透析方式对终末期肾病患者血清晚期糖基化终产物水平的影响。

Influence of dialysis modalities on serum AGE levels in end-stage renal disease patients.

作者信息

Stein G, Franke S, Mahiout A, Schneider S, Sperschneider H, Borst S, Vienken J

机构信息

Department of Internal Medicine IV, Friedrich Schiller University of Jena, Erlanger Allee 101, D-07740 Jena, Germany.

出版信息

Nephrol Dial Transplant. 2001 May;16(5):999-1008. doi: 10.1093/ndt/16.5.999.

DOI:10.1093/ndt/16.5.999

PMID:11328907

Abstract

BACKGROUND

The accumulation of advanced glycation end-products (AGEs) in end-stage renal disease (ESRD) influenced by dialysis modalities is of current interest. Highly permeable membranes in haemodialysis or haemofiltration should be able to eliminate circulating AGEs as well as their AGE precursors more efficiently.

METHODS

In our study, 10 non-diabetic and 10 diabetic ESRD patients were on haemodialysis with low-flux membranes (LF) followed by a cross-over haemodialysis with high-flux or super-flux polysulfone membranes (HF, SF) for 6 months each. We measured the protein-bound pentosidine and free pentosidine serum levels by high-performance liquid chromatography (HPLC) as well as the serum AGE peptide, AGE-beta(2)-microglobulin and beta(2)-microglobulin concentrations, using ELISA assays.

RESULTS

All parameters investigated were significantly higher in dialysis patients than in healthy subjects. The reduction rates during a single dialysis session were found to be higher using the SF than those obtained with the HF (free pentosidine 82.4+/-7.3 vs 76.6+/- 8.7%; AGE peptides 79.7+/-7.7 vs 62.3+/-14.7%; AGE-beta(2)-microglobulin 64.0+/-16.5 vs 45.4+/-17.7%; beta(2)-microglobulin 70.5+/-5.6 vs 58.2+/-6.0%). The protein-bound pentosidine levels remained constant over the respective dialysis sessions. In the 6-month treatment period with the SF, decreased pre-dialysis serum levels of protein-bound pentosidine, free pentosidine and AGE peptides were observed in non-diabetics and diabetics as compared with values obtained with the LF. The respective pre-dialysis AGE-beta(2)-microglobulin concentrations decreased insignificantly, whereas those of beta(2)-microglobulin were significantly lower. Using the HF dialyser, only moderate changes of the parameters measured were noted.

CONCLUSION

Treatment with the biocompatible polysulfone SF dialyser seems to be better suited to lower serum AGE levels and to eliminate their precursors.

摘要

背景

晚期肾病（ESRD）中受透析方式影响的晚期糖基化终产物（AGEs）的蓄积是当前研究的热点。血液透析或血液滤过中使用的高通透性膜应该能够更有效地清除循环中的AGEs及其AGE前体。

方法

在我们的研究中，10例非糖尿病和10例糖尿病ESRD患者先使用低通量膜（LF）进行血液透析，随后交叉使用高通量或超高通量聚砜膜（HF、SF）进行血液透析，每种膜使用6个月。我们通过高效液相色谱法（HPLC）测定了蛋白结合戊糖苷和游离戊糖苷的血清水平，以及使用酶联免疫吸附测定法（ELISA）测定了血清AGE肽、AGE-β2-微球蛋白和β2-微球蛋白的浓度。

结果

所有研究参数在透析患者中均显著高于健康受试者。发现单次透析过程中，使用SF时的降低率高于使用HF时（游离戊糖苷82.4±7.3%对76.6±8.7%；AGE肽79.7±7.7%对62.3±14.7%；AGE-β2-微球蛋白64.0±16.5%对45.4±17.7%；β2-微球蛋白70.5±5.6%对58.2±6.0%）。蛋白结合戊糖苷水平在各自的透析过程中保持恒定。在使用SF进行6个月的治疗期间，与使用LF时获得的值相比，非糖尿病患者和糖尿病患者透析前血清中蛋白结合戊糖苷、游离戊糖苷和AGE肽的水平均下降。各自透析前的AGE-β2-微球蛋白浓度下降不显著，而β2-微球蛋白的浓度则显著降低。使用HF透析器时，仅观察到所测参数有适度变化。