硫酸吲哚酚清除方式的研究进展

Progress of research on the clearance of indoxyl sulfate

硫酸吲哚酚(IS)是一种尿毒症毒素,由肠道微生物分解色氨酸产生,它是小分子溶质,但是与血浆蛋白结合率高达90%以上。肾功能正常时,通过肾小管分泌作用排出体外。肾功能受损时,在体内蓄积,因此慢性肾脏病(CKD)患者血浆IS水平升高。IS具有肾毒性,可以导致肾间质纤维化和肾小球硬化,加速CKD的进展;同时具有心血管毒性,导致心肌纤维化和左室肥厚等造成心血管系统损害。心血管疾病被公认为是CKD患者死亡的主要原因。研究发现,IS可以增加终末期肾病(ESRD)患者全因死亡及心血管疾病死亡的风险。因此通过透析或非透析的方式降低血浆IS水平非常重要。本文将针对近年来国内外学者关于IS清除的研究成果进行归纳总结。

Indoxyl sulfate （IS） is a uremic toxin that is a small molecule solute, as many as 90% of which bind to the plasma proteins. IS derives from the breakdown of tryptophan by gut microbes. Normal renal function can lead to IS excretion through the tubular secretion, while impaired renal function can result in accumulation of IS in the body. So plasma IS levels are elevated in patients with chronic kidney disease （CKD）. IS has nephrotoxicity, and can cause renal interstitial fibrosis and glomerulosclerosis, accelerating the progression of CKD. IS also has cardiovascular toxicity, leading to myocardial fibrosis and left vcntricular hypertrophy, etc. Cardiovascular disease has been widely recognized as the leading cause of death in CKD patients. Studies have found that IS can increase the risk of all-cause death and cardiovascular death in patients with end-stage renal disease （ESRD）. Therefore, it is very important to reduce plasma IS level by means of dialysis or non-dialysis method. This article summarized the research results on IS clearance by domestic and foreign scholars in recent years.