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1、Xing Changying(邢昌赢）Department of NephrologyJiangsu Province HospitalNanjing Medical University,Blood Purification,(2012-9-26),DefinitionPrincipleCategoryComplication,Definition,Artificial Equipments,or peritoneal membraneRemove waste or bad materialsSupply useful materialsKeep balance,血液净化适应症,CKD 5期
2、AKI 23期中毒免疫系统疾病顽固性心衰ARDS重症胰腺炎重症肝病高脂血症,Defining“Chronic Kidney Disease,CKD”,Kidney damage for 3 months,defined by structural or functional abnormalities of the kidney,with or without decreased GFR,manifest by eitherPathologic abnormalities,orMarkers of kidney damage,such as abnormalities of the blood
3、 or urine,or in imaging tests(but NOT HTN).GFR 60 mL/min/1.73 m2 for 3 months with or without kidney damage.,Gold Standards,Inulin clearanceTedious,time consuming&unavailableRadionuclides125Iodine-iothalamate,technetium DTPA,51Chromium-EDTA clearanceTime consuming and expensiveResearch,accurate drug
4、 dosing,Serum Creatinine:Problems,Non-renal influencesGender,ethnicity,age and muscle massNutrition/dietDrugs(e.g.cimetidine)Clinical utilityPoor sensitivity for CKDNot useful in ARFMuscle wasting disorders and amputeesAnalytical problemsNon-specificity(protein,ketones,ascorbic acid)No international
5、 standardizationSpectral interferences(icterus/lipaemia/haemolysis),http:/www.kidney.org/professionals/kdoqi/gfr_calculator.cfm,eGFR的计算,Stages of CKD by GFR,*It is helpful to think of GFR(mL/min/1.72m2)as an approximation of%Kidney function,Prevalence CKD,Stevens et al,EDTA-ERA Lisbon 2004,Adjusted
6、incident rates&annual percent change,Incident ESRD patients;rates adjusted for age,gender,&race.USRDS 2010 ADR,Kawaguchi YPDI 19(suppl2)1999,我国ESRD救治率仍处于较低水平,世界各地终末期肾病治疗率每百万人口-1998,中国:ESRD增长率高于人口增长率,ESRD Patients,0.7%per year,10-12%per year,Population,Source&Courtesy Chinese Medical Insurance Agency
7、 2006 data presented in ISPD 2006 Dialysis Economics Roundtable,急性肾损伤Acute Kidney Injury,AKI的定义,广义：肾脏功能或结构异常，包括血、尿、组织学或影像学检测肾损伤标志物异常，时间不超过3个月。狭义：肾功能在48小时内突然减退：血肌酐升高绝对值 26.4 mol/L（0.3 mg/dL）；或肌酐较前升高50（增加1.5倍）；或尿量减少（尿量小于0.5ml/kg/h，时间超过6小时）。,2.1.1:Acute kidney injury(AKI)is defined as any of the follow
8、ing(Not Graded):,符合以下情况之一者即可诊断为AKI：48小时内Scr升高超过26.5mol/L(0.3mg/dl)；Scr升高超过基线1.5倍确认或推测7天内发生；尿量0.5ml/（kgh），且持续6小时以上。,2.1.2:AKI is staged for severity according to the following criteria(Not Graded):,Coca等对35,302例第一次行非心脏手术的糖尿病患者进行了回顾性队列研究，以确定急性肾损伤（AKI）病程是否对患者预后具额外的预测作用。根据急性肾损伤网络（AKIN）分期（1、2、3期）和病程短(2天)
