De Angelis A, Tullio T, Ferrannini M, Vega A, Dessì M R, Casciani S, Ruggia R, Pastore A, Cortese C, Splendiani G
Servizio di Nefrologia e Dialisi, Policlinico Tor Vergata, Rome.
G Ital Nefrol. 2004 Nov-Dec;21 Suppl 30:S106-10.
Homocysteine (Hcy) is grossly elevated in hemodialysis (HD) patients. Treatment with folic acid and/or vitamin B12 fails to normalize Hcy levels in the majority of patients. Treatment with various dialyzers with different flux characteristics has produced contrasting results. Hemodiafiltration reinfusion (HFR) on-line (double chamber hemodiafiltration (HDF) with regenerated ultrafiltrate reinfusion) is a novel method combining the processes of diffusion, convection and absorbance. The ultrafiltrate is regenerated through a charcoal-resin device. Our aim was to observe the effect of the HFR on-line technique on removing Hcy. We investigated the effect of this treatment on Hcy levels in 10 patients with a mean Hcy level of 57.6 micromol/L (range 24.1-119.7). We measured Hcy, folate and vitamin B12 pre- and post-dialysis and in the ultrafiltrate pre- and post-cartridge at 10, 120 and 240 min. Mean Hcy levels were 57.6 and 35.3 micromol/L (range 9.9-80.3) (p=0.005) pre- and post-dialysis, respectively, while folate and vitamin B12 were unchanged. Pre- and post-cartridge Hcy levels were 11.6 vs 2.5 (p=0.005), 9.3 vs 3.9 (p=0.005), 7.7 vs 4.6 micromol/L (p=0.012) at three time points considered, while folate and vitamin B12 were essentially undetectable. These preliminary data, which need confirmation in a long-term study, seem to indicate that HFR on-line reduces Hcy levels, not only through a possible reduction in uremic toxins, but also through the actual removal of Hcy by absorbance on the charcoal-resin cartridge.
同型半胱氨酸（Hcy）在血液透析（HD）患者中显著升高。大多数患者使用叶酸和/或维生素B12治疗无法使Hcy水平恢复正常。使用具有不同通量特性的各种透析器进行治疗产生了截然不同的结果。在线血液透析滤过再输注（HFR）（带再生超滤液再输注的双腔血液透析滤过（HDF））是一种结合了扩散、对流和吸附过程的新方法。超滤液通过一个活性炭 - 树脂装置进行再生。我们的目的是观察在线HFR技术对去除Hcy的效果。我们研究了这种治疗方法对10例平均Hcy水平为57.6微摩尔/升（范围24.1 - 119.7）患者的Hcy水平的影响。我们在透析前、透析后以及在10、120和240分钟时在滤器前后的超滤液中测量了Hcy、叶酸和维生素B12。透析前和透析后平均Hcy水平分别为57.6和35.3微摩尔/升（范围9.9 - （此处原文有误，应为80.3））（p = 0.005），而叶酸和维生素B12水平未变。在三个时间点，滤器前后的Hcy水平分别为11.6对2.5（p = 0.005）、9.3对3.（此处原文有误，应为9）9（p = 0.005）、7.7对4.6微摩尔/升（p = 0.012），而叶酸和维生素B12基本检测不到。这些初步数据需要在长期研究中得到证实，似乎表明在线HFR不仅通过可能降低尿毒症毒素，还通过活性炭 - 树脂滤器上的吸附作用实际去除Hcy来降低Hcy水平。 （注：原文中存在一些小错误，已在译文中括号标注）
