本文選題：血液透析 + 營養(yǎng)不良��； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景 終末期腎臟病(end-stage renal disease, ESRD)的流行病學(xué)研究(美國腎臟病數(shù)據(jù)庫系統(tǒng)及歐洲等資料)顯示全球ESRD人數(shù)仍在持續(xù)增加,每年新增的人數(shù)超過了人口的年增長(zhǎng)率。維持性血液透析是ESRD的一種常規(guī)治療,也是目前應(yīng)用最多的腎臟替代治療,至今已有50余年的歷史。 由于腎臟功能的衰竭,大量的毒素蓄積在體內(nèi)難以清除。在中國,鑒于目前的國情,絕大部分ESRD患者選擇了血液透析治療。血液透析將血液引出體外后,借助透析膜分隔血液和透析液,主要通過擴(kuò)散、對(duì)流、超濾三種方式達(dá)到部分替代正常腎臟排泄水分、代謝廢物、調(diào)節(jié)水電解質(zhì)平衡、糾正酸中毒等功能。一般血液透析治療僅能替代正常腎臟功能的十分之一左右。血液透析是一種體外的血液凈化手段,維持性血液透析患者(maintenance hemodialysis patients, MHD)經(jīng)常接觸到體外循環(huán)系統(tǒng)如穿刺針、透析器、透析管路等。另外,一般每周2-4次往返醫(yī)院進(jìn)行血液透析、源源不斷的經(jīng)濟(jì)支出以及接踵而至的各種并發(fā)癥等,種種因素導(dǎo)致絕大部分MHD面臨病痛、經(jīng)濟(jì)、精神等多重負(fù)擔(dān)。隨著透析時(shí)間的延長(zhǎng),往往頻發(fā)營養(yǎng)不良、免疫紊亂、心血管疾病、不寧腿綜合征(restless legs syndrome、抑郁、焦慮、睡眠障礙、鈣磷代謝紊亂、貧血等。 營養(yǎng)不良和免疫失調(diào)是MHD的顯著特征。目前已有大量的數(shù)據(jù)表明營養(yǎng)不良是透析病人死亡的最大原因之一。營養(yǎng)不良可導(dǎo)致血液透析患者的免疫功能和體力活動(dòng)功能下降,與各種感染和非感染的并發(fā)癥相關(guān),是尿毒癥死亡率升高的獨(dú)立危險(xiǎn)因素。另外,尿毒癥患者固有免疫和適應(yīng)性免疫功能雙重受損,這種免疫系統(tǒng)的改變與高發(fā)的心血管疾病和死亡率與有關(guān)。炎癥-免疫紊亂也是導(dǎo)致尿毒癥患者發(fā)生心血管疾病的重要機(jī)制之一,免疫活化可導(dǎo)致微炎癥狀態(tài),引起冠狀動(dòng)脈粥樣硬化和心血管事件的發(fā)生。目前認(rèn)為免疫紊亂也是導(dǎo)致MHD其他多種并發(fā)癥的重要原因。因此研究并干預(yù)MHD的營養(yǎng)狀態(tài)和免疫功能對(duì)降低感染和心血管事件發(fā)生率,改善MHD的預(yù)后有重要的科研和臨床意義。 免疫功能障礙是導(dǎo)致血液透析患者感染和腫瘤高發(fā)的主要原因。色氨酸(Tryptophan,Trp)是人體的一種必需氨基酸,參與蛋白質(zhì)的合成及多種組織代謝,犬尿氨酸(kynurenine,Kyn)是Trp的代謝終產(chǎn)物,吲哚胺2,3-雙加氧酶(indloeamine-2,3-dioxygenase,IDO)是Trp代謝為Kyn的關(guān)鍵酶,IDO可通過抑制T細(xì)胞的增值來誘導(dǎo)免疫耐受。免疫耐受是尿毒癥患者免疫紊亂的重要機(jī)制,樹突狀細(xì)胞群可通過誘導(dǎo)調(diào)節(jié)性T細(xì)胞介導(dǎo)免疫耐受。目前認(rèn)為,表達(dá)IDO的樹突狀細(xì)胞是發(fā)揮免疫耐受作用的關(guān)鍵分子,使用IDO抑制劑能快速誘導(dǎo)T細(xì)胞介導(dǎo)的排斥反應(yīng),因此IDO被認(rèn)為是調(diào)控免疫平衡的重要機(jī)制。既往研究也發(fā)現(xiàn)Trp及其代謝產(chǎn)物Kyn參與免疫調(diào)控,尿毒癥患者Trp/Kyn的水平與低免疫反應(yīng)及心血管疾病相關(guān),但目前MHD的IDO的水平及引起免疫紊亂的機(jī)制尚未完全清楚。 定量分析MHD血漿中Trp和Kyn可為了解MHD的營養(yǎng)狀態(tài)及免疫功能提供理論依據(jù),具有一定的科研和臨床意義。高壓液相色譜法(High Performance Liquid Chromatography,HPLC)是目前常見的用以檢測(cè)血漿中Trp和Kyn的方法,當(dāng)檢測(cè)樣品流經(jīng)色譜柱時(shí),檢測(cè)樣品中各組分因吸附力大小不同而分離,當(dāng)通過檢測(cè)器時(shí),可得到相應(yīng)的信號(hào)-時(shí)間曲線,從而定量各種組分。既往有研究者使用HPLC檢測(cè)了慢性腎功能不全患者血漿中的Trp和Kyn,但我們?cè)诮梃b該方法檢測(cè)MHD血漿中這兩種氨基酸時(shí),可能因MHD血漿中尿毒癥毒素多,彼此干擾大、難以分離。為了簡(jiǎn)化操作流程,在同一色譜條件下同時(shí)檢測(cè)到MHD血漿中的Trp和Kyn,本研究對(duì)此進(jìn)行了探討。 