不同透析方式尿毒症患者血清胱抑素C清除的研究

Research of the Clearance of Serum Cystatin C on Different Dialysis Modalities

目的：评价以不同方式透析的尿毒症患者血清胱抑素C清除效果。方法：将36例维持性血液透析患者随机分为A、B两组，每周透析3次，A组每周血液透析滤过（hemodiafiltration，HDF）1次，B组每两周血液透析滤过1次。每两月检查透前、透后血清胱抑素C、B2-微球蛋白浓度，观察6个月。结果：A组前、中、后二月透前血清胱抑素C浓度分别为（6．79±1．45）、（5．73±1．88）、（4．48±1．48）mg／L，B2-微球蛋白浓度分别为（22．54±2．20）、（20．06±6．20）、（18．11±6．10）mg／L。B组前、中、后二月透前血清胱抑素c浓度分别为（6．79±1．71）、（5．89±1．38）、（5．06±1．35）mg／L，B2-微球蛋白浓度分别为（21．03±4．17）、（20．00±3．69）、（18．24±4．67）mg／L。两组前、中、后二月透前血清胱抑素C、B2-微球蛋白浓度比较差异无统计学意义｜P〉O．05）。后二月透前血清胱抑素C、B2-微球蛋白浓度与前二月比较差异有统计学意义（P〈O．05）。血清胱抑素C下降率（cystatin Creduction ratio，CyRR）、B2-微球蛋白下降率（B2-microglobulin reduction rati0，B2-MRR）均40％～50％，清除效果相当。结论：每周1次HDF与每2周1次HDF对血清胱抑素C、B2-微球蛋白清除效果相似，血清胱抑素C下降率可作为理想的中分子毒素清除率指标。

Objective ：To evaluate the clearance of serum eystatin C on different dialysis modalities in maintenance hemodialysis patients.Methods ： 36 maintenance hemodialysis patients were divided into group A and group B with random.Each group performed dialysis thrice a week.Group A performed hemodiafiltration once a week while group B once two weeks.Cystatin C and B2-microglobulin concentration at pre-dialysis and post-dialysis were measured every two months.Results ：In group A cystatin C concentrations at pre-dialysis were （6.79 ± 1.45）, （5,73 ± 1.88）, （4.48 ± 1.48）mg/L in the first, second and the last two months respectively. B2-microglobulin concentrations at pre-dialysis were （22.54 ± 2,20）, （20.06 ± 6.20）, （18.11 ± 6.10）mg/L in the first, second and the last two months respectively.In group B cystatin C concentrations at pre-dialysis were （6.79± 1.71）, （5.89±1.38）, （5.06±1.35） mg/L in the first, second and the last two months respectively. B2-microglobulin concentrations at pre-dialysis were （21.03 ± 2.20）, （20.00 ± 3.69）, （18.24 ± 4.67）mg/L in the first, second and the last two months respectively.There was no significance in cystatin C and B2-microglobulin concentration at pre-dialysis in both groups.There was significant statistical difference in cystatin C and B2-microglobulin concentration at pre-dialysis between the last two months and the first two months.Cystatin C reduction ratio and B2-microglobulin reduction ratio was 40%-50%.The efficacy of dialysis was similar.Concluslon ：To perform hemodiafiltration once a week is similar to perform hemodiafihration once two weeks in removing efficacy of dialysis for serum cystatin C and B2-microglobulin.Serum cystatin C reduction ratio is an ideal marker for clearance of the middle molecular weight uremic toxins.