Kt与胱抑素C清除率在高通量血液透析中的相关性及临床应用  

The correlation and clinical application of Kt and cystatin C clearance rate in high-flux hemodialysis

作　　者：丁宁[1] 郑洁[1] 赵慧颖[1] 张国娟[1] DING Ning;ZHENG Jie;ZHAO Hui-ying;ZHANG Guo-juan(Department of Nephrology,Beijing TongRen Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院肾内科,北京100730

出　　处：《中国血液净化》2021年第9期586-590,共5页Chinese Journal of Blood Purification

摘　　要：目的分析Kt与胱抑素C清除率的相关性,证实Kt在评估中分子透析充分性上的优势。方法选取在首都医科大学附属北京同仁医院肾内科血液净化中心行高通量维持性血液透析的患者资料。根据体表面积(body surface area,BSA)计算目标透析剂量Kt[1/(0.0237/BSA+0.006)]。根据Kt/V计算实际Kt值;对透析前胱抑素C水平、胱抑素C清除率(cystatin C reduction ratio,CCRR)进行单因素分析;对CCRR进行多元线性回归分析;根据Kt及Kt/V达标情况进行分组研究。采用SPSS 22.0软件进行统计学分析。结果本研究共纳入患者56例,其中男31例,女25例。透析前胱抑素C水平不受透析患者一般资料影响;与Kt/V和Kt均达标患者相比,在Kt/V达标而Kt不达标组,CCRR更低(t=3.394,P=0.001),甲状旁腺激素水平更高(Z=-2.621,P=0.008)。单因素分析中CCRR的影响因素较多,但经多因素分析后仅Kt差值(实际Kt值-目标Kt值)与CCRR线性相关(β=0.797,P=0.014)。结论胱抑素C可用于评估透析患者中分子毒素水平;Kt可用于评估高通量血液透析患者中分子毒素清除水平,弥补Kt/V在评估充分性方面的不足。Objective To analyze the association between Kt and the clearance of medium molecular toxin in uremia.Methods We collected the data of high-flux maintenance hemodialysis patients in the dialysis center of Tong Ren Hospital.The target Kt was calculated by the formula:target Kt=1/[0.0069+(0.0237/BSA)].Calculate the actual Kt according to Kt/V;Univariate analysis was performed for prEdialysis cystatin C level and cystatin C reduction ratio(CCRR).The CCRR was analyzed by multiple linear regression.The analysis was performed by SPSS(Version 22.0).Results Among 56 patients,31 were males and 25 were females.The prEdialysis cystatin C was not affected by the characteristics of dialysis patients.Compared with the patients who meet both the target of Kt/V and Kt,the patients who only meet the target of Kt/V had lower CCRR(t=3.394,P=0.001)and higher parathyroid hormone(Z=-2.621,P=0.008).In univariate analysis,there were many factors correlated with CCRR,but after multiple regression analysis,only Kt difference(the actual Kt value-the target Kt value)had a linear correlation with CCRR(β=0.797,P=0.014).Conclusion Cystatin C can be used to evaluate the level of medium molecular toxin in dialysis patients.Kt can be used to evaluate the medium molecular clearance in high-flux hemodialysis patients,to make up the restrictions of Kt/V in accessing adequacy.

关 键 词：尿素清除体积 胱抑素C 高通量血液透析 

分 类 号：R459.5[医药卫生—治疗学]