研究目的 1、評(píng)估2012年12月在廣東省人民醫(yī)院血液凈化中心行維持性血液透析的患者的營養(yǎng)狀態(tài),了解營養(yǎng)不良的發(fā)生率,分析營養(yǎng)不良的相關(guān)影響因素； 2、改良HPLC同時(shí)定量分析MHD血漿中的Kyn和Trp,為評(píng)估透析患者的營養(yǎng)狀態(tài)、免疫功能,了解IDO的活性提供一定的理論依據(jù)。 研究方法 本研究主要采用橫斷面分析的研究方法,通過問卷調(diào)查、臨床身體指標(biāo)測(cè)量、各種實(shí)驗(yàn)室指標(biāo)、透析數(shù)據(jù)的收集等方法搜集資料以了解MHD營養(yǎng)不良的現(xiàn)狀,基本入組標(biāo)準(zhǔn)為：1)同意參與本項(xiàng)調(diào)查并簽署知情同意書,2)維持性血液透析時(shí)間≥3個(gè)月,3)能清楚自主表達(dá)自己的意愿；采用HPLC方法檢測(cè)MHD血漿中的Trp和Kyn。 關(guān)于MHD營養(yǎng)狀態(tài)的評(píng)估,本研究不僅關(guān)注了傳統(tǒng)的血漿白蛋白及營養(yǎng)不良相關(guān)的主觀評(píng)估,同時(shí)聯(lián)合了目前國際上常用的營養(yǎng)不良-炎癥評(píng)分(Malnutrition-Inflammation Score,MIS)及透析營養(yǎng)的客觀評(píng)分表(Objective Score of Nutrition on Dialysis,OSND)。其中MIS評(píng)估內(nèi)容涉及到MHD過去3到6個(gè)月干體重的變化、飲食攝入、胃腸道癥狀、營養(yǎng)相關(guān)的功能障礙、透析合并癥、透析時(shí)間、脂肪儲(chǔ)備實(shí)測(cè)值、肌肉消耗、身高體重指數(shù)(Body Mass Index,BMI)、血漿白蛋白、總鐵結(jié)合力、轉(zhuǎn)鐵蛋白；OSND的評(píng)估包括過去3到6個(gè)月干體重的變化、BMI、三頭肌皮褶厚度、上臂中圍周徑、轉(zhuǎn)鐵蛋白、血清白蛋白、膽固醇等。這兩個(gè)量表的各項(xiàng)指標(biāo)根據(jù)不同的等級(jí)劃分不同的分?jǐn)?shù),匯總后得到最終的評(píng)估結(jié)果,其中MIS的評(píng)分標(biāo)準(zhǔn)為：8分,輕度營養(yǎng)不良；9-18分,中度營養(yǎng)不良；18分,重度營養(yǎng)不良,MIS正常值為0分,最高30分。OSND的評(píng)分標(biāo)準(zhǔn)為：28-32分為正常,23-27分中度營養(yǎng)不良,≤22分重度營養(yǎng)不良,OSND正常值為5分,最高32分。調(diào)查表由研究者在MHD透析期間進(jìn)行臨床問詢并記錄結(jié)果,其中皮褶厚度、肌肉儲(chǔ)備、中臂圍周徑等臨床測(cè)量也在透析期間進(jìn)行。所有測(cè)量使用同一個(gè)皮褶厚度測(cè)量?jī)x和同一個(gè)標(biāo)尺,每次測(cè)量前校正,每個(gè)指標(biāo)測(cè)量3次,取平均值,對(duì)測(cè)量數(shù)據(jù)進(jìn)行記錄。同期收集入組患者的基本資料、實(shí)驗(yàn)室、透析數(shù)據(jù)及問卷調(diào)查內(nèi)容,如年齡、基礎(chǔ)病、維持性血液透析的時(shí)間、殘余尿量、血紅蛋白、血清鐵、甲狀旁腺素、透析器的通透性、血流量、透析模式等。各評(píng)估量表身體指數(shù)的測(cè)量、診斷及嚴(yán)重程度評(píng)估、實(shí)驗(yàn)室資料的錄入由同一名研究者負(fù)責(zé),匯總相關(guān)數(shù)據(jù)后進(jìn)行統(tǒng)計(jì)分析。 既往研究者使用HPLC檢測(cè)了慢性腎功能不全患者血漿中的Trp和Kyn,本研究在借鑒該方法用于檢測(cè)MHD血漿中的Trp和Kyn時(shí),發(fā)現(xiàn)在色譜圖上,Trp和Kyn峰與周圍色譜峰融合,譜帶拖尾,無法分離,難以定量分析。本研究通過調(diào)整HPLC的2個(gè)關(guān)鍵因素,色譜柱和流動(dòng)相,擬摸索到一個(gè)比較合適的檢測(cè)窗。采用的色譜柱為Sinochrom ODS-BP C18柱(4.6mm x150mm,id,4.5μm),流動(dòng)相15mmol/L乙酸鈉-乙酸(含5%乙腈,PH4.8),流動(dòng)相流速1.0mL/min,紫外檢測(cè)波長(zhǎng)225mm。取MHD上機(jī)前全血3-4ml,置于4mlEDTA管內(nèi),采血后1小時(shí)內(nèi)于常溫下以2500r/min的速率,離心5分鐘分離血漿,血漿經(jīng)5%高氯酸溶液去除蛋白質(zhì)后沉淀,取上清液20μ l直接進(jìn)樣分析測(cè)定。 統(tǒng)計(jì)學(xué)分析 對(duì)符合正態(tài)分布的數(shù)據(jù)用x±S表示,不符合正態(tài)分布的數(shù)據(jù)用中位數(shù)表示,采用logistic回歸分析方法進(jìn)行相關(guān)因素分析,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義,應(yīng)用SPSS17.