血液透析联合血液灌流治疗对清除维持性血液透析患者体内蛋白结合类毒素的长期临床研究  

Long-term clinical study of effects of hemodialysis combined with hemoperfusion on clearance of protein-bound uremic toxins in maintenance hemodialysis patients

作　　者：欧志强 伦立德[2] 李新伦[2] 李检 窦桂芳[3] OU Zhi-qiang LUN Li-de LI Xin-lun LI Jian DOU Gui-fang(Hebei North College, Zhangjiakou, Hebei 075000, China Department of Nephrology, Air Force General Hospital, Beijing 100142, China Pharmacokinetic Laboratory, Institute of Transfusion Medicine, Academy of Military Medical Sciences, Beijing 100850, China)

机构地区：[1]河北北方学院研究生院,河北张家口075000 [2]空军总医院肾病科,北京100142 [3]军事医学科学院野战输血研究所药代动力学实验室,北京100850

出　　处：《军事医学》2017年第7期611-614,共4页Military Medical Sciences

摘　　要：目的观察长期血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)治疗对维持性血液透析(maintenance hemodialysis,MHD)患者体内蛋白结合类毒素(protein-bound uremic toxins,PBUT)水平的影响。方法选取46例MHD患者,分为HD+HP组及HD组。HD+HP组(n=22)采取HD(2次/周)和HD+HP(1次/周)治疗;HD组(n=24)采取HD治疗(3次/周)。随访观察36周,测定试验前、12、24、36周透前PBUT水平。PBUT包括马尿酸(hippuric acid,HA)、硫酸吲哚酚(indoxyl sulphate,IS)、硫酸对甲酚(p-cresyl sulphate,PCS),测定方法为高效液相色谱-串联质谱(high-performance liquid chromatography/tandem mass spectrometry,HPLC-MS/MS)。结果经过36周随访观察,HD+HP组的3种毒素水平在整个研究期间均低于HD组。结束时,HD+HP组HA、IS、PCS分别下降33.5%、12.8%和24.2%,HD组分别上升2.3%、21.8%和2.8%,血清HA、PCS、IS浓度下降HD+HP组大于HD组(P<0.05)。结论长期应用血液透析联合血液灌流能更加有效地清除PBUT,使之维持在较低水平。Objective To observe the effects of long-term hemodialysis（ HD） combined with hemoperfusion（ HP） on the levels of protein-bound uremic toxins（ PBUTs） in maintenance hemodialysis（ MHD） patients. Methods Forty-six patients with MHD were selected and divided into HD ＋ HP group and HD group. HD ＋ HP group（ n = 22） was treated with low-flux HD twice a week and HD combined with HP once a week,while HD group（ n = 24） was treated with low-flux HD three times a week. The follow-up lasted 36 weeks. The pre-dialysis concentration of PBUTs was measured at week 12,24,36 and baseline. PBUTs included hippuric acid（ HA）,indoxyl sulphate（ IS） and p-cresyl sulphate（ PCS）. High performance liquid chromatography-tandem mass spectrometry（ HPLC-MS/MS） was used for determination. Results After36 weeks of follow-up,the concentration of the three toxins in the HD ＋ HP group was lower than that in the HD group during the study. At the end of the study,the reduction rates of HA,IS and PCS were 33. 5%,12. 8% and 24. 2%,respectively,in HD ＋ HP group. The three toxins in HD group increased by 2. 3%,21. 8% and 2. 8%. The clearance rate of HA,PCS and IS in the HP ＋ HD group was higher than in HD group（ P〈0. 05）. Conclusion Long-term HD combined with HP can more effectively remove PBUTs,and keep them at a lower level.

关 键 词：蛋白结合类毒素 血液灌流 血液透析 高效液相色谱-串联质谱 

分 类 号：R692.5[医药卫生—泌尿科学]