高通量聚砜透析器可增强血浆瘦素浓度的长期降低效果。

Enhanced long-term reduction of plasma leptin concentrations by super-flux polysulfone dialysers.

作者信息

van Tellingen Anne, Grooteman Muriel P C, Schoorl Margreet, ter Wee Piet M, Bartels Piet C M, Schoorl Marianne, van der Ploeg Tjeerd, Nubé Menso J

机构信息

Department of Nephrology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.

出版信息

Nephrol Dial Transplant. 2004 May;19(5):1198-203. doi: 10.1093/ndt/gfh122. Epub 2004 Feb 19.

DOI:10.1093/ndt/gfh122

PMID:14993491

Abstract

BACKGROUND

Hyperleptinaemia in chronic haemodialysis (CHD) patients has been associated with malnutrition, which is an independent predictor of morbidity and mortality in this patient group.

METHODS

To assess the influence of HD on plasma leptin, 10 CHD patients were crossover randomized to low-flux polysulfone (PS: F 6HPS), high-flux PS (F 60S), super-flux PS (F 500S) or super-flux cellulose-tri-acetate (CTA: Tricea 150G) for 12 weeks each. Blood samples were collected at the start of the study and each 12-week period. In addition, the relationship between patient characteristics, inflammation and leptin was analysed.

RESULTS

At baseline, all groups showed similar leptin concentrations (mean 33.6+/-21.7 ng/ml). After a single HD session, a significant (P<0.01) decrease was observed with all three high permeable devices (Tricea 150G -52.7+/-6.4%; F 60S -63.1+/-5.7%; F 500S -68.7+/-8.2%), whereas leptin remained stable with low-flux PS. After 12 weeks, a marked increase was observed with low-flux PS (week 1, 30.4+/-23.0; week 12, 40.5+/-5.4 ng/ml, P = 0.05), no change with super-flux CTA and high-flux PS (Tricea 150G week 1, 29.4+/-23.7; week 12, 32.0+/-27.9 ng/ml, P = ns; F 60S week 1, 36.0+/-31.8; week 12, 33.0+/-31.2 ng/ml, P = ns), and a significant decrease with super-flux PS (week 1, 38.3+/-33.0; week 12, 29.5+/-31.9 ng/ml, P = 0.02). The change in leptin after 12 weeks was significantly different between super-flux PS, and both low-flux PS (P = 0.009) and super-flux CTA (P = 0.01). Besides interleukin-6 (IL-6) at the start of the study (P = 0.006), no correlations were observed between patient characteristics, parameters of inflammation and plasma leptin levels.

CONCLUSIONS

Apart from low-flux PS, plasma leptin decreased considerably with all three high permeable dialysers after a single HD session. In the long run, leptin levels were lower with high-flux PS than with low-flux PS. Moreover, after switching from high-flux PS to super-flux PS (but not super-flux CTA), an additional decrease in leptin was observed. Apart from IL-6 at the start of the study, neither patient characteristics nor inflammatory parameters correlated with plasma leptin levels in this patient group.

摘要

背景

慢性血液透析（CHD）患者的高瘦素血症与营养不良有关，而营养不良是该患者群体发病和死亡的独立预测因素。

方法

为评估血液透析（HD）对血浆瘦素的影响，10例CHD患者交叉随机分组，分别使用低通量聚砜（PS：F 6HPS）、高通量PS（F 60S）、超高通量PS（F 500S）或超高通量三醋酸纤维素（CTA：Tricea 150G）进行治疗，每组治疗12周。在研究开始时及每个12周治疗期结束时采集血样。此外，分析了患者特征、炎症与瘦素之间的关系。

结果

基线时，所有组的瘦素浓度相似（平均33.6±21.7 ng/ml）。单次HD治疗后，使用三种高通透性透析器（Tricea 150G -52.7±6.4%；F 60S -63.1±5.7%；F 500S -68.7±8.2%）后瘦素均显著（P<0.01）下降，而使用低通量PS时瘦素保持稳定。12周后，低通量PS组瘦素显著升高（第1周，30.4±23.0；第12周，40.5±5.4 ng/ml，P = 0.05），超高通量CTA组和高通量PS组无变化（Tricea 150G第1周，29.4±23.7；第12周，32.0±27.9 ng/ml，P = 无统计学意义；F 60S第1周，36.0±31.8；第12周，33.0±31.2 ng/ml，P = 无统计学意义），超高通量PS组显著下降（第1周，38.3±33.0；第12周，29.5±31.9 ng/ml，P = 0.02）。12周后，超高通量PS组与低通量PS组（P = 0.009）和超高通量CTA组（P = 0.01）的瘦素变化有显著差异。除研究开始时的白细胞介素-6（IL-6）（P = 0.006）外，未观察到患者特征、炎症参数与血浆瘦素水平之间的相关性。