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。 研究結(jié)果 1、2012年12月廣東省人民醫(yī)院血液凈化中心MHD營養(yǎng)狀況及相關(guān)影響因素： 1)共217名MHD符合入選要求納入本項(xiàng)調(diào)查,MIS評(píng)分為9±2分,其中輕度營養(yǎng)不良81人,中度營養(yǎng)不良135人,重度營養(yǎng)不良1人； 2) OSND評(píng)分為12±3分,均為重度營養(yǎng)不良； 3)84.4%患者血漿白蛋白未達(dá)標(biāo),30.4%患者BMI低于正常值,三頭肌皮褶厚度14.5±7.0mm,中臂圍24.6±3.5cm,42.9%的患者存在飲食攝入障礙,37.1%的患者有胃腸道功能不適,25%的患者存在營養(yǎng)相關(guān)的損傷。 4)MIS與透析時(shí)間、性別、Kt/V. Hb相關(guān)；CRP與白蛋白、血尿酸、MIS、 OSND相關(guān)。 2、在既往研究的基礎(chǔ)上,通過調(diào)整色譜柱的填料和孔徑、流動(dòng)相的條件,改變了Trp和Kyn的解離度和峰保留時(shí)間,得到一個(gè)比較合適的檢測(cè)窗。將原方法色譜柱SymmetryaShieldRP-18column(150mmX3.9mm,id)換成色譜柱為Sinochrom ODS-BP C18柱(4.6mmX150mm,id,4.5μm);加大了流動(dòng)相的酸堿度和乙腈的含量,最終流動(dòng)相為15mmol/L乙酸鈉-乙酸(含5%乙腈,PH4.8),流速1.0mL/min,紫外檢測(cè)波長(zhǎng)225mm,血漿標(biāo)本經(jīng)5%高氯酸溶液去除蛋白質(zhì)后取上清液20μl直接進(jìn)樣分析測(cè)定。Kyn的保留時(shí)間為6.766min,線性范圍為0.08-50μmol/L,最低檢測(cè)濃度0.02μmol/L, Trp的保留時(shí)間為13.072min,線性范圍為0.8-500μmol/L,最低檢測(cè)濃度為0.2μmol/L, Kyn和Trp日內(nèi)、日間測(cè)定的相對(duì)標(biāo)準(zhǔn)偏差均小于4%。 結(jié)論 1、營養(yǎng)不良是尿毒癥患者預(yù)后的獨(dú)立危險(xiǎn)因素,MIS更適合中國人,營養(yǎng)不良在維持性血液患者普遍存在,需要定期評(píng)估,綜合管理,及時(shí)干預(yù)； 2、血漿中Kyn和Trp與MHD的營養(yǎng)狀態(tài)及免疫功能均相關(guān),而營養(yǎng)不良可導(dǎo)致免疫紊亂,本研究采用HPLC的方法,在借鑒既往研究的基礎(chǔ)上,通過調(diào)整色譜柱的直徑、流動(dòng)相的PH值等方法,成功地在同一條件下同時(shí)檢測(cè)到了MHD血漿內(nèi)的Kyn和Trp的含量,該方法簡(jiǎn)便、快速、穩(wěn)定,可應(yīng)用于臨床和科研工作。
[Abstract]:Research background
The epidemiological study of end-stage renal disease (ESRD) (data from the American kidney disease database system and Europe) shows that the number of ESRD in the world is still increasing, and the annual increase of the number of people is more than the annual growth rate of the population. Maintenance hemodialysis is a routine treatment of ESRD and is the most used renal replacement. It has been over 50 years in the history of treatment.
Due to renal failure, a large number of toxins are hard to be removed in the body. In China, in view of the current national conditions, most ESRD patients have chosen hemodialysis treatment. After hemodialysis, the blood is extracted from the body, and the hemodialysis membrane is used to separate the blood and dialysate with the aid of the dialysis membrane, which