Pomen določanja esencialnih in toksičnih elementov pri dializnih bolnikih

magistrski študij laboratorijske biomedicine

Žan Pušnik (Avtor), Milan Skitek (Mentor), Alenka France Štiglic (Komentor)

Povzetek

Kronična ledvična bolezen povzroča trajno okvaro ledvic, zdravljenje pa poteka z dializo. Dializa je postopek prečiščevanja krvi z odstranjevanjem neţelenih snovi in dodajanjem ţelenih snovi skozi polprepustno membrano hemodializatorja. Hemodializa deluje po principu difuzije, hemodiafiltracija pa poleg difuzije izkorišča še ultrafiltracijo. Dializni bolniki so letno izpostavljeni od 15000 L do 20000 L dializne tekočine, kar lahko posledično vpliva na koncentracije esencialnih in toksičnih elementov. Ţeleli smo preveriti, ali imajo dializni bolniki niţje koncentracije esencialnih elementov (baker, cink, krom, molibden in selen v plazmi ter mangan v krvi) in višje koncentracije toksičnih elementov (aluminij in nikelj v plazmi ter arzen, kadmij, svinec in ţivo srebro v krvi) kot kontrolna skupina zdravih preiskovancev. Prav tako smo želeli ugotoviti, ali je količina rezidualne diureze pri dializnih bolnikih povezana s koncentracijami elementov, ki se izločajo preteţno preko ledvic, ali je trajanje dializnega zdravljenja povezano z niţjimi koncentracijami esencialnih elementov in višjimi koncentracijami toksičnih elementov ter, če imajo dializni bolniki na hemodiafiltraciji niţje koncentracije esencialnih elementov in višje koncentracije toksičnih elementov kot bolniki na hemodializi. Vzorce smo analizirali na masnem spektrometru z induktivno sklopljeno plazmo. Za esencialne elemente smo ugotovili, da imajo dializni bolniki v primerjavi s kontrolno skupino niţje koncentracije bakra (743,6 μg/L; 878,8 μg/L), cinka (634,7 μg/L; 769,1 μg/L) in selena (64,81 μg/L; 89,21 μg/L) ter višje koncentracije kroma (2,2 μg/L; 0,28 μg/L), molibdena (4,6 μg/L; 0,81 μg/L) in mangana (9,38 μg/L; 7,65 μg/L). Izmed toksičnih elementov imajo dializni bolniki višje koncentracije aluminija (2,83 μg/L; 1,73 μg/L), kadmija (1,27 μg/L; 0,35 μg/L), niklja (2,06 μg/L; 0,33 μg/L) in svinca (74,33 μg/L; 18,42 μg/L) ter niţje koncentracije ţivega srebra (0,47 μg/L; 1,27 μg/L) kot kontrolna skupina, koncentracije arzena pa se med skupinama statistično pomembno ne razlikujejo. Ugotovili smo, da imajo dializni bolniki z večjo rezidualno diurezo niţje koncentracije kroma, niklja, kadmija in svinca. Trajanje dializnega zdravljenja je povezano z višjimi koncentracijami bakra in svinca ter niţjimi koncentracijami ţivega srebra. Bolniki na hemodiafiltraciji so imeli višje koncentracije niklja in niţje koncentracije arzena kot bolniki na hemodializi. V prihodnje bi bilo smiselno meriti koncentracije še po končani dializi ter v dializni tekočini pred in po dializi, da dobimo še bolj jasno sliko kako dializa vpliva na elemente v sledovih.

Ključne besede

hemodiafiltracija;esencialni elementi;toksični elementi;masna spektrometrija;induktivno sklopljena plazma;

Podatki

Jezik:	Slovenski jezik
Leto izida:	2017
Tipologija:	2.09 - Magistrsko delo
Organizacija:	UL FFA - Fakulteta za farmacijo
Založnik:	[Ž. Pušnik]
UDK:	543.51:616.61-78(043.3)
COBISS:	4331121
Št. ogledov:	342
Št. prenosov:	57
Ocena:	0 (0 glasov)
Metapodatki:

Ostali podatki

Sekundarni jezik:	Angleški jezik
Sekundarni naslov:	ǂThe ǂimportance of essential and toxic elements determination in dialysis patient
Sekundarni povzetek:	Chronic kidney disease causes permanent kidney damage and is treated with dialysis. Dialysis is a blood purification technique which removes unwanted molecules and adds necessary substances through a semi-permeable membrane of a haemodialyser. Haemodialysis uses diffusion as its mechanism of action, whereas haemodiafiltration uses ultrafiltration as well as diffusion. Dialysis patients are exposed to 15000 to 20000 L of dialysis fluid per year and are therefore at risk for altered concentrations of essential and toxic elements. We wanted to see if dialysis patients have lower concentrations of essential elements (copper, zinc, chromium, molybdenum and selenium in plasma and manganese in blood) and higher concentrations of toxic elements (aluminium, nickel in plasma and arsenic, cadmium, lead and mercury in blood) compared to the control group of healthy volunteers. Additionally, we wanted to determine if the volume of residual diuresis of dialysis patients is associated with lower concentrations of elements, primarily eliminated by kidneys; if the duration of the dialysis treatment is associated with lower concentrations of essential elements and higher concentrations of toxic elements; and whether dialysis patients treated with haemodiafiltration have lower concentrations of essential elements and higher concentrations of toxic elements as opposed to patients treated with haemodialysis. Samples of plasma and blood were analysed with inductively coupled plasma mass spectrometry. Our results regarding essential elements show that dialysis patients had decreased level of copper (743,6 μg/L; 878,8 μg/L), zinc (634,7 μg/L; 769,1 μg/L) and selenium (64,81 μg/L; 89,21 μg/L) as well as increased levels of chromium (2,2 μg/L; 0,28 μg/L), molybdenum (4,6 μg/L; 0,81 μg/L) and manganese (9,38 μg/L; 7,65 μg/L) in comparison with the control group. Compared with the control group, dialysis patients showed increased levels of aluminium (2,83 μg/L; 1,73 μg/L), cadmium (1,27 μg/L; 0,35 μg/L), nickel (2,06 μg/L; 0,33 μg/L) and lead (74,33 μg/L; 18,42 μg/L), decreased level of mercury (0,47 μg/L; 1,27 μg/L), whereas arsenic level showed no significant difference between the groups. We found decreased level of chromium, nickel, cadmium and lead in dialysis patients with greater residual diuresis. The duration of dialysis treatment was associated with higher level of copper and lead, and lower level of mercury. Haemodiafiltration patients had increased level of nickel and decreased level of arsenic, compared with haemodialysis patients. In the future it would be useful to determine essential and toxic element concentrations after a dialysis session, as well as in fresh and used dialysis fluids, which would give us a much clearer picture of the effect of dialysis treatment on trace element levels.
Sekundarne ključne besede:	Hemodializa;
Vrsta dela (COBISS):	Magistrsko delo/naloga
Komentar na gradivo:	Univ. Ljubljana, Fak. za farmacijo
Strani:	IX, 57 str.
ID:	12044630