| Serum ?2-microglobulin??2-MG? is produced by the liver, and it increases in patients with hepatitis B virus infection. Serum ?2-MG is removed by renal excretion. Due to renal function exhaustion, serum ?2-MG can not be removed by kidney, so it increases in patients with end stage renal disease. It is unknown that what is the level of serum ?2-MG in chronic hepatitis B patients that on hemodialysis?HD?, there is also no related research report at home and abroad. The accumulation of ?2-MG results in dialysis-related amyloidosis. At present, the treatment methods of serum ?2-MG include high flux hemodialysis?HFHD?, hemodiafiltration?HDF? and hemodialysis plus hemoperfusion?HD+HP?. The cost of HFHD is high, it has opposite ultrafiltration and pyrogen reaction, even it can cause nutrition loss. The domestic research results are different about whether HP can clean serum ?2-MG. The treatment frequency of HDF and HD+HP is different in clinical, and there is also no consistent standard about it. Our aim is to observe the level of serum ?2-MG in chronic hepatitis B patients that on HD, and discuss its influencing factors, and find an effective treatment method and its appropriate treatment frequency on cleaning serum ?2-MG. In order to delay the happening of dialysis-related amyloidosis, and improve the survival rate and quality of life of dialysis patients.Referring to Guidelines for Chronic Hepatitis B in China?version 2010?, 30 chronic hepatitis B patients that on HD are selected and included in this study?HBV+group?. 30 HD patients with hepatitis B virus?HBV? negative are selected as control?HBV-group?. Collect study information. Blood laboratory indexes of the two groups are compared by independent-sample t test. Risk factors of serum ?2-MG are analyzed with multiple linear regression analyses. We conclude that the level of serum ?2-MG in HBV+group is?65.64±10.18??g/ml, it is significantly higher than that in HBV-group?44.90±12.81? ?g/ml?P<0.010?. Multiple linear regression analyses show that the level of serum ?2-MG is negatively related to serum albumin?ALB??B=-0.001,P=0.015?, and positively related to HBV+, duration of dialysis and alanine aminotransferase?ALT??B=14.127, P=0.000; B=0.421,P=0.001; B=0.077, P=0.032?.The 30 chronic hepatitis B patients that on HD are randomly assigned to the hemodiafiltration group?HDF group? and hemodialysis plus hemoperfusion group?HD+HP group?. The two groups are given four months treatment of HDF and HD+HP respectively, the treatment frequency in each month is respectively once every two weeks, once a week, twice a week, and three times a week. Test serum ?2-MG level before and after treatment. Compare clearance indicators of serum ?2-MG after treatment by independent-sample t test between HDF group and HD+HP group. Compare drop rate of serum ?2-MG after different frequency treatment by paired-sample t test within HDF group or HD+HP group. By comparison, we find that serum ?2-MG has significantly decreased after treatment in either HDF group or HD+HP group?P<0.010?. The clearance rate of serum ?2-MG in HD+HP group is significantly higher than that in HDF group? 34.59±10.11 VS 16.56±4.02,P<0.010?. The drop rates of serum ?2-MG after once a week HDF, twice a week HDF, and three times a week HDF are higher than that after once every two weeks HDF?P<0.010?. The drop rates of serum ?2-MG after once a week HD+HP, twice a week HD+HP, and three times a week HD+HP are higher than that after once every two weeks HD+HP?P<0.010?.From what has been discussed above, we conclude that the level of serum ?2-MG in chronic hepatitis B patients that on HD is significantly high when compared with HD patients with HBV-. The level of serum ?2-MG is associated with serum ALB and ALT, the same with HBV+ and duration of dialysis. Both HDF and HD+HP can clean serum ?2-MG effectively. The clearance rate of serum ?2-MG by HD+HP is significantly higher than that by HDF. At least once a week HDF or HD+HP can clean serum ?2-MG effectively. Combine cost factors, once a week HDF or HD+HP treatment on cleaning serum ?2-MG can reach clinical curative effect and reduce costs. |
PDF Full Text Request