can be partially replaced by three ways of spreading, convection and ultrafiltration. The kidney Excrets water, metabolize waste, regulates the balance of water and electrolyte, and corrects the function of acidosis. General hemodialysis can only replace about 1/10 of normal kidney function. Hemodialysis is an in vitro blood purification method, and maintenance hemodialysis patients (maintenance hemodialysis patients, MHD) often come into contact with the body. The ring system such as puncture needle, dialyzer, dialysis pipeline, etc., in addition, 2-4 times a week to and from the hospital to carry out hemodialysis, the continuous economic expenditure and the following complications, a variety of factors lead to the overwhelming majority of MHD face the pain, economic, mental and multiple burdens. With the extension of dialysis time, often frequent malnutrition, Immune disorders, cardiovascular diseases, restless legs syndrome (restless legs syndrome), depression, anxiety, sleep disorders, calcium and phosphorus metabolism disorders, anemia and so on.
Malnutrition and immune disorders are the prominent features of MHD. There is a large number of data showing that malnutrition is one of the biggest causes of death in dialysis patients. Malnutrition can lead to a decline in immune function and physical activity in hemodialysis patients, associated with various infections and non infectious complications, and is the only increase in the mortality of uremia. In addition, the inherent immunity and adaptive immune function of uremia patients are double damaged, and the changes of this immune system are associated with high incidence of cardiovascular disease and mortality. Inflammation - immune disorders are also one of the important mechanisms of cardiovascular disease in patients with uremia. Immune activation can lead to the state of micro inflammation and cause the crown. The occurrence of atherosclerosis and cardiovascular events is considered as an important cause of many other complications of MHD. Therefore, the study and intervention of the nutritional status and immune function of MHD have important scientific and clinical significance in reducing the incidence of infection and cardiovascular events and improving the prognosis of MHD.
