長期接受血液透析的尿毒症病人，所引發的透析性類澱粉沈積症已是眾所周知的併發症。在臨床表現上，透析性類澱粉沈積症最常引發腕關節隧道症候群及各種關節病變。其致病機轉目前雖尚未完全清楚，然而被認為與其他乙型徵球蛋白的沈積應有關聯。在長期接受血液透析的尿毒症病人，為探討與比較使用傳統高透量血液透析術與血液透析過濾術對於清除血液中其他乙型微球蛋白的效我們設計了本研究。八位長期接受血液透析的尿毒病人被列入這項研究計劃。血液樣本分別在施行傳統高透量血液透析術與血液透析過濾術兩種透析方法之透析前後各採進一次。而透析液樣本則是每個小時各收集一次。樣本皆進行貝他乙型微球蛋白與小分子包括血中尿素氮、肌酸酐及磷之測量。並分別計算貝他乙型微球蛋白與各個小分子之下降率與廓清率。研究結果顯示在所有尿毒症患者血液中，其透析前貝他乙型微球蛋白的濃度皆有明顯的增加（平均值為45.0 ± 10.7mg/L）。傳統高透量血液透析術與血液透析過濾術之下降率平均值分別為75.5% ± 4.5%與83.1% ± 5.4%。血液透析過濾術對於貝他乙型微球蛋白的透除明顯高於傳統高透量血液透析術（p<0.01）。而血液透析過濾術對於貝他乙型微球蛋白的廓清率亦明顯的優於傳統高透量血液透析術（128.0 ± 8.3 vs 97.4 ± 5.8ml/min，p<0.0001）。另外血液透析過濾術對於小分子的廓清率亦顯著的優於傳統高透量血液透析術。本研究結果顯示在長期接受血液透析的尿毒症病人，血液透析過濾術可以提供較有效率的清除貝他乙型徵蛋白的能力。同時血液透析過濾術亦顯示有較佳的小分子廓清率。所以對於一位長期接受血液透析的尿毒症病人，為防範併發透析性類澱粉沈積症，血液透析過濾術是一項可以優先考慮的透析模式。 Dialysis-related amyloidosis has been well documented in chronic hemodialysis patients, and leads to carpal tunnel syndrome and various arthropathies. It is well established that beta2-microglobulin (β2M), a key amyloidogenic factor, causes dialysis-related amyloidosis. The present study was undertaken to investigate any differences in the efficiency of removing serum β2M between conventional high-flux hemodialysis (HD) and hemodiafiltration (HDF) in stable, chronic hemodialysis patients. Eight end-stage renal disease patients with chronic hemodialysis were studied. Blood samples were drawn at the beginning and at the end of HD and HDF treatments. However, dialysate samples were collected each hour. The reduction rates and clearances of serum β2M, as well as those of three other small molecules (blood urea nitrogen, creatinine, and phosphorus), were measured. The mean predialysis serum β2M level of 45.0 ± 10.7mg/L in our patients was markedly elevated. The reduction rate of β2M was significantly greater with HDF than with HD treatment (83.1% ± 5.4% vs 75.5% ± 4.5%, p<0.01). The clearance of β2M was also significantly higher with HDF than with HD treatment (128.0 ± 8.3 vs 97.4 ± 5.8ml/min，p<0.0001). There were also statistically significant greater clearances for the three small molecules with HDF treatment. In conclusion, our results demonstrate that HDF provides a better reduction rate and clearance for the efficient removal of β2M in chronic hemodialysis patients. Significantly superior clearances of BUN, creatinine, and phosphorus were also noted. Treatment with HDF offers good removal of both small and large molecules.
