接受血液透析治療的慢性乙肝患者血清β2-微球蛋白水平及其影響因素和清除的研究

接受血液透析治療的慢性乙肝患者血清β2-微球蛋白水平及其影響因素和清除的研究接受血液透析治療的慢性乙肝患者血清β2-微球蛋白水平及其影響因素和清除的研究

摘要：目的：探討接受血液透析治療的慢性乙肝患者血清β2-微球蛋白（β2-MG）水平及其影響因素和清除情況。方法：選取2017年1月至2018年12月在我院血液透析治療的60例慢性乙肝患者為觀(guān)察組，同期選取60例非透析治療的慢性乙肝患者為對(duì)照組，比較兩組患者血清β2-MG水平和清除情況，分析其相關(guān)影響因素。結(jié)果：觀(guān)察組患者血清β2-MG水平高于對(duì)照組（P<0.05），且透析時(shí)β2-MG清除率遠(yuǎn)高于非透析治療患者（P<0.05）。年齡、病程、血清ALT、護(hù)理質(zhì)量、感染史等因素均與β2-MG水平相關(guān)（P<0.05）。結(jié)論：血液透析治療的慢性乙肝患者血清β2-MG水平高于非透析治療患者，且β2-MG清除率明顯高于非透析治療患者；患者年齡、病程、肝功能指標(biāo)、護(hù)理質(zhì)量和感染史等因素影響β2-MG水平與清除情況。

關(guān)鍵詞：血液透析治療；慢性乙肝；β2-微球蛋白；清除率；影響因素

Introduction:ChronichepatitisBisacommonliverdiseaseinclinicalpractice.HemodialysistreatmentisoftenusedforpatientswithseverecomplicationsduetohepatitisB.Thelevelofβ2-microglobulin(β2-MG)inbloodserumisanimportantindicatorforevaluatingtheclearancefunctionofhemodialysis.Thisstudyaimedtoinvestigatethelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatment,aswellasitsinfluencingfactorsandclearance.

Methods:SixtychronichepatitisBpatientsundergoinghemodialysistreatmentinourhospitalfromJanuary2017toDecember2018wereselectedastheobservationgroup.SixtychronichepatitisBpatientswhoreceivednon-dialysistreatmentduringthesameperiodwereselectedasthecontrolgroup.Thelevelsofserumβ2-MGanditsclearancewerecomparedbetweenthetwogroups,andtherelatedinfluencingfactorswereanalyzed.

Results:Thelevelofserumβ2-MGintheobservationgroupwashigherthanthatinthecontrolgroup(P<0.05),andtheβ2-MGclearancerateduringhemodialysiswassignificantlyhigherthanthatofnon-dialysistreatmentpatients(P<0.05).Age,courseofdisease,serumALT,nursingquality,infectionhistoryandotherfactorswereallrelatedtothelevelofβ2-MG(P<0.05).

Conclusion:Thelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentishigherthanthatofnon-dialysispatients,andtheβ2-MGclearancerateissignificantlyhigherthannon-dialysispatients.Age,courseofdisease,liverfunctionindexes,nursingquality,infectionhistory,etc.haveanimpactonthelevelofβ2-MGanditsclearanceIntroduction:

ChronichepatitisBisaseriousliverdiseasethatcanleadtolivercirrhosisandhepatocellularcarcinoma.Hemodialysistreatmentisacommontreatmentforpatientswithend-stagerenaldisease,andpatientswithchronichepatitisBmayneedtoundergohemodialysistreatment.β2-Microglobulin(β2-MG)isasmallmolecularproteinthatisexcretedbythekidneysandisanimportantindicatorofrenalfunction.Thelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentisnotwellunderstood.Thisstudyaimstoinvestigatethelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentanditsinfluencingfactors.

Methods:

120patientswithchronichepatitisBwereenrolledinthisstudy,ofwhich60receivedhemodialysistreatmentand60didnotreceivedialysistreatment.Thelevelofserumβ2-MGinthesepatientswasmeasuredbeforeandafterhemodialysistreatment.Theinfluencingfactorsofβ2-MGwereanalyzed,includingage,courseofdisease,liverfunctionindexes,nursingquality,infectionhistory,etc.

Results:

Thelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentwassignificantlyhigherthanthatofnon-dialysispatients(P<0.05).Theβ2-MGclearancerateinhemodialysispatientswassignificantlyhigherthanthatinnon-dialysispatients(P<0.05).Theage,courseofdisease,serumcreatinine,serumALT,nursingquality,infectionhistoryandotherfactorswereallrelatedtothelevelofβ2-MG(P<0.05).

Conclusion:

Inconclusion,thelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentishigherthanthatofnon-dialysispatients.Theβ2-MGclearancerateissignificantlyhigherindialysispatientsthaninnon-dialysispatients.Age,courseofdisease,liverfunctionindexes,nursingquality,infectionhistory,etc.haveanimpactonthelevelofβ2-MGanditsclearance.Cliniciansshouldpayattentiontothelevelofserumβ2-MGinchronichepatitisBpatientsundergoinghemodialysistreatmentandtakemeasurestopreventfurtherdamagetotheliverandkidneysInadditiontoserumβ2-MG,thereareotherindicatorsthatcanbeusedtoassessliverandkidneyfunctioninchronichepatitisBpatientsonhemodialysis.Serumcreatinine,bloodureanitrogen,alaninetransaminase,andaspartatetransaminaselevelsarecommonlyusedindicatorsinclinicalpractice.Theseindicatorscanreflectthepatient'sliverandkidneyfunctionandhelpcliniciansadjusttreatmentplansinatimelymanner.

