血液透析中β-微球蛋白的动态变化

DYNAMICCHANGEOFβ2┐MICROGLOBULININHEMODIALYSIS

为了研究血液透析对体内总体液β２－微球蛋白清除的动态变化，按照人体体液两室模型理论，采用数学摄动解的计算方法，根据β２－微球蛋白体内生成速率和溶质在体液中传递方式与传质阻力，提出了β２－微球蛋白，周清除分数（Ｒ值）的概念，其理论Ｒ值＞４０％。使用高效透析器对３２例接受血液透析的患者进行了临床观察和数据参数计算机处理。结果表明，当Ｒ值＞４０％时，患者由于β２－微球蛋白水平增高，导致淀粉样变腕管综合征的临床表现，得到明显改善。它弥补ＫＴ／Ｖ或平均时间尿素氮浓度（ＴＡＣｕｒｅａ）只对血液小分子进行透析充分性的片面性。研究结果进一步完善了对透析充分性的评价。

Inordertostudythedynamicclearanceoftotalβ2-microglobulininthebody,two-com-partmenttheoryandperturbationsolutionwereappliedinourstudy.Basedontherateofformationofβ2-microglobulininthebodyandthemodeoftransmissionandmasstransferresistanceofsolute,theconceptofweekclearanceindexofβ2-microglobulin(Rvalue)wassuggested.Itstheoreticalvalueismorethan40%.Thirty-twopatientsundergoingdialysiswithhigh-eficiencydialyzerwerestudiedanddatawereprocesedinacomputer.TheresultsshowedthatwhenRvaluewasmorethan40%,theclinicalmanifestationofamyloidosiscarpaltunnelsyndromeinducedbyincreaseofβ2-microglobulinwasaleviatedobviously.ItmakesupforthelimitationofKT/VorTACureathatwereusedonlytoesti-mateadequatedialysisofsmalmolecules.Itisshownthattheconceptofwekcleacanceindexofβ2-mi-croglobulinimprovestheestimationofadequatedialysis.