BETA-MICROGLOBULIN LEVELS IN PATIENTS WITH RENAL-INSUFFICIENCY
BETA-MICROGLOBULIN LEVELS IN PATIENTS WITH RENAL-INSUFFICIENCY
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DOI：
10.1016/s0272-6386(89)80119-2
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发表时间：
1989-01-01
影响因子：
13.2
通讯作者：
JENNINGS, BR
中科院分区：
文献类型：
--
作者：
ACCHIARDO, S;KRAUS, AP;JENNINGS, BR
β2-微球蛋白（β2M）与长期透析患者淀粉样变性的发病机制有关。在慢性肾功能衰竭患者中测量了β2M水平：30名患者在常规血液透析前后，35名患者在高通量（HF）血液透析前后，5名患者在第一次血液透析治疗期间，以及13名接受连续不卧床腹膜透析（CAPO）患者的血清和腹膜液以及3名接受肾移植的患者的血清和尿液中的β2M水平。透析患者的β2M水平显着升高；接受传统 vHF 血液透析的患者的血液透析前值没有显着差异。这些患者大多数为功能性无肾病，β2M 水平与年龄、性别或透析时间无关。在使用醋酸纤维素膜进行常规血液透析的患者中，血液透析后β2M水平增加了25.4%，而在使用聚砜膜进行高频血液透析的患者中，血液透析后β2M水平显着下降（43.0%）。由于残留肾小球滤过率（GFR），首次透析的终末期肾病患者的β2M值显着低于其他两组。 CAPO 患者的值也较低，因为他们的透析液中的 β2M 估计损失为 80.4 mg/d。在慢性肾功能衰竭患者中，β2M 水平与血清肌酐水平平行升高。接受肾移植的患者的 β2M 水平显着下降，这与 GFR 的改善相关。 β2M 与残余 GFR 相关，其去除具有膜依赖性。通过高频血液透析或 CAPO 去除的 β2M 量不足以避免其积累。接受肾移植且肾功能良好的患者β2M水平迅速恢复正常。
β2-microglobulin (β2M) has been implicated in the pathogenesis of amyloidosis in long-term dialysis patients. β2M levels were measured in patients with chronic renal failure: before and after conventional hemodialysis in 30, before and after high-flux (HF) hemodialysis in 35, and during the first hemodialysis treatment in five patients, as well as in the serum and peritoneal fluid of 13 patients who were receiving continuous ambulatory peritoneal dialysis (CAPO) and in the serum and urine of three patients who had received kidney transplants. Dialysis patients had markedly elevated β2M levels; prehemodialysis values were not significantly different for patients receiving conventionalvHF hemodialysis. Most of these patients were functionally anephric, and the β2M levels did not correlate with age, sex, or time on dialysis. In patients receiving conventional hemodialysis using cellulose acetate membrane, β2M levels increased 25.4% after hemodialysis, whereas in patients receiving HF hemodialysis using polysulfone membrane, β2M levels decreased significantly (43.0%) after hemodialysis. End-stage renal disease patients dialyzed for the first time had β2M values significantly lower than the other two groups because of residual glomerular filtration rate (GFR). CAPO patients also had lower values because they had an estimated loss of 80.4 mg/d of β2M in the dialysate fluid. In patients with chronic renal failure, β2M levels paralleled the increase in serum creatinine. Patients who received kidney transplants had a dramatic decrease in β2M levels that correlated with improvement in GFR. β2M correlated with the residual GFR, and its removal was membrane-dependent. The amount of β2M removed by HF hemodialysis or CAPO was not sufficient to avoid its accumulation. Patients who had received kidney transplants with good renal function rapidly normalized β2M levels.