長期接受血液透析的尿毒症病人，所引發之類澱粉沈積症已是大家所知道的併發症。在臨床表現上，透析性類澱粉沈積症 (dialysis amyloidosis) 最常引發腕關節隧道症候群 (carpal tunnel syndrome) 及各種關節病變。其發病機轉雖尚未非常清楚，然而卻被認為與貝他乙型微球蛋白 (beta2-microglobulin) 的沈積有關。八位長期接受血液透析的腎病末期病人被列入這項研究。血液樣本分別在傳統高透量血液透析術 (conventional high flux hemodialysis) 及血液透析過濾術 (hemodiafiltration) 兩種透析方法之透析前後各採集一次。每個樣本皆進行血中尿素氮 (BUN)、肌酸酐 (Cr)、磷 (P) 及貝他乙型微球蛋白之測量。研究結果顯示貝他乙型微球蛋白在所有尿毒症患者中皆有明顯的增加。下降率 (reduction rate) 之平均值分別是在傳統高透量血液透析術為75.49 ± 4.49%及在血液透析過濾術為83.08 ± 5.40%。血液透析過濾術之貝他乙型微球蛋白清除效率明顯優於傳統高透量血液透析術，P < 0.05；而在小分子物質的下降率方面，尿素氮、肌酸酐與磷在傳統高透量血液透析術及在血液透析過濾術中分別為79.31 ± 5.84%及72.99 ± 11.31%，73.80 ± 8.83%及67.96 ± 11.29%，46.63 ± 12.54%及49.64 ± 9.28%。在這兩種透析方法中，尿素氮、肌酸酐和磷下降率的差異上，沒有統計上的意義。所以對於一位長期接受血液透析的患者而言，選擇一項可以有效清除貝他乙型微球蛋白的透析方式，對於預防透析併發的類澱粉沈積症，佔有極重要之角色。而血液透析過濾術在清除貝他乙型微球蛋白的能力上確實比傳統高透量血液透析術高出許多，所以對於需要長期接受血液透析的尿毒症病人，血液透析過濾術可以是一種優先考慮的透析模式。
Dialysis amyloidosis is well known in chronic hemodialysis patients, and causes carpal tunnel syndrome and varies arthropathy. Beta2-microglobulin has been well established that causes dialysis amyloidosis. Eight end stage renal diseases with chronic hemodialysis were studied. Blood samples were drawn at the beginning and at the end of the conventional high flux hemodialysis and hemodiafiltration procedure. The beta2-microglobulin levels and small molecules (BUN, Creatinine, P) were measured. The beta2-microglobulin levels were markedly elevated in all the chronic hemodialysis patients. The reduction rate of beta2-microglobulin was significantly higher in hemodiafiltration than in conventional high flux hemodialysis with a mean reduction rate of 83.08±5.40% and 75.49±4.49%, respectively (p<0.05). The reduction rate of BUN, Cr and P were calculated between conventional high flux hemodialysis and hemodiafiltration with mean reduction rate of 79.31± 5.84% and 72.99±11.31%, 73.80±8.83% and 67.96±11.29%, 46.63 ±12.54% and 49.64±9.28% respectively. There was no significant difference in the reduction rate of small molecules between hemodiafiltration and conventional high flux hemodialysis. In conclusion, choosing a good modality to eliminate beta2-microglobulin in chronic hemodialysis is a very important issue to prevent dialysis-related amyloidosis. Hemodiafiltration provides a higher reduction rate and efficient removal of beta2-microglobulin in chronic hemodialysis patients.
