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目的:探讨不同血液净化方式对维持性血液透析(MHD)患者蛋白结合类毒素清除的效果。方法:选取符合入选标准的MHD患者136例,经4周洗脱期,随机分成4组:低通量血液透析(LFHD)组、高通量血液透析(HFHD)组,血液透析滤过(HDF)组和血液透析联合血液灌流(HD+HP)组,采用高效液相色谱串联质谱法(HPLC-MS/MS)方法测定不同血液净化方法治疗前后血清、透析废液和血液灌流器中马尿酸(HA)、硫酸对甲酚(PCS)、硫酸吲哚酚(IS)、3-羧基-4-甲基-5-丙基-2-呋喃丙酸(CMPF)的浓度,观察对蛋白结合类毒素的清除效果。结果:四种模式皆能有效清除HA,各组之间无差异。对血清PCS的清除,HDF组和HD+HP组的下降率高于LFHD组(P<0.01)和HFHD组(P<0.05,P<0.01)。对血清IS的清除,HDF组和HD+HP组高于LFHD组、HFHD组(均P<0.05)。对于血清CMPF的清除,HD+HP组和HDF组明显高于LFHD组、HFHD组(P<0.01),HD+HP组高于HDF组(P<0.01),LFHD组与HFHD组相比无差别(P>0.05)。结论:四种方式对于蛋白结合力较低的蛋白结合类毒素清除效率接近于小分子毒素的清除效果;HDF、HD+HP对中等蛋白结合力的蛋白结合类毒素的清除能力优于HFHD、LFHD;HD+HP清除高蛋白结合力的蛋白结合毒素的能力最佳,HDF次之,LFHD和HFHD几乎无效。
Objective: To investigate the effect of different blood purification methods on the clearance of protein-bound toxoids in patients with maintenance hemodialysis (MHD). Methods: Thirty-six MHD patients who met the inclusion criteria were randomly divided into 4 groups: low-flux hemodialysis (HFHD) group, high-flux hemodialysis (HFHD) group, hemodiafiltration ) And hemodialysis combined with hemodialysis (HD + HP) group, the contents of hippuric acid and malondialdehyde in serum, dialysis waste fluid and hemoperfusion device were determined by high performance liquid chromatography tandem mass spectrometry (HPLC-MS / MS) (HA), p-cresyl sulfate (PCS), indoxyl sulfate (IS) and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) Toxin removal effect. Results: All four models could effectively remove HA without any difference among the groups. Serum PCS clearance was significantly lower in HDF and HD + HP than in LFHD (P <0.01) and HFHD (P <0.05, P <0.01). Serum IS clearance, HDF group and HD + HP group than LFHD group, HFHD group (P <0.05). For serum CMPF clearance, HD + HP group and HDF group were significantly higher than LFHD group and HFHD group (P <0.01), HD + HP group was higher than HDF group (P <0.01) (P> 0.05). CONCLUSION: The four ways are better for the clearance of protein-binding toxins with lower protein binding ability than that of small molecule toxins. HDF and HD + HP are better than HFHD and LFHD for protein binding toxins with medium protein binding ability ; HD + HP was the best at clearing protein-binding protein-binding toxins, with HDF followed by LFHD and HFHD almost ineffective.