腹膜透析患者血清蛋白结合毒素水平及影响因素分析  

Analysis of serum protein-bound toxins levels in patients undergoing peritoneal dialysis and its influencing factors

作　　者：阮梦娜 陈旭娇[1] 陈思秀[1] 杨博[1] 许晶[1] 张彤[1] 邢小红[1] 毛志国[1] RUAN Meng-na;CHEN Xu-jiao;CHEN Si-xiu;YANG Bo;XU Jing;ZHANG Tong;XING Xiao-hong;MAO Zhi-guo(Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China)

机构地区：[1]第二军医大学长征医院肾内科,上海200003

出　　处：《第二军医大学学报》2017年第10期1238-1243,共6页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81570621)~~

摘　　要：目的比较腹膜透析(PD)患者与健康人群血清蛋白结合毒素(PBT)代表物质硫酸吲哚酚(IS)和硫酸对甲酚(PCS)水平的差异,并探讨影响IS及PCS水平的因素。方法纳入2015年2月至7月第二军医大学长征医院腹透中心符合入选标准的72例PD患者及同期体检中心的24例健康志愿者,采集空腹静脉血3mL。采用高效液相色谱-电喷雾电离串联质谱法(HPLC-ESI-MS/MS)检测血清中总IS、PCS以及游离IS、PCS浓度,采用简单线性相关及多元线性回归方法分析IS、PCS与年龄、性别、小分子毒素、腹透充分性、残余肾功能、营养及C-反应蛋白(CRP)等因素的相关性。结果 PD患者血清总IS及总PCS浓度高于健康志愿者(P<0.001)。无残肾功能PD患者血清总IS浓度高于有残肾功能者(P=0.001)。血清总IS与血清游离IS(r=0.719,P<0.01)、透析龄(r=0.306,P<0.01)呈正相关,与残肾尿素清除指数(Kt/V;r=-0.372,P<0.01)、残肾肌酐清除率(Ccr;r=-0.515,P<0.01)、残肾肾小球滤过率估计值(eGFR;r=-0.495,P<0.01)呈负相关。血清游离IS与残肾Ccr(r=-0.430,P<0.01)、残肾eGFR(r=-0.431,P<0.01)负相关。血清总IS和游离IS均与年龄、血红蛋白、CRP无明显相关性。结论 PD患者血清IS水平与患者残肾功能呈负相关,与年龄、性别和CRP无明显相关性,提示保护残肾功能有利于PD患者清除血清中的IS。ObjectiveTo compare the levels of indoxyl sulfate(IS)and p cresyl sulfate(PCS),representative substances of serum protein bound toxins,between patients undergoing peritoneal dialysis(PD)and healthy volunteers,and to explore the factors influencing the levels of serum IS and PCS.MethodsLimosis vein blood(3mL)were collected from72PD patients in Peritoneal Dialysis Center and24healthy voluteers in Physical Examination in Changzheng Hospital of Second Military Medical University from Feb.2015to Jul.2015.The concentrations of serum total IS,total PCS,free IS and free PCS were detected by high performance liquid chromatography electrospray ionization tandem mass spectrometry(HPLC ESI MS/MS)method.The relationship between IS,PCS and age,gender,small molecule toxins,adequacy of PD,residual renal function,nutritional status and C reaction protein(CRP)in PD patients were analyzed by simple correlation and multivariable linear regression analysis.ResultsThe concentrations of serum total IS and total PCS in PD patients were significantly lower than those in healthy volunteers(P<0.001).Compared with PD patients without residual renal function(RRF),the concentration of serum total IS was significantly lower in PD patients with RRF(P=0.001).Serum total IS was positively correlated with free IS(r=0.719,P<0.01)and dialysis duration(r=0.306,P<0.01),while it was negatively correlated with residual renal Kt/V(r=-0.372,P<0.01),residual renal creatinine clearance rate(Ccr)(r=-0.515,P<0.01),and residual renal estimated glomerular filtration rate(eGFR)(r=-0.495,P<0.01).Serum free IS was negatively correlated with residual renal Ccr(r=-0.430,P<0.01)and residual renal eGFR(r=-0.431,P<0.01).Serum total IS and free IS were not related to age,hemoglobin or CRP.ConclusionSerum IS level is negatively correlated with RRF,but not with age,hemoglobin or CRP,suggesting that protection of RRF is conducive to the removal of serum IS in patients undergoing PD.

关 键 词：蛋白结合毒素 硫酸吲哚酚 硫酸对甲酚 腹膜透析 影响因素 

分 类 号：R459.51[医药卫生—治疗学]