蛋白结合尿毒症毒素与血液净化的研究现状

Research status of protein-bound uremic toxins and blood purification

既往研究主要集中于非蛋白结合尿毒症毒素,利用其指导血液净化治疗,但终末期肾脏病(end-stage renal disease,ESRD)患者的死亡率改善仍不理想。然而大量研究已表明,蛋白结合尿毒症毒素(protein-bound uremic toxins,PBUTs)可加速慢性肾脏疾病(chronic kidney disease,CKD)的进展,并与心血管疾病等尿毒症并发症的发生、发展显著相关。而且,传统的血液净化模式无法对其产生良好的清除效果。近年来,在PBUTs清除动力学及血液净化技术研究方面,不断有研究提出新的思路。故本文将简要介绍PBUTs的特性、致病机制,并就其血液净化技术(血液透析滤过、竞争性结合剂、吸附)及动力学研究现状作一阐述,以期对其充分清除提供思路。

Previous studies have focused on non-protein-bound uremic toxins,which are used to guide blood purification treatment,but the improvement of mortality in end-stage renal disease(ESRD)patients is still not ideal.However,a large number of studies have shown that protein-bound uremic toxins(PBUTs)can accelerate the progress of chronic kidney disease(CKD),and it is significantly related to the occurrence and development of cardiovascular disease and other uremic complications.Moreover,the traditional blood purification mode can not produce good cleaning effect.In recent years,new ideas have been put forward in the study of PBUTs clearance kinetics and blood purification technology.Therefore,this paper will briefly introduce the characteristics and pathogenesis of PBUTs,and describe the current situation of its blood purification technology(hemodialysis filtration,competitive binders,adsorption)and kinetics research,in order to provide ideas for its adequate clearance.