无统计学意义。结论使用国产新型血液灌流器MG150 HP联合HD治疗能够有效清除蛋白结合类毒素,疗效安全确切,值得临床推广应用。Objective To study the effect of the novel hemoperfusion apparatus on removing protein-bound toxins,such as advanced glycation end products（ AGEs） and indoxyl sulfate（ IS）. Methods Eighty-eight patients undergoing maintenance hemodialysis（ HD） from The Foshan First People＇s Hospital and Shanghai Changzhen Hospital were randomly divided into two groups. Patients in group A received HA130（ the commonly used perfusion apparatus） HP ＋ HD,followed by the combined MG150 HP ＋ HD treatment once,and those in group B were first treated with MG150 HP ＋ HD and then received the HA130 HP ＋ HD treatment. The serum AGEs,IS and β_2-microglobulin were detected before and after treatment. The effectiveness and safety of the MG150 apparatus on removing protein-bound toxins were observed. Results Forty-four patients were included in each hospital. There was no signifi-cant difference in sex,age,body weight,blood pressure,Kt/V,serum levels of hemoglobin,albumin,β_2-microglobulin（ β_2-MG）,IS and tumor necrosis factor-α（ TNF-α）,except AGEs（ 285. 77 ±107. 03 vs. 456. 89 ± 129. 10 ng/L,P 0. 01） and C-reactive protein（ CRP）（ 2. 67 ± 2. 58 vs.6. 38 ± 8. 83 mg/L,P 0. 01） between the two groups at the beginning of the treatment. Patients treated with HP ＋ HD had higher levels of AGEs and IS. Meanwhile,patients treated with the combined HP＋ HD with the MG150 apparatus exhibited significantly lower levels of serum AGEs and IS than HA130. There were 7 cases of slight adverse events. Conclusions The novel hemoperfusion apparatus MG150 combined with HD can effectively remove the protein-bound uremic toxins,and it is deserved to be promoted and used clinically.

关 键 词：终末期肾脏疾病 血液灌流 血液透析 晚期糖基化终产物 硫酸吲哚酚 

分 类 号：R692.5[医药卫生—泌尿科学]