不同透析器膜材料对维持性血液透析患者体内双酚A暴露情况的影响

The influence of different dialysis membrane composition on bisphenol A exposure in maintenance hemodialysis patients

目的评估维持性血液透析(maintenance hemodialysis,MHD)患者体内双酚A(bisphenol A,BPA)的暴露情况以及不同透析器膜材料对BPA暴露情况的影响。方法选取健康人群15例作为对照组。选取MHD的慢性肾脏病患者共66例,随机分为A、B 2组,A组应用聚砜(polysulfone,PS)膜透析器、B组应用聚醚砜(polyethersulfone,PES)膜透析器治疗3个月,随后2组交换透析器类型继续治疗3个月。用酶联免疫吸附测定检测健康人群以及MHD患者第1次透析前后、治疗3个月以及治疗6个月后的血清BPA进行对比分析。结果2组MHD患者的血清BPA均高于健康人群(t=9.378,P<0.001;t=8.784,P<0.001)。A组在第1次血液透析后血清BPA较前升高(t=2.794,P=0.009)。B组在第1次血液透析后血清BPA同前无明显变化(t=-0.631,P=0.533)。A组应用PS膜透析器血液透析治疗3个月后血清BPA较基线无显著变化(t=1.721,P=0.095),换用PES膜透析器血液透析治疗3个月后血清BPA较基线及治疗3个月时均下降(t=-4.690,P<0.001;t=-6.378,P<0.001)。B组应用PES膜透析器血液透析治疗3个月后血清BPA较基线下降(t=-3.604,P=0.001),换用PS膜透析器血液透析治疗3个月后血清BPA较3个月时回升(t=4.412,P<0.001),与基线水平无显著差异(t=-0.679,P=0.502)。治疗3个月时2组间血清BPA差异有统计学意义(t=3.367,P=0.002)。相关性分析提示血清BPA与透析龄(r=0.391,P=0.001)、体质量指数(r=0.355,P=0.003)、糖尿病(r=0.364,P=0.003)、高脂血症(r=0.405,P=0.001)呈正相关,与残余尿量(r=-0.721,P<0.001)呈负相关。结论MHD患者存在较高的体内BPA蓄积风险,可能导致多系统的潜在损害,影响远期预后。长期应用PS膜透析滤器进行血液透析可加重BPA体内蓄积,而应用PES膜透析器进行血液透析不会加重BPA体内蓄积。

Objective To evaluate the exposure of bisphenol A(BPA)and the influence of different dialysis membrane composition on BPA exposure in maintenance hemodialysis(MHD)patients.Methods A total of 66 chronic kidney disease patients with MHD were recruited and randomly divided into group A or group B.Group A was treated with polysulfone(PS)membrane dialyzer,and group B was treated with polyethersulfone(PES)membrane dialyzer for hemodialysis for 3 months.The dialyzer types for the two groups were then exchanged and used for hemodialysis for another 3 months.Fifteen healthy people were selected as the control group.EnzymElinked immunosorbent assay was used to measure serum BPA before and after the first dialysis,3 months and 6 months after the treatment as well as serum BPA in healthy people for comparison.Results Serum BPA of the two MHD patient groups was significantly higher than that of healthy people(t=9.378,P<0.001;t=8.784,P<0.001).In group A after the first hemodialysis,serum BPA was significantly higher than that before hemodialysis(t=2.794,P=0.009);while in group B after the first hemodialysis,serum level did not change significantly as compared with the level before hemodialysis(t=-0.631,P=0.533).In group A after hemodialysis using PS membrane dialyzer for 3 months,serum level did not change significant-ly as compared with that of the value(t=1.721,P=0.095);after switching to hemodialysis using PES membrane dialyzer for 3 months,serum level decreased significantly as compared with that of the value and the value at the third month of the treatment(t=-4.690,P<0.001;t=-6.378,P<0.001).In group B after hemodialysis using PES membrane dialyzer for 3 months,serum level decreased significantly as compared with that of the value(t=-3.604,P=0.001);after switching to hemodialysis using PS membrane dialyzer for 3 months,serum level increased significantly as compared with that before 3 months(t=4.412,P<0.001)and similar to that of the baseline level(t=-0.679,P=0.502).After the treatment for 3 months,serum BPA was statistically different between the two groups(t=3.367,P=0.002).Correlation analysis showed that serum BPA was positively correlated with dialysis age(r=0.391,P=0.001),body mass index(r=0.355,P=0.003),diabetes(r=0.364,P=0.003),and hyperlipidemia(r=0.405,P=0.001),and negatively correlated with residual urine volume(r=-0.721,P<0.001).Conclusions MHD patients are at the high risk of BPA accumulation,potentially causing damage to multiple systems and affecting long-term prognosis.Long-term application of PS membrane dialyzer for hemodialysis increases the accumulation of BPA,while the application of PES membrane dialyzer for hemodialysis decreases this risk.