Koda Y, Nishi S, Miyazaki S, Haginoshita S, Sakurabayashi T, Suzuki M, Sakai S, Yuasa Y, Hirasawa Y, Nishi T
Kidney Center of Shinraku-en Hospital, Niigata University, School of Medicine, Japan.
Kidney Int. 1997 Oct;52(4):1096-101. doi: 10.1038/ki.1997.434.
The use of a high-flux membrane, which eliminates larger molecular weight solutes with better biocompatibility, has steadily increased since the discovery of beta-2 microglobulin (beta 2m) amyloidosis in 1985. The long-term effects of a dialyzer membrane on morbidity and mortality are not completely understood. To examine the membrane effect as a factor of carpal tunnel syndrome onset and mortality, multivariate Cox regression analysis with time-dependent covariate was conducted on 819 patients from March 1968 to November 1994 at a single center. Two hundred and forty-eight of the patients were either switched from the conventional to high-flux membrane or treated only with a high-flux membrane. Fifty-one patients underwent a CTS operation and 206 died. Membrane status (on high-flux or on conventional) was considered as time-dependent covariate and risk was adjusted for age, gender, type of renal disease and calendar year of dialysis initiation. The relative risk of CTS was reduced to 0.503 (P < 0.05) and mortality 0.613 (P < 0.05) by dialysis on the high-flux membrane, compared to the conventional membrane. Serial measurements of beta 2m indicated significantly lower beta 2m to persist in patients on the high-flux membrane. The high-flux membrane decreased the risk of morbidity and mortality substantially. Larger molecule elimination was shown important not only for preventing beta 2m amyloidosis, but for prolonging survival of dialysis patients as well.
自1985年发现β2微球蛋白（β2m）淀粉样变性以来，具有更好生物相容性且能清除较大分子量溶质的高通量膜的使用稳步增加。透析器膜对发病率和死亡率的长期影响尚未完全明确。为了研究膜效应作为腕管综合征发病和死亡率的一个因素，对1968年3月至1994年11月在单一中心的819例患者进行了带有时间依赖性协变量的多变量Cox回归分析。其中248例患者要么从传统膜换成了高通量膜，要么仅接受高通量膜治疗。51例患者接受了腕管综合征手术，有206例死亡。膜状态（使用高通量膜或传统膜）被视为时间依赖性协变量，并针对年龄、性别、肾脏疾病类型和开始透析的日历年对风险进行了调整。与传统膜相比，使用高通量膜透析使腕管综合征的相对风险降至0.503（P<0.05），死亡率降至0.613（P<0.05）。对β2m的系列测量表明，使用高通量膜的患者体内β2m持续显著降低。高通量膜显著降低了发病和死亡风险。事实表明，清除较大分子不仅对预防β2m淀粉样变性很重要，对延长透析患者的生存期也很重要。
