| Objectives: To observe the level of maintenance hemodialysis patients’ serumβ2-microglobulin and analyze relevant factors.Methods: 128 patients of CKD5 maintenance hemodialysis(MHD) treated in the nephrology department of the second hospital of Dalian medical university during June~December, 2014 are chosen as objects of study, and another 73 patients with the same conditions are chosen as control group. All the patients meet the diagnosis standard of K/DOQI chronic kidney disease. Exclusion standards: patients with malignant tumor, acute cerebrovascular disease, severe cardiopulmonary disease,rheumatic autoimmune disease, hyperthyroidism, gout acute attack, allergic constitution,poor glycemic control, active inflammation, chronic infectious diseases(tuberculosis,virus hepatitis, parasites, etc) and liver function damage. Patients’ e GFR is calculated by using the abbreviated modification of diet in renal disease(MDRD) equation. Based on the diagnosis and staging made in accordance with K/DOQI(The Kidney Disease Outcomes Quality Initiative) for chronic kidney disease patients, patients are divided into CKD5 MHD group and control group(patients with normal renal function). There are 66 male MHD patients(51.56%) and 62 female MHD patients(48.43%). The average age is 52.82±6.15, and average dialysis age is 46.76±25.71 months. Regular hemodialysis age is more than 3 months(at least 3 times a week), and blood flow is around 200-250ml/min, Kt/V≥1.2. For patients treated with intermittent CVVH treatment, bicarbonate substitution fluid rate is 3000-4000ml/h, and each infusion lasts for 6-8h. There are 38 male patients(52.05%) and 35 female patients(47.95%) in thecontrol group, with an average age of 48.71±5.19. All the objects are aware of the study and agree to participate in it. General clinical data of all objects are collected, including gender, age, dialysis age, etc. Automatic analyser is used to measure cholesterol, low density lipoprotein(LDL), high density lipoprotein(HDL), triglyceride, high-sensitivity C-reactive protein(HS-CRP), blood calcium and blood phosphate; Radioimmunoassay method is used to measure intact parathyroid hormone(PTH); ELISA method is used to measure serum β2-microglobulin concentration. SPSS17.0, a statistical software, is used for data statistic analysis and processing. With p<0.05, differences are statistically significant.Results: For patients in the control group, with p>0.05, there exists no significant linear correlation between the serum β2-MG and age, total cholesterol, triglyceride,blood calcium, blood phosphate, CRP and PTH. For MHD patients, there is no linear correlation between serum β2-MG and age(r=0.000, P=0.997). The analysis of linear correlation between average dialysis age(46.76±25.71 months) and serum β2-MG is of statistical significance(r=0.255,p=0.004). Based on 24 h urine volume, MHD patients are divided into 3 subgroups, with the urine volume of subgroup 1<100 ml(62 patients),subgroup 2: 100~400ml(39 patients) and subgroup 3>400ml(27 patients), the average serum β2-MG for the three subgroups are respectively(18.23±1.02)mg/L,(17.33±0.81)mg/L,(16.89±0.87)mg/L. By comparison(one-way ANOVA), with F=8.434, P<0.001, the differences are of statistical significance. Linear trend test(F=14.23, P<0.001) indicates that there is remarkable correlation between residual urine volume and β2-MG. There is linear correlation between MHD patients’ serum β2-MG and UA(r=0.655, p=0.027), CRP(r=0.557, p<0.001) and PTH(r=0.531, p=0.003). The correlation between MHD patients’ serum β2-MG and CRP is remarkable. To further study the relationship of MHD patients’ serum β2-MG level and the relevant factors, 60 MHD patients are randomly chosen for analysis. In accordance with residual urine volume during the dialysis intermission, these patients are divided into urine volume≥200ml/24 h and urine volume<200ml/24 h. The result shows that the β2-MG of urine volume≥200ml/24 h is(16.94+0.72) mg/L, lower than that of the urinevolume<200ml/24h((18.17+1.24) mg/L), so the difference is of statistical significance(P<0.05). To study the influence of MHD patients’ microinflammatory state on β2-MG,50 MHD patients are randomly chosen for analysis. In accordance with whether Hs-CRP is perfectly normalduring the dialysis intermission, these patients are divided into two subgroups. The result shows that β2-MG concentration of subgroup with normal Hs-CRP is(17.53±1.08) mg/L, and β2-MG concentration of subgroup with higher Hs-CRP is(18.47±0.89) mg/L. There is statistical difference in the β2-MG of the two subgroups. β2-MG concentration of of subgroup with higher Hs-CRP is higher than that of the subgroup with normal Hs-CRP. To observe the influence of dialysis modalities on MHD patients’ serum β2-MG level, 48 MHD patients are chosen for analysis, with 26 patients in the HD subgroup, and 22 patients in the intermittent CVVH subgroup. The values of β2-MG before and after a single dialysis is observed, The result shows that, for the CVVH subgroup, the pre-dialysis β2-MG is(18.67±0.60)mg/L, and the post-dialysis β2-MG is(16.13±0.75)mg/L. There is statistical difference between the pre-dialysis and post-dialysis values(P<0.05). For HD subgroup, the pre-dialysisβ2-MG is(18.49±0.69)mg/L, and the post-dialysis β2-MG is(17.37±0.54)mg/L. There is no statistical difference between the pre-dialysis and post-dialysis values(P>0.05).Conclusions:The serum β2-MG level of MHD patients is related to factors like dialysis age,parathyroid function, etc. However, it is more closely related to patients’ residual urine volume, dialysis modalities and chronic microinflammatory state. |
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