9、、中(36天)、长(7天)期，研究者对发生AKI的患者进行分层。,ASN 2009 Congress,Siew等以4,863例住院患者为研究对象，评价基础肾功能的不同评估方法对AKI分期和预后的影响。研究所用血肌酐（SCr）评价方法包括：急性透析质量动议（ADQI）提出的eGFR为75ml/（min1.73m2）；入院后7天内最低SCr；入院时SCr。将上述方法所得SCr与患者入院前7365天内最新院外所测SCr相比较。,ASN 2009 Congress,Han等通过酶联免疫吸附法（ELISA）评估联合检测患者血、尿多种生物标志物是否可提高AKI诊断敏感性。研究共纳入94例AKI患者和211
10、例非AKI患者，根据各检测指标描绘出抽检特性曲线并计算用于AKI诊断的曲线下面积（AUC）值。,ASN 2009 Congress,血液净化的基本原理,Procedure,Principle,Procedure,Principle,Dialyzers,Principle,Dialyzer,Principle,Dialyzer,Principle,透析器膜的历史,Membranes for Medical Applications,regeneratedcellulose,modifiedcellulose,hydrophilized copolymers,hydrophobic/hydroph
11、ilicblend,syntheticmembranes,cellulosicmembranes,AN69(Hospal)PMMA(Toray)EVAL(Kuraray)PEPA(Nikkiso)SPAN(Akzo/Asahi),PA/PAES/PVP(Gambro)PAES/PVP(Hospal)PSU/PVP(Fresenius/Minntech/Braun Kawasumi,Toray,Asahi)PES/PVP(Membrana-Bellco-Baxter Nipro),Cuprophan(Membrana)RC(Asahi)RG(Tejin,Terumo),Hemophan(Memb
12、rana)CA,CTA(Membrana/Toyobo)SMC(Membrana)PEG(Asahi)SCE(Membrana/Tejin),透析器膜应用情况,全世界选择透析膜的趋势,39%,30%,31%,23%,33%,44%,5%,27%,67%,Data Courtesy Gambro Renal products,High-flux and high-efficiency dialysis,High-flux defined as dialyzer ultrafiltration coefficient20ml/hr/mmHgHigh-efficiency defined as di
13、alyzer ultrafiltration 1019ml/hr/mmHg,Low-flux HD High-flux HDHDF HF,透析器/膜的筛系数,DiffuseConvectionAdsorption,Principle,Hemodialysis(HD)血液透析Peritoneal Dialysis(PD)腹膜透析Continuous Renal Replacement Therapy(CRRT)连续性肾替代疗法Plasma Exchange(PE)血浆置换Hemoperfusion(HP)血液灌流Lipid Separation 血脂分离Artificial Liver 人工肝,
14、Category,Hemodialysis(HD)血液透析Bicarbonate Hemodialysis(BHD)血液透析 碳酸氢钠血液透析Hemofiltration（HF)血液滤过Hemodiafiltration(HDF)血液透析滤过Low-Flux Hemodialysis(LFD)低流率血液透析High-Flux Hemodialysis（HFD)高流率血液透析On-line Hemodiafiltration 联机血液透析滤过Single Ultrafiltration 单纯超滤,Category,Prepare dialysis machinePatientsAcupunctu
15、reConnect tubeAnticoagulateStart pumpObserveEnd,Procedure of HD,Procedure of HD dialysis machine,Procedure of HD dialysate,water suppliment,生物性污染物的清除,透析用水与透析液的细菌和内毒素标准指引,美国 AAMI RD-52 2004年标准-细菌 200 cfu/ml/内毒素 2 eu/ml超纯-细菌 0.1 cfu/ml/内毒素 0.03 eu/ml输注用透析液 细菌 1x10-6(1cfu/1000 liter)内毒素 0.03 eu/ml,最终透析
16、液的纯度分级,ISO 11663-2009 2009年4月标准-细菌 100 cfu/ml/内毒素 0.5 eu/ml超纯-细菌 0.1 cfu/ml/内毒素 0.03 eu/ml无菌无热源液 及 在线生产的置换液 细菌 1x10-6(1cfu/1000 liter)内毒素 0.03 eu/ml,透析液纯度,生物相容性提高改善透析病人微炎症反应降低透析相关并发症,透析用水品质评估,反馈控制,结果,目的,水处理系统的保养和维护 采用高品质的浓缩液 细菌超滤器的使用 科学系统的卫生规范,透析用水质量控制 反馈系统,透析用水纯度提高的核心,透析用水品质的质量梯度,标准透析用水,标准透析液,+浓缩液+
