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目的非对称性二甲基精氨酸(asymmetrical dimethylarginine,ADMA)作为一种尿毒症毒素,是维持性血液透析患者心血管疾病和不良预后的独立危险因素。因其蛋白结合特性,常规血液透析、血液透析滤过对其清除能力有限。本研究拟评价具有高截留分子量的超高通量聚醚砜膜对ADMA的清除能力。方法采取自身前后对照研究。10例稳定的、透析龄大于6个月、已应用高通量聚醚砜膜透析器治疗3月以上的维持性血液透析患者,转为超高通量聚醚砜膜透析器治疗4周。分别于进入超高通透析前及后的2周、4周测定透析前后ADMA血浓度、透析前血L-精氨酸/ADMA比值、白蛋白浓度及单次透析废液ADMA清除量。结果转入超高通量透析后第2周和第4周,单次透析ADMA清除量显著增高(P分别为<0.001和0.006)。第4周时,透前ADMA血浓度呈显著性下降(P=0.003),L-精氨酸/ADMA比值呈显著性增高(P=0.001)。整个观察期内,透析液白蛋白丢失无显著性增加,血浆白蛋白维持稳定。结论聚醚砜膜超高通量透析器与传统高通量透析器相比,对ADMA的清除能力显著增强,能减轻ADMA在体内的蓄积。同时其白蛋白的丢失又在可接受范围内,不明显影响患者的营养状态。
Asymmetric dimethylarginine (ADMA), an uremic toxin, is an independent risk factor for cardiovascular disease and adverse prognosis in maintenance hemodialysis patients. Because of its protein binding properties, conventional hemodialysis, hemodiafiltration clearance capacity is limited. This study was to evaluate the scavenging ability of ADMA by ultra-high flux polyethersulfone membrane with high molecular weight cut-off. Methods to take their own before and after the control study. Ten patients with stable dialysis ages> 6 months had been treated with a high-throughput polyethersulfone membrane dialyzer for more than 3 months in maintenance hemodialysis patients and switched to ultra-high-flux polyethersulfone membrane dialyzers for 4 weeks. The levels of ADMA blood before and after dialysis, L-arginine / ADMA ratio before dialysis, albumin concentration and ADMA clearance of single dialysis waste before and after hyperconcentration were measured at two weeks and four weeks respectively. RESULTS: At week 2 and week 4 after ultrahigh-flux dialysis, ADMA clearance was significantly increased in single dialysis (P <0.001 and 0.006, respectively). At 4 weeks, there was a significant decrease (P = 0.003) in ADMA blood concentration and a significant increase in L-arginine / ADMA ratio (P = 0.001). Throughout the observation period, no significant increase in dialysate albumin loss, plasma albumin remained stable. CONCLUSION Polyethersulfone membrane ultrahigh-flux dialyzers have significantly enhanced ADMA-scavenging capacity compared with traditional high-pass dialyzers and can reduce ADMA accumulation in the body. At the same time, the loss of albumin is within the acceptable range, and does not significantly affect the nutritional status of patients.