發(fā)布時間：2018-03-17 06:21

  本文選題：蛋白結(jié)合類毒素　切入點：中大分子毒素　出處：《河北北方學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：蛋白結(jié)合類毒素(Protein-bound uremic toxins,PBUTs)因其與白蛋白結(jié)合以及多室分布的特點難以被常規(guī)血液透析清除,血液透析(Hemodialysis,HD)聯(lián)合血液灌流(Hemoperfusion,HP)治療較常規(guī)血液透析增加對PBUTs的清除,但PBUTs在體內(nèi)分布容積遠(yuǎn)大于血漿室容積,長期HD+HP治療能否將PBUTs維持在較低水平尚未可知,因此本研究旨在探討長期應(yīng)用HD+HP治療對PBUTs的清除效果,同時觀察對生活質(zhì)量的影響。本研究選取46例維持性血液透析(Maintenance hemodialysis,MHD)患者,分為HD+HP組及HD組。HD+HP組(n=22例)采取HD(2次/周)和HD+HP(1次/周)治療;HD組(n=24例)采取HD治療(3次/周),隨訪觀察36周。測定試驗前、12、24、36周透前PBUTs、β2-MG,同時監(jiān)測治療前、后臨床指標(biāo),并行KDQOL-SF1.3量表評估生活質(zhì)量。PBUTs包括馬尿酸(hippuric acid,HA)、硫酸吲哚酚(indoxyl sulfate,IS)、硫酸對甲酚(p-cresyl sulphate,PCS),測定方法為高效液相色譜-串聯(lián)質(zhì)譜方法(High-performance liquid chromatography/tandem mass spectrometry,HPLC-MS/MS)。臨床指標(biāo)包括血清鈣、血清磷、全段甲狀旁腺激素、血紅蛋白、血清白蛋白、血清鐵蛋白、血清轉(zhuǎn)鐵蛋白飽和度、透析充分性(Kt/V)。經(jīng)36周治療后,1.HD組和HD+HP組各臨床指標(biāo)與治療前相比差異均無統(tǒng)計學(xué)意義(P0.05),治療后兩組間比較差異均無統(tǒng)計學(xué)意義(P0.05);2.HD+HP組血清β2-MG水平在整個研究期間均低于HD組。結(jié)束時,HD+HP組下降約15.6%,顯著低于治療前(P0.01);HD組下降約1.2%,治療前、后差異無統(tǒng)計學(xué)意義(P0.05);HD+HP組血清β2-MG下降大于HD組(P0.05);3.HD+HP組的PBUTs在整個研究期間均低于HD組。結(jié)束時,HD+HP組HA、IS、PCS分別下降33.5%、12.8%、24.2%。HD組分別上升2.3%、21.8%、2.8%。血清HA、PCS、IS濃度下降HD+HP組大于HD組(P0.05)。4.HD組生活質(zhì)量評分(軀體疼痛、精力)較治療前明顯降低(P0.05),HD+HP組生活質(zhì)量評分(癥狀與不適、腎病影響、精力)較治療前明顯改善(P0.05)。HD+HP組治療后生活質(zhì)量評分(腎病影響、認(rèn)知功能、睡眠質(zhì)量、生理機(jī)能、軀體疼痛、總體健康、社會功能、精力)明顯高于HD組(P0.05)。綜上所述,長期應(yīng)用血液透析聯(lián)合血液灌流(1次/周)治療對中大分子及蛋白結(jié)合類毒素的清除優(yōu)于常規(guī)血液透析,同時顯著改善MHD患者生活質(zhì)量。
[Abstract]:Protein-bound uremic toxin (PBUTs) is difficult to be cleared by routine hemodialysis because of its characteristics of binding to albumin and multicompartment distribution. Hemodialysis combined with hemoperfusion is more effective than routine hemodialysis in the treatment of PBUTs. However, the volume distribution of PBUTs in vivo is much larger than that of plasma ventricular volume. It is not known whether long-term HD HP treatment can maintain PBUTs at a lower level. Therefore, the purpose of this study was to investigate the effect of long-term HD HP therapy on PBUTs clearance. In this study, 46 patients with maintenance hemodialysis and maintenance hemodialysis (MHD) were studied. The patients were divided into HD HP group and HD HP group (n = 22) received HD(2 times / week) and HD HP(1 group (n = 24) were treated with HD three times a week, followed up for 36 weeks. The quality of life. PBUTs including hippuric acid, indoxyl sulfate sulfate, p-cresyl sulphate were evaluated by high performance liquid chromatography/tandem mass spectrometric HPLC-MS-MSP. The clinical parameters included serum calcium, serum phosphorus, and P-cresyl sulphate. Whole parathyroid hormone, hemoglobin, serum albumin, serum ferritin, serum transferrin saturation, After 36 weeks of treatment, there was no significant difference in the clinical indexes of HD group and HD HP group compared with that before treatment. There was no significant difference in serum 尾 2-MG level between the two groups after treatment. 2. The serum 尾 2-MG level in HD HP group was not significantly different from that in HD HP group during the whole study period. At the end of treatment, the decrease of HP group was about 15.6g, which was significantly lower than that of P0.01U HD group before treatment, about 1.2%, before treatment, and before treatment, there was no significant difference between HD group and HD group. There was no significant difference in serum 尾 2-MG between HD HP group and HD HP group. The PBUTs of HD group was lower than that of HD group during the whole study period. Quality of life score (body pain) in HD group (P 0.05). Energy) significantly decreased the scores of quality of life (symptoms and discomfort, the influence of nephropathy, energy) before and after treatment. The scores of quality of life (influence of nephropathy, cognitive function, sleep quality, physiological function) were significantly improved after treatment. Somatic pain, overall health, social function and energy) were significantly higher than those in HD group (P 0.05). In conclusion, long-term hemodialysis combined with hemoperfusion once a week was superior to routine hemodialysis in the clearance of medium and large molecules and protein-binding toxoid. At the same time, the quality of life of MHD patients was improved significantly.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5

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