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目的观察长期血液透析(hemodialysis,HD)联合血液灌流(hemoperfusion,HP)治疗对维持性血液透析(maintenance hemodialysis,MHD)患者体内蛋白结合类毒素(protein-bound uremic toxins,PBUT)水平的影响。方法选取46例MHD患者,分为HD+HP组及HD组。HD+HP组(n=22)采取HD(2次/周)和HD+HP(1次/周)治疗;HD组(n=24)采取HD治疗(3次/周)。随访观察36周,测定试验前、12、24、36周透前PBUT水平。PBUT包括马尿酸(hippuric acid,HA)、硫酸吲哚酚(indoxyl sulphate,IS)、硫酸对甲酚(p-cresyl sulphate,PCS),测定方法为高效液相色谱-串联质谱(high-performance liquid chromatography/tandem mass spectrometry,HPLC-MS/MS)。结果经过36周随访观察,HD+HP组的3种毒素水平在整个研究期间均低于HD组。结束时,HD+HP组HA、IS、PCS分别下降33.5%、12.8%和24.2%,HD组分别上升2.3%、21.8%和2.8%,血清HA、PCS、IS浓度下降HD+HP组大于HD组(P<0.05)。结论长期应用血液透析联合血液灌流能更加有效地清除PBUT,使之维持在较低水平。
Objective To observe the effects of hemodialysis (HD) combined with hemoperfusion (HP) on the levels of protein-bound uremic toxins (PBUT) in patients with maintenance hemodialysis (MHD). Methods 46 MHD patients were selected and divided into HD + HP group and HD group. Patients in the HD + HP group (n = 22) received HD (2 cycles / week) and HD + HP (1 cycle / week) and HD patients (n = 24) received HD treatment (3 times / week). After 36 weeks of follow-up, the levels of PBUT before 12,24 and 36 weeks were determined. PBUTs include hippuric acid (HA), indoxyl sulphate (IS) and p-cresyl sulphate (PCS). The assay method is high-performance liquid chromatography / tandem mass spectrometry, HPLC-MS / MS). Results After 36 weeks of follow-up, all three toxins in HD + HP group were lower than those in HD group throughout the study period. At the end of the experiment, the HA, IS and PCS of HD + HP group decreased by 33.5%, 12.8% and 24.2%, HD group increased by 2.3%, 21.8% and 2.8% Group (P <0.05). Conclusion Long-term hemodialysis combined with hemoperfusion can remove PBUT more effectively and keep it at a lower level.