Immune dysfunction is the main cause of high incidence of infection and tumor in hemodialysis patients. Tryptophan (Trp) is an essential amino acid in the human body. It is involved in the synthesis of protein and the metabolism of various tissues. Kynurenine (Kyn) is the metabolic end product of Trp, and the indolamine 2,3- dioxygenase (indloeamine-2,3-dioxygenase, IDO) It is the key enzyme of Trp metabolism as Kyn. IDO can induce immune tolerance by inhibiting the increment of T cells. Immune tolerance is an important mechanism of immune disorder in patients with uremia. Dendritic cells can mediate immune tolerance by inducing regulatory T cells. At present, the dendritic cells expressing IDO are the key molecules of immune tolerance. IDO inhibitors can quickly induce T cell mediated rejection, so IDO is considered an important mechanism for regulating immune balance. Previous studies have also found that Trp and its metabolite Kyn are involved in immunoregulation. The level of Trp/Kyn in uremia patients is associated with low immune responses and cardiovascular disease, but the level of IDO in MHD and the cause of immune disorder at present. The disorderly mechanism is not completely clear.
The quantitative analysis of Trp and Kyn in MHD plasma can provide a theoretical basis for understanding the nutritional status and immune function of MHD. It has certain scientific and clinical significance. High pressure liquid chromatography (High Performance Liquid Chromatography, HPLC) is a common method for detecting Trp and Kyn in plasma. Each component in the sample is separated because of the different size of the adsorption force. When the detector is used, the corresponding signal time curve can be obtained to quantify various components. Previous researchers used HPLC to detect Trp and Kyn in the plasma of patients with chronic renal insufficiency, but we may use this method to detect the two kinds of amino acids in MHD plasma. In order to simplify the operation process, the Trp and Kyn in the plasma of MHD are simultaneously detected in the same chromatographic condition. This study has been discussed in this study, in order to simplify the operation process, the MHD plasma has many uremic toxins.
research objective
1, to evaluate the nutritional status of patients with maintenance hemodialysis in the blood purification center of Guangdong General Hospital in December 2012, to understand the incidence of malnutrition and to analyze the related factors of malnutrition.
2, the quantitative analysis of Kyn and Trp in MHD plasma by modified HPLC provides a theoretical basis for assessing the nutritional status, immune function and understanding of the activity of IDO in dialysis patients.
research method
This study mainly adopts the method of cross-sectional analysis. Through questionnaire survey, clinical physical indicators measurement, various laboratory indicators, dialysis data collection and other methods to collect data to understand the status of MHD malnutrition, the basic entry standard is: 1) consent to participate in this regulation and sign informed consent, 2) maintenance hemodialysis time. More than 3 months, 3) can clearly express their wishes; HPLC method was used to detect Trp and Kyn. in MHD plasma.
With regard to the assessment of the nutritional status of MHD, this study not only focused on the subjective assessment of the traditional plasma albumin and malnutrition, but also combined the current international common malnutrition score (Malnutrition-Inflammation Score, MIS) and the objective assessment of dialysate (Objective Score of Nutrition on Dialysis, OSND). The MIS assessment involves the changes in dry weight of MHD over the past 3 to 6 months, dietary intake, gastrointestinal symptoms, nutritional related dysfunction, dialysis complication, dialysis time, the measured value of fat reserve, muscle consumption, Body Mass Index, BMI, plasma albumin, total iron binding force, transferrin, and OSND assessment included The changes in body weight for 3 to 6 months, BMI, skin fold thickness of triceps, circumference of the upper arm, transferrin, serum albumin, cholesterol and so on. The indexes of the two scales were divided according to different grades, and the final evaluation results were collected, in which the scoring criteria for MIS were: 8, mild malnutrition; 9-18 points. Dystrophy, 18 points, severe dystrophy, MIS normal value of 0 points, and the highest score of 30.OSND, were normal, 23-27 moderate dystrophy, less than 22 points severe dystrophy, OSND normal value 5, and the highest 32. The questionnaire was conducted by the researchers during the MHD dialysis period and recorded the results, of which the skin fold thickness, Clinical measurements such as the muscle reserve and the circumference of the middle arm were also carried out during the dialysis. All measurements were made with the same skin fold thickness measuring instrument and the same scale, corrected before each measurement. Each measure was measured 3 times, the average value was taken, and the measured data were recorded. The basic data, laboratory, dialysis data and questionnaire survey were collected during the same period. Content, such as age, basic disease, time of maintenance hemodialysis, residual urine volume, hemoglobin, serum iron, parathyroid hormone, permeability of dialysator, blood flow, dialysis mode, etc.. Measurement of body index, diagnosis and severity assessment of each assessment scale. The entry of laboratory data is responsible for the same researcher. Statistical analysis.
