活性炭与树脂对尿毒症患者中分子物质、甲状旁腺素的体外吸附研究

目的分析探讨活性炭和树脂对尿毒症患者体内的中分子物质总量(middle molecular substances,MMS)及甲状旁腺素(parathyroid hormone,PTH)的清除性能差异。方法取维持性透析患者的血液,随机分为4组,分别用AC活性炭、MR1、MR2、MR3树脂4种吸附剂进行体外吸附,检测吸附前后血液中的MMS和PTH,结合吸附剂的孔结构检测,分析活性炭与树脂对MMS、PTH的清除性能差异。结果同组内吸附前后比较,4组血样的MMS、PTH水平均显著降低(P<0.01;MMS指标P值分别为0.006、0.001、0.001、0.000,PTH指标P值均为0.000)。对MMS清除水平,AC组最高(32.73%±3.29%),MR1组(22.96%±7.18%)最低,且2组比较有统计学意义(P<0.05;P=0.027),而3种树脂间MMS清除水平差异无统计学意义。对PTH清除水平,MR1组最高(90.52%±4.05%),MR2组次之(77.43%±3.65%),MR3组较小(63.71%±1.49%),AC组最低(36.53%±4.95%),且4组差异显著(P<0.01;P值均为0.000)。结论活性炭由于孔径分布范围广,能吸附的毒素分子量范围更广,对中分子物质总量清除更有利;大孔吸附树脂具有较为集中的孔径分布,对以PTH为目标的单一中分子毒素清除更有利。

In vitro studies on the adsorption of middle molecular substances and parathyroid hormone from uremic blood samples using activated carbon and resins

Objective To explore the removal performance of middle molecular substances （MMS） and parathyroid hormone （PTH） in uremic blood samples by activated carbon and several resin adsorbents. Methods Blood samples from maintenance hemodialysis patients were randomly divided into four groups for in vitro adsorption tests byAC （activated carbon）, MR1, MR2 and MR3 （resin）. Measurement of MMS and PTH in blood samples before and after the adsorption combined with the sorbent pore structure was used to analyze the performance differences of MMS and PTH removal by activated carbon and the 3 kinds of resins. Results MMS and PTH levels decreased significantly after adsorption within the same group, and this was found in the AC, MR1, MR2 and MR3 groups （P 〈 0.01; for MMS, P value was 0.006, 0.001, 0.001, and 0, respectively; for PTH, P values were all 0.000 ）. The clearance of MMS was highest in AC group, lowest in MR1 group （P 〈 0.05 between the two groups）, but the clearance was indifferent among the 3 kinds of resins. The clearance of PTH was in the order of MR1 group （90.52% 4± 4.05%）, MR2 group （77.43% ± 3.65%）, MR3 group （63.71% ± 1.49%）, andAC group （36.53% ±4.95%）, with statistical significance among the 4 groups （P 〈 0.01; P values were all 0.000）. Conclusions Activated carbon can adsorb the toxins of greater scope of molecular weight due to the wider pore size distribution range, and is suitable for removal of middle molecule substances; resins of larger pore size have relatively centralized pore size distribution, and are suitable for the clearance of single molecule toxins such as PTH.