尿毒素吸附劑（AST-120）於慢性腎臟病治療的多重角色

The Pleiotropic Effects of Uremic Oral Sorbent AST-120 in Chronic Kidney Disease

劉文治(Wen-Chih Liu) ； 盧國城(Kuo-Cheng Lu)

《內科學誌》 27卷6期 (2016/12) Pp. 317-332

https://doi.org/10.6314/JIMT.2016.27(6).04

摘要

慢性腎臟病患者腎功能的惡化和尿毒素息息相關，尿毒素能誘發炎症反應與增加氧化壓力，而促使腎絲球的硬化與間質的纖維化，更加重腎功能的衰退。研究發現尿毒素中硫酸吲哚酚(Indoxyl sulfate; IS)，對硫甲酚(P-cresol or p-cresyl sulfate; PCS)對於慢性腎臟病患者腎功能的惡化及預後不良，有著重要的影響。硫酸吲哚酚及對硫甲酚為親蛋白質的尿毒素，能與血清白蛋白結合，因此經由血液透析也無法有效地清除。AST-120是一種口服的尿毒素吸附劑，可在腸道中吸附胺基酸代謝所產生硫酸吲哚酚及對硫甲酚的前驅物，減少尿毒素在慢性腎病患者體內的堆積，延緩慢性腎臟病患者病程的進展。本文除探討硫酸吲哚酚或對硫甲酚等尿毒素對身體所產生病理傷害外，並討論AST-120在慢性腎臟病患者治療上所扮演的角色。

關鍵字

慢性腎臟病(Chronic kidney disease) ； 硫酸吲哚酚(Indoxyl sulfate) ； 對硫甲酚(P-cresyl sulfate) ； 尿毒素吸附劑(AST-120)

並列摘要

Uremic toxins are related with the deterioration of Chronic Kidney Disease (CKD). Uremic toxins can induce inflammatory reaction and enhance oxidative stress, which prompt the glomerular sclerosis and interstitial fibrosis to aggravate a decline in renal function. Some studies have approved uremic toxins: Indoxyl sulfate (IS) and P-cresol or p-cresyl sulfate (PCS) play an important impact for worsening renal function and poor prognosis in CKD patients. IS and PCS attach to serum albumin with high protein binding affinity, therefore they cannot be effectively removed via hemodialysis. AST-120, an orally administered intestinal sorbent, adsorbs the precursors of IS/PCS, produced from amino acid metabolism. Accordingly, AST-120 reduces uremic toxins accumulate in serum and slows the progression of CKD. This article will discuss how IS/PCS cause pathological damage in body and the role of AST-120 in CKD treatment.