LiverandkidneydysfunctionaresignificantcomplicationsinchronichepatitisBpatientsundergoinghemodialysis.Itiscrucialtopreventfurtherdamagetotheliverandkidneysandmanagethesecomplicationseffectively.Inclinicalpractice,cliniciansshouldpayattentiontothefollowingaspects:

1.Regularmonitoringofliverandkidneyfunction:Regularmonitoringofliverandkidneyfunctioncandetectdysfunctionearlyandmaketimelyadjustmentstotreatmentplans.Cliniciansshouldestablisharegularmonitoringmechanismforliverandkidneyfunctionandcloselytrackanychangesintheseindicators.

2.Optimizehemodialysistreatment:Optimalhemodialysistreatmentcanalleviatetheburdenontheliverandkidneysandreducetheriskofcomplicationdevelopment.Cliniciansshouldadjustthehemodialysistreatmentplanbasedonthepatient'scondition,includingfrequency,duration,anddialysateflowrate.

3.Preventandtreatinfections:InfectionisacommoncomplicationinchronichepatitisBpatientsundergoinghemodialysis.Itcanleadtofurtherdamagetotheliverandkidneysandmayevenbelife-threatening.Cliniciansshouldstrengthenthepreventionandtreatmentofinfections,includinghandhygiene,environmentalhygiene,andantibioticuse.

4.Improvenursingquality:NursingqualitycansignificantlyaffectpatientoutcomesinchronichepatitisBpatientsundergoinghemodialysis.High-qualitynursingcarecanimprovepatientcomfort,reducecomplications,andpromoterecovery.Cliniciansshouldoptimizenursingcaredeliveryandensurethatpatientsreceiveappropriatecareandsupport.

Inconclusion,serumβ2-MGisavaluableindicatorforassessingliverandkidneyfunctioninchronichepatitisBpatientsundergoinghemodialysis.Cliniciansshouldpayattentiontoitslevelandclearancerate,aswellasotherindicators,topreventfurtherdamagetotheliverandkidneysandmanagecomplicationseffectively.Acomprehensivetreatmentplanthatincludesregularmonitoring,optimalhemodialysistreatment,infectionprevention,andhigh-qualitynursingcarecanimprovepatientoutcomesandpromoterecoveryInadditiontomonitoringALTandASTlevels,cliniciansshouldalsomonitorlevelsofotherliverandkidneyfunctionindicators,suchasserumcreatinine,bloodureanitrogen(BUN),albumin,andbilirubin.Theselevelscanbeaffectedbyanumberoffactors,includingage,gender,bodysize,andmedicationuse,soitisimportanttointerprettheminthecontextoftheindividualpatient'smedicalhistoryandcurrentstatus.

Serumcreatinineisacommonlyusedindicatorofrenalfunction.Itisproducedbymusclemetabolismandfilteredbythekidneys,solevelscanbeaffectedbymusclemass,hydrationstatus,andotherfactors.Normalserumcreatininelevelsrangefrom0.6to1.2mg/dLformenand0.5to1.1mg/dLforwomen,butthesevaluesmaybehigherinpatientswithchronickidneydiseaseorundergoinghemodialysis.Elevatedserumcreatininelevelscanindicateimpairedkidneyfunction,buttheymayalsoreflectmusclebreakdownorotherfactors.

Bloodureanitrogen(BUN)isanotherindicatorofrenalfunction.Itmeasurestheamountofureaintheblood,whichisproducedwhentheliverbreaksdownproteins.NormalBUNlevelsrangefrom7to20mg/dL,butthesevaluesmaybehigherinpatientswithkidneydiseaseorundergoinghemodialysis.ElevatedBUNlevelscanindicateimpairedkidneyfunctionordehydration,buttheymayalsoreflectdietaryfactorsorotherfactors.

Albuminisaproteinproducedbytheliverthathelpsmaintainosmoticpressureinthebloodandtransportshormones,drugs,andothersubstances.Normalalbuminlevelsrangefrom3.5to5.0g/dL,butthesevaluesmaybelowerinpatientswithliverdiseaseormalnutrition.Lowalbuminlevelscanindicateliverdysfunctionormalnutrition,buttheymayalsoreflectotherfactors.

Bilirubinisayellowpigmentproducedbytheliverasabyproductofthebreakdownofredbloodcells.Itisexcretedinbileandgivesurineitscharacteristicyellowcolor.Normaltotalbilirubinlevelsrangefrom0.3to1.2mg/dL,butthesevaluesmaybehigherinpatientswithliverdiseaseorhemolysis.Elevatedbilirubinlevelscanindicateliverdysfunctionorhemolysis,buttheymayalsoreflectotherfactors.

Inadditiontomonitoringtheseindicators,cliniciansshouldalsomonitortheclearancerateoftheseindicatorsduringhemodialysis.Thiscanhelpdeterminewhetherthecurrenthemodialysisregimenisadequateforremovingwasteproductsandmaintainingoptimalorganfunction.Clearanceratescanbecalculatedusingvariousformulasandtechniques,suchastheKt/Vformula,whichmeasurestheamountofbloodclearedofureaduringdialysis.

Finally,cliniciansshouldalsoconsiderotherfactorsthatcanaffectliverandkidneyfunction,suchasinfections,medications,andcomorbidities.HepatitisBpatientsundergoinghemodialysisareatincreasedriskforinfections,particularlyviralinfectionssuchashepatitisCandHIV.Theymayalsorequiremedicationstomanagevarioussymptomsandcomplicationsoftheircondition,butthesemedicationscaninteractwithothermedicationsandpotentiallycauseorgandamage.Therefore,regularmonitoringandadjustmentof