血液透析中透析溶質特性探討

The Behavior of Solutes in Hemodialysis

黃冠崧(Kuan-Sung Huang)

指導教授 ： 張炎林

中原大學/工學院/生物醫學工程研究所/碩士(2012年)

https://doi.org/10.6840/cycu201201028

摘要

血液透析為目前最常採用治療末期腎臟疾病(ESRD)之療法，是以擴散及運流方式將血液中的尿毒溶質去除。本研究第一部份探討血液透析時使用之透析器血液廓清特性。血液廓清的部份是依照國際標準ISO8637:2010要求，測試國內研發的中空纖維透析器廓清率性能。透析器有兩型160及180，各取3個透析器進行測試。透析器廓清率性能測試範圍涵蓋廠商標示之血液流量、透析液流量以及溶質之總質傳面積係數(K0A)。測試溶質包括尿素、肌酸酐、磷酸鹽及維生素B12。在透析液流量為500 mL/min及血液流量為200、300、350、400及500 mL/min下計算之廓清率值，再經計算求得平均K0A，得到透析器160及180對於四種溶質之K0A為824、588、518、302 mL/min及894、642、549、316 mL/min。然而利用理論公式計算出不同流量下之廓清率理論值，其結果與實驗值相較之下偏差值在±5%內，顯示理論公式可用於臨床應用計算。第二部份是於透析液中添加鐵焦磷酸鹽及EGCG抗氧化劑，探討含鐵質及抗氧化透析液之潛在應用。結果顯示鐵質透析液會造成血液中脂質氧化程度上升。透析液中含EGCG在透析5分鐘後血液中測得FRAP數值逐漸上升，表示EGCG逐漸進入血液中，且在透析期間皆能穩定提供定量EGCG，能夠增加血液中的抗氧化能力並保護血液中成份避免鐵質對人體造成的氧化損傷，可以用來改善透析患者體內之氧化壓力。

關鍵字

溶質 ； 血液透析 ； 抗氧化劑 ； 氧化壓力 ； 廓清率

並列摘要

Hemodialysis is the most comment method for the treatment of patients with end-stage renal failure (ESRD). The principle of hemodialysis is to remove uremic toxins from uremic patients through diffusion and convection. This dissertation includes two parts. First part of this dissertation is to discuss about the characteristics of clearance for hemodialyzers based on ISO regulation ISO8637:2010. The tested hemodialyzers were produced in Taiwan. The models of the tested hemodialyzers were 160 and 180. The results for all of the evaluations were obtained by performing 3 hemodialyzers for each model. The evaluations for hemodialyzers covered all necessary indices including blood flow, dialysate flow, K0A, and clearance of blood urea, creatinine, phosphorous ion as well as vitamin B12. Under constant dialysate flow rate (500 mL/min) and different blood flow rates (200, 300, 350, 400 and 500 mL/min), we found that mean K0A values for hemodialyzer model 160 and 180 are 824, 588, 518, 320 mL/min and 894, 624, 549, 316 mL/min, respectively based on the clearance of above dialysate solutes. In addition, we calculated the theoretical clearance values for above two hemodialyzers by using theoretical equations. The variable between theoretical clearance values and experimental clearance values is less than 5%. This result shows that the theoretical equations may be applied in clinical use in calculating clearance values for hemodialyzer. Second part of my dissertation is to discuss the potential use of ferric pyrophosphate and epigallocatechin gallate (EGCG) in dialysate. The experimental results showed that addition of ferric pyrophosphate into dialysate (iron dialysate) is capable of inducing the increase of oxidative stress during hemodialysis. Meanwhile, addition of ferric pyrophosphate and EGCG into dialysate (iron-EGCG dialysate) can reduce oxidative stress induced by iron. This result may be due to the diffusion of EGCG from dialysate to blood, leading to increase antioxidant potential of blood and decrease oxidative damage induced by iron. We suggest that these findings could be an effective method for improving oxidative stress in patients with hemodialysis.

並列關鍵字

Solute ； Antioxidant ； Clearance ； Oxidative stress ； Hemodialysis

參考文獻

[1] ISO 8637, Hemodialyzers, hemodiafilters, hemofilters and hemoconcen- trators(2010).

[7] 鄭振傑：血液透析機標準比較與性能測試研究，中原大學生物醫學工程學系碩士論文(2009)。

[27] 陳冬生：氧化壓力檢測平台之開發與降低血液透析病人氧化壓力之策略，中原大學生物醫學工程學系博士論文(2009)。

[28] 吳妙玲：抗氧化劑之血液透析動力學模式與試驗探討，中原大學生物醫學工程學系碩士論文(2010)。

[37] 蔡旻都，陳皓君：蔬果中類黃酮之抗氧化作用與生物活性，中國化學會，64(3)，353-315(2006)。