维持性血液透析患者的白蛋白氧化还原状态在治疗后得到正向改变。

Albumin redox state of maintenance haemodialysis patients is positively altered after treatment.

机构信息

Department of Nephrology, University Hospital Essen, University Duisburg-Essen, 45147, Essen, Germany.

Division of Medicinal Chemistry, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.

出版信息

BMC Nephrol. 2023 Sep 18;24(1):273. doi: 10.1186/s12882-023-03317-9.

DOI:10.1186/s12882-023-03317-9

PMID:37723426

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10506191/

Abstract

BACKGROUND AND AIM

Maintenance haemodialysis patients have increased morbidity and mortality which is mainly driven by an elevated inflammation level due to the uraemic milieu. A major part of this increased inflammation level is the degree of oxidative stress which can be assessed by albumin redox state (ARS). Aim of this study was to evaluate how the ARS is affected by a haemodialysis treatment and different dialyzer properties.

METHODS

ARS was determined before and after haemodialysis treatment by fractionating it into reduced human mercaptalbumin (HMA), reversibly oxidized human non-mercaptalbumin 1 (HNA-1), and irreversibly oxidized human non-mercaptalbumin 2 (HNA-2) by high-performance liquid chromatography. In healthy individuals, albumin circulates in the following proportions: HMA 70-80%, HNA-1 20-30% and HNA-2 2-5%. High flux (FX 100 [Fresenius Medical Care], BG 1.8 [Toray], Xevonta Hi 18 [B. Braun], CTA-2000 [Kawasumi]) and low flux FX10 [Fresenius Medical Care] dialyzers were used.

RESULTS

58 patients (59% male, median age 68 years, median time on haemodialysis 32 month) were included in the study. Before haemodialysis treatment, HMA (median 55.9%, IQR 50.1-61.2%) was substantially lower than in healthy individuals. Accordingly, oxidized albumin fractions were above the level of healthy individuals (median HNA-1 38.5%, IQR 33.3-43.2%; median HNA-2 5.8%, IQR 5.1-6.7%). Before haemodialysis treatment HMA was significantly higher in patients usually treated with high flux membranes (p < 0.01). After haemodialysis treatment there was a significant increase of HMA and a decrease of HNA-1 and HNA-2 (p < 0.01). These effects were more pronounced in patients treated with high flux dialyzers (p < 0.01). There were no differences of ARS alteration with regard to the dialyzer´s sterilization mode or the presence of diabetes.

CONCLUSION

The study confirms that the ARS is positively altered by haemodialysis and shows for the first time that this effect depends on dialyzer properties.

摘要

背景与目的

维持性血液透析患者的发病率和死亡率较高，这主要是由于尿毒症环境导致炎症水平升高所致。这种炎症水平的主要部分是氧化应激程度，可以通过白蛋白氧化还原状态（ARS）来评估。本研究旨在评估血液透析治疗以及不同透析器特性如何影响 ARS。

方法

通过高效液相色谱法将其分为还原型人巯基白蛋白（HMA）、可逆氧化型人非巯基白蛋白 1（HNA-1）和不可逆氧化型人非巯基白蛋白 2（HNA-2），在血液透析治疗前后测定 ARS。在健康个体中，白蛋白以以下比例循环：HMA 70-80%，HNA-1 20-30%和 HNA-2 2-5%。使用高通量（FX100[费森尤斯医疗保健]，BG1.8[东丽]，Xevonta Hi18[贝朗]，CTA-2000[川澄]）和低通量（FX10[费森尤斯医疗保健]）透析器。

结果

本研究纳入了 58 名患者（59%为男性，中位年龄 68 岁，中位血液透析时间 32 个月）。在血液透析治疗前，HMA（中位数 55.9%，IQR 50.1-61.2%）明显低于健康个体。相应地，氧化白蛋白分数高于健康个体（中位数 HNA-1 38.5%，IQR 33.3-43.2%；中位数 HNA-2 5.8%，IQR 5.1-6.7%）。在血液透析治疗前，通常使用高通量膜治疗的患者的 HMA 明显更高（p<0.01）。血液透析治疗后，HMA 显著增加，HNA-1 和 HNA-2 显著减少（p<0.01）。在使用高通量透析器治疗的患者中，这些作用更为明显（p<0.01）。ARS 变化与透析器的消毒模式或是否存在糖尿病无关。