尿毒症中大分子毒素及其相关症状血透清除研究进展  

Progress in Hemodialysis Clearance of Macromolecular Toxins and Related Symptoms in Uremia

作　　者：陈露[1] 刘昌华[2] CHEN Lu;LIU Changhua(Department of Nephrology and Blood Purification Center,Jingjiang People's Hospital,Yangzhou University School of Medicine,Jingjiang,Jiangsu Province,214500 China;Department of Nephrology and Blood Purification Center,Subei People's Hospital,Yangzhou University School of Medicine,Yangzhou,Jiangsu Province,225000 China)

机构地区：[1]扬州大学医学院附属靖江市人民医院肾内科、血液净化中心,江苏靖江214500 [2]扬州大学医学院附属苏北人民医院肾内科、血液净化中心,江苏扬州225000

出　　处：《中外医疗》2021年第24期193-198,共6页China & Foreign Medical Treatment

基　　金：扬州市科技计划项目合同(YZ2014197)。

摘　　要：慢性肾脏病肾小球滤过率降低,肾脏不能有效清除血液中的有毒物质,于是在体内蓄积产生毒性作用,这些具有生物活性的有毒化合物为尿毒症毒素。欧洲尿毒症毒素协作组(EUTox)根据尿毒症毒素分子的理化特性和相对分子质量的大小将毒素分为3类:分子水溶性化合物,其分子量为<500 Da的小分子毒素,代表物有尿素氮、肌酐等,容易被普通透析清除;中分子化合物,其分子量>500 Da,代表物有β2-微球蛋白、瘦素、PTH等,仅能被腹膜透析、高通量透析器清除;蛋白质结合化合物,其自身分子量为<500 Da,其主要通过与蛋白结合后,形成大分子复合物,而传统透析难以将相关复合物清除。近年来随着血液净化模式的改进,血液透析技术日益成熟,使得体内代谢废物、毒素、免疫复合物等有效清除,能有效缓解血液透析的各种并发症,有效延长患者的生存期,从而达到治疗尿毒症的目的,对提高患者的生存率具有重要意义。The glomerular filtration rate of chronic kidney disease is reduced,and the kidneys cannot effectively remove toxic substances in the blood,so they accumulate in the body and produce toxic effects.These toxic compounds with biological activity are uremic toxins.The European Uremia Toxin Collaboration Group(EUTox)divides toxins into three categories according to the physical and chemical properties of the uremic toxin molecules and the relative molecular mass:Molecular water-soluble compounds,small molecular toxins with a molecular weight of<500 Da,and representative materials are:Urea nitrogen,creatinine,etc.,are easily removed by ordinary dialysis;Mid-molecular compounds,with a molecular weight of>500 Da,and representative substances such asβ2-microglobulin,leptin,PTH,etc.,can only be removed by peritoneal dialysis and high-flux dialyzers;Protein-binding compounds,which have a molecular weight of<500 Da,mainly form macromolecular complexes after binding to proteins,which are difficult to remove by traditional dialysis.In recent years,with the improvement of blood purification mode,hemodialysis technology has become more and more mature,which can effectively remove metabolic wastes,toxins,immune complexes,etc.,can effectively alleviate various complications of hemodialysis,and effectively extend the survival period of patients,so as to achieve the purpose of treating uremia,which is of great significance to improving the survival rate of patients.

关 键 词：尿毒症 毒素 血液透析 

分 类 号：R692[医药卫生—泌尿科学]