透析器膜材料的研究进展-PPT.pptVIP

透析器的封装与切割 切割工艺比较 高通量（HIGH FLUX）-KUF20 ml/hr.mmHg 用于HDF/HF 和HIGH FLUX HD CTA/TRICEA, AN69, Nephral ST, Polyflux, DIAPES, Xenium, Polysulfone, PMMA. 低通量（LOW FLUX）-Kuf 20ml/hr.mmHg Cuprophan, Hemophan, Cellulose Acetate, LF Polysulfone, LF PMMA, EVAL, LF PES 基于通透性的膜的分类 (Materials) Cellulose Hollow Fiber Polysulfone Hollow Fiber Polyacryronitrile Hollow Fiber Hemodialyser Plasma Therapy Products Leukocyte Reduction Filter Polyethylene Hollow Fiber Cellulose diacetate Hollow Fiber Amino acids immobilized PVA Styrene divinyl benzene Column Activated charcoal Column Polyethylene Hollow Fiber Non-woven polyester sheet Low-Flux Urea 1 Creatinine 1 Vitamin B12 0.65 Inulin 0.05 ?2-microglobulin 0 Albumin 0 High-Flux Urea 1 Creatinine 1 Vitamin B12 1 Inulin 1 ?2-microglobulin 0.65 0.8 Albumin 0.001 透析器 / 膜的筛系数 提高的中大分子清除能力 透析膜的吸附能力 -脂蛋白A和脂多糖 Source: Weber et al. Int J Artif Organs 1997, 20: 144-152 聚甲基丙烯酸甲酯膜（PMMA)、AN69膜吸附能力最强 聚酰胺膜（PA)和聚砜膜（PS）次之 铜仿膜的吸附能力最差 高通量透析器的吸附功能不完全相同： 临床益处 透析膜和死亡率 Krane V et al. Am J Kidney Dis (2007); 49:267-275 透析膜和死亡率 (Woods et al.) 膜通量和膜材料对淀粉样变性的影响 (Hemo Study) b2m MD=11,800D Schiffl et al. Nephrol Dial Transplant 15:1399-1409, 2000 Improvement of lipid profile *p0.05 vs time 0 and 4 weeks time [weeks] Modified Cellulose Polyflux S 0 20 40 60 80 100 120 0 4 12 20 28 lipid concentration [mg/dl] 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 ratio LDL/HDL * * * * LDL HDL LDL/HDL Pitone J et al, ISBP, 2003 Modified cellulose versus Polyflux S 43 patients Polyflux: Improvements in lipid profile may help to reduce the lipid lowering medications 保存残余肾功能 Inflammatory markers and dialysis membrane randomized cross-over study in 18 patients, 3 x 8 weeks Ref: Schindler et al, 2000 对血清白蛋白的影响 (Hemo study) Marcus et al. Am J Kidney Dis 31: 491-494, 1998 用 F80之前 用 F80之后 ** * ** * * P0.05 ** P0.01 血清白蛋白 (g/dl) Low-Fux High-Fux 死亡率 生存率 白蛋白水平 传统透析膜的改进 研发新型透析膜 发展生物活性膜 1.利用几种高分子材料物理共混 聚醚砜膜+聚乙烯