血清胱抑素C作为检测血液透析对低分子蛋白清除率一种新标志物探讨

Study of Serum Cystatin C as a Marker of Low Molecular Weight Proteins (LMWPs) Clearance Rate on Measuring Hemodialysis

目的评估血清胱抑素 C(cystatin C,Cys C)能否作为血液透析对低分子质量蛋白质(low molecular weight pro-teins,LMWPs)清除率的一种重要标志物。方法测定52例次血液透析患者透析前后的 Cys C、β_2-微球蛋白(β_2-microglobu-lin,β_2-MG)、尿素氮(blood urea nitrogen,BUN)和血肌酐(seaum creatinine,Scr)的浓度,其中30例次采用常规血液透析(hemodialysis,HD)治疗,22例次采用血液透析滤过(hemodiafiltration,HDF)治疗,并进行透析前后样本均数比较、计算对 CysC、β_2-MG、BUN、Scr 的清除率及二种透析方式 Kt/V(urea clearance divided by volume of distribution)值。结果在 HD 治疗组Cys C 的浓度透后较透前升高,透前(6.59±1.32)mg/L,透后(8.16±1.88)mg/L,P<0.01,而经 HDF 治疗组透后 Cys C 的浓度较透前明显降低,透前(6.89±1.47)mg/L,透后(2.39±1.06)mg/L,P<0.01,且在 HDF 治疗组 Cys C 清除率达62.8%,同 Scr 清除率61.5%近似。结论 Cys C 是一个较好的评价血液透析对 LMWPs 清除率的指标,且优于β_2-MG。

Objective To evaluate whether serum Cystatin C(Cys C)as a marker of Low molecular weight proteins(LMWPs)clearance rate could play an important role in hemodialysis.Method Cys C and other uremic toxins[Blood urea nitrogen(BUN),Seaum creatininc(Scr) and β_2-microglobulin(β_2-MG)]are measured before and after a dialysis session in 52 hemedialysis patients:30 on hemodialysis(HD)and 22 on hemodiafiltration(HDF).their means,clearance and Kt/V are compared between pre-and post-dialysis in different dialysis modes, respectively.Results The mean post-dialysis Cys C level is more obviously increased than that of pre-dialysis(8.16±1.88 vs 6.59±1.32, P<0.01)in HD,although the mean post-dialysis Cys C level is more evidently decreased than that of pre-dialysis(2.39±1.06 vs 6.89± 1.47,P<0.01)in HDF,and the clearance rate of Cys C is nearly the same as Scr(62.8 % vs 61.5%).Conclusion Cys C is a better marker to evaluate hemodialysis,and superior to β_2-MG.