Previous researchers used HPLC to detect Trp and Kyn in plasma of patients with chronic renal insufficiency. This study was used for reference to the detection of Trp and Kyn in MHD plasma. It was found that on the chromatogram, the peaks of Trp and Kyn were fused with the peaks of the surrounding chromatograph, and the band trailing, unable to be separated, was difficult to quantify. This study by adjusting 2 key factors of HPLC, The chromatographic column and the mobile phase are used to find a suitable detection window. The chromatographic column used is Sinochrom ODS-BP C18 column (4.6mm x150mm, ID, 4.5 u m), the mobile phase 15mmol/L acetate acetic acid (5% acetonitrile, PH4.8), the flow phase velocity 1.0mL/min, and the UV detection wavelength 225mm. take the whole blood before the MHD, and 1 hours after the blood collection. At the rate of 2500r/min at normal temperature, plasma was separated by centrifugation for 5 minutes. The plasma was precipitated after 5% perchloric acid solution was removed, and the supernatant was obtained by direct injection of 20 mu L.
Statistical analysis
The data that conform to the normal distribution are expressed in X + S, the data that do not conform to the normal distribution are expressed in the median, and the correlation factors are analyzed by the logistic regression analysis method. The difference is statistically significant by P0.05, and the data are statistically analyzed with the SPSS17.0 software.
Research results
Nutritional status and related factors of MHD in the blood purification center of Guangdong General Hospital in December 12012:
1) a total of 217 MHD were included in the survey. The MIS score was 9 + 2, of which 81 were mild dystrophy, 135 were moderate dystrophy and 1 were severe dystrophy.
2) the OSND score was 12 + 3, all of which were severe malnutrition.
3) in 84.4% patients, plasma albumin did not reach the standard, 30.4% patients were lower than normal BMI, triceps skin fold thickness 14.5 + 7.0mm, middle arm circumference 24.6 + 3.5cm, 42.9% of patients with dietary intake disorders, 37.1% of the patients with gastrointestinal dysfunction, 25% of the patients with nutritional related damage.
4) MIS was correlated with dialysis time, gender and Kt/V. Hb; CRP was associated with albumin, serum uric acid, MIS and OSND.
2, on the basis of previous studies, by adjusting the packing and pore size of the column and the conditions of the mobile phase, the dissolution and peak retention time of Trp and Kyn were changed, and a suitable detection window was obtained. The original method of chromatographic column SymmetryaShieldRP-18column (150mmX3.9mm, ID) was replaced by a Sinochrom ODS-BP C18 column (4.6mmX150mm, ID, 4.5). The acidity and alkalinity of the mobile phase and the content of acetonitrile were increased, the final flow phase was 15mmol/L acetate sodium acetate (5% acetonitrile, PH4.8), the flow velocity 1.0mL/min, the UV detection wavelength 225mm, the plasma specimen after 5% perchloric acid removal of the protein and the supernatant 20 mu l direct injection analysis and determination of.Kyn was 6.766min, and the linear range was 0.08-5 The minimum detection concentration is 0 mu mol/L, the minimum detection concentration is 0.02 mu, the retention time of Trp is 13.072min, the linear range is 0.8-500 mu mol/L, the minimum detection concentration is 0.2 u mol/L, the relative standard deviation of daytime determination is less than 4%. within Kyn and Trp days.
conclusion
1, malnutrition is an independent risk factor for the prognosis of uremic patients. MIS is more suitable for Chinese people. Malnutrition is common in the maintenance of blood patients. Regular assessment, comprehensive management and timely intervention are needed.
2, Kyn and Trp in plasma are related to the nutritional status and immune function of MHD, and malnutrition can lead to immune disorders. This study uses the method of HPLC, and on the basis of previous studies, by adjusting the diameter of the column and the pH value of the mobile phase, the content of Kyn and Trp in the MHD plasma is successfully detected in the same condition. The method is simple, rapid and stable, and can be applied to clinical and scientific research.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.5

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