Chanard J, Caudwell V, Valeire J, Vincent C, Randoux C, Wuillai A, Wynckel A
Service de Néphrologie, Centre Hospitalier et Universitaire, Reims, France.
Artif Organs. 1998 Jul;22(7):574-80. doi: 10.1046/j.1525-1594.1998.06197.x.
The kinetics of 131I-beta2-microglobulin (beta2-M) were studied using external total body gamma counting in a low noise chamber after administration of trace doses of radioactivity (4 microCi) in 14 uremic patients treated by either hemodialysis or hemofiltration. Data were collected over a 1 week period that included 3 dialysis sessions. The following artificial membranes were used: Cuprophan, polyacrylonitrile AN69, polysulfone, polymethylmethacrylate (PMMA), and polyamide. Radiolabeled beta2-M excretion by an extrarenal route was nearly nonexistent. The 131I-beta2-M half-life was between 2.4 and 8 days, shorter in patients with residual diuresis. A mean removal of 153+/-33 mg/L of beta2-M was obtained per dialysis session with a highly permeable membrane. A hemofiltration session (25 L exchange per session) was slightly more efficient in removing beta2-M than a 4 h hemodialysis session with the same AN69 highly permeable membrane. The amounts of 131I-beta2-M binding on the membranes, expressed as beta2-M equivalents, were 0, 16, 54, 58, and 59 mg/m2 for Cuprophan, polysulfone, polyacrylonitrile AN69, polyamide, and PMMA, respectively. In conclusion, the decrease of total body gamma counting directly reflected the beta2-M breakdown and removal in hemodialysis patients. Intact beta2-M was removed by convection with synthetic, highly permeable membranes. In addition, membrane adsorption accounted for 15% (polysulfone) to near 100% (PMMA) of the beta2-M removal per session. Adsorption was of the same magnitude regardless of the dialysis technique in use, indicating a membrane saturability process. None of the currently available dialysis procedures based on a 3 sessions per week schedule can balance beta2-M generation.
在14例接受血液透析或血液滤过治疗的尿毒症患者中，给予微量放射性物质（4微居里）后，在低噪声室内使用全身γ计数法研究了131I-β2-微球蛋白（β2-M）的动力学。数据收集期为1周，包括3次透析治疗。使用了以下人工膜：铜仿膜、聚丙烯腈AN69、聚砜、聚甲基丙烯酸甲酯（PMMA）和聚酰胺。放射性标记的β2-M经肾外途径排泄几乎不存在。131I-β2-M的半衰期在2.4至8天之间，有残余利尿的患者半衰期较短。使用高通透性膜时，每次透析治疗平均清除β2-M的量为153±33mg/L。使用相同的AN69高通透性膜时，一次血液滤过治疗（每次置换25L）在清除β2-M方面比4小时的血液透析治疗略有效。以β2-M当量表示，铜仿膜、聚砜、聚丙烯腈AN69、聚酰胺和PMMA上131I-β2-M的结合量分别为0、16、54、58和59mg/m2。总之，全身γ计数的降低直接反映了血液透析患者β2-M的分解和清除。完整的β2-M通过与合成高通透性膜的对流作用被清除。此外，膜吸附占每次治疗β2-M清除量的15%（聚砜）至近100%（PMMA）。无论使用何种透析技术，吸附量都相同，表明存在膜饱和过程。目前基于每周3次治疗方案的透析程序均无法平衡β2-M的生成。
