接受血液透析治疗的慢性乙肝患者血清β2-微球蛋白水平及其影响因素和清除的研究

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

摘要：目的：探讨接受血液透析治疗的慢性乙肝患者血清β2-微球蛋白（β2-MG）水平及其影响因素和清除情况。方法：选取2017年1月至2018年12月在我院血液透析治疗的60例慢性乙肝患者为观察组，同期选取60例非透析治疗的慢性乙肝患者为对照组，比较两组患者血清β2-MG水平和清除情况，分析其相关影响因素。结果：观察组患者血清β2-MG水平高于对照组（P<0.05），且透析时β2-MG清除率远高于非透析治疗患者（P<0.05）。年龄、病程、血清ALT、护理质量、感染史等因素均与β2-MG水平相关（P<0.05）。结论：血液透析治疗的慢性乙肝患者血清β2-MG水平高于非透析治疗患者，且β2-MG清除率明显高于非透析治疗患者；患者年龄、病程、肝功能指标、护理质量和感染史等因素影响β2-MG水平与清除情况。

关键词：血液透析治疗；慢性乙肝；β2-微球蛋白；清除率；影响因素

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