17、消毒（反渗系统+血透机）,超纯透析液,+细菌超滤器,无菌无热原液体,+超滤器,Max:100-200 100-200 0.1 10-6 CFU/mlMax:0.25-20.25-2 0.03 0.03 EU/ml,Ref:Ledebo,Blood Purif,2004,重复使用,一次性,透析用水质量控制监测,1、纯水的pH 值应维持在57 的正常范围。2、细菌培养应每月1次，要求细菌数200 cfu/ml；采样部位为反渗水输水管路的末端。透析机每台透析机每年至少检测1 次。3、内毒素检测至少每3 个月1 次，要求细菌数200 cfu/ml，内毒素2 EU/ml；采样部位同上。每台透析机每年至少
18、检测1 次。4、化学污染物情况至少每年测定1 次，软水硬度及游离氯检测至少每周进行1 次，参考2008 年美国AAMI 标准。,化学性污染物的清除,生物膜恶化透析用水水质的源头,生物薄膜的形成过程,生物膜无法用常规手段检测和杀灭,消毒前,消毒后,采用预防式反渗系统消毒理念,水体中浮游微生物水中的微生物细菌通过消毒可以抑制生长容易被灭活。表面生长水中的细菌微生物在水管内表面积聚（生物膜）生物膜一旦形成，难以去除；必须有针对性地加强对反渗系统的消毒频率，预防生物膜的形成。,A/B浓缩液的盐含量和PH值,盐含量3.5mol/L醋酸盐透析液 抑制细菌生长 PH3.5 盐含量3.5mol/L 醋酸A浓缩
19、液 抑制细菌生长 PH3.5碳酸氢盐 透析液 某些细菌能耐受，主要 盐含量=1.2mol/L是革兰氏阴性杆菌，这 碳酸氢盐 些细菌生长的最佳温度 B浓缩液 是室温或低于室温，故 PH=8 一般的储存条件能促进 细菌繁殖,Gambro,铜绿假单胞杆菌,Ref:Nystrand,Nurbo,JASN 1996,血透机内碳酸氢盐浓缩液的品质,Blood Agar=血液培養琼脂TGEA=Tryptone Glucose Extract Agar 胰化朣葡萄糖膏琼脂培养琼脂TGEA+Bc=胰化朣葡萄糖膏琼脂培养琼脂+碳酸氢钠溶液(i.e.模仿B浓缩液的碱性环境),碳酸氢盐浓缩液是制备超纯透析液的关键,应
20、最大限度减少B液可能污染的源头：B液配液装置B液桶长期处于与空气接触的状态中央供B浓缩液不规范的配液装置以及盛液桶的消毒程序,Times of HD,45 hours per time3 times per WEEKCRRT 8 to 24 hoursPE,HP 24 hours,Continuous Renal Replacement Therapy(CRRT)连续性肾替代疗法,Category,Continuous Renal Replacement Therapy(CRRT)连续性肾替代疗法 Continuous Arteriovenous Hemofiltration(CAVH)连续性
21、动静脉血液滤过Continuous VenoVenous Hemofiltration（CVVH)连续性静-静脉血液滤过Continuous Veno-Venous Hemodiafiltration(CVVHDF)连续性静-静脉血液透析滤过Continuous Veno-Venous Hemodialysis(CVVHD)连续性静-静脉血液透析Slow continuous ultrafiltration Indication:Multiple Organ Dysfunction Syndrome,Category,Continuous Renal Replacement Therapy(C
22、RRT),含链接,血浆置换（plasma exchange,PE）,是一种清除血液中大分子物质的血液净化方式，将血液引出后分离血浆和血细胞，去除血浆或选择性地去除血浆中的某些致病因子，然后将细胞成份、净化后血浆及所需补充的置换液输回体内。,血浆置换主要方式,单重血浆置换双重血浆置换,单重血浆置换,利用离心或膜分离技术分离并丢弃体内含有高浓度致病因子的血浆，同时补充同等体积的新鲜冰冻血浆或新鲜冰冻血浆加少量白蛋白溶液。,单重血浆置换（TPE）,离心或膜分离技术,双重血浆置换,血浆分离出来后再通过血浆成份分离器，将血浆中相对分子质量远远大于白蛋白的致病因子丢弃，将含有大量白蛋白的血浆成份回输至体内
23、,它可以利用不同孔径的血浆成份分离器来控制血浆蛋白的除去范围。,双重血浆置换(DEPP),血浆置换适应症,风湿免疫性疾病 免疫性神经系统疾病 消化系统疾病 血液系统疾病 代谢性疾病,肾脏疾病 器官移植 药物中毒药物过量自身免疫性皮肤疾病 自身免疫性甲状腺疾病,Hemoperfusion(HP),Hemoperfusion/Hemoadsorption,Blood passed over bed of activated charcoalWaste materials adsorbed on charcoalNo dialysateRelatively simpleLittle urea rem
24、oval,no water removalUsed in combination with hemodialysis/hemoperfusion,适应症,1、急性药物或毒物中毒。2、尿毒症，尤其是顽固性瘙痒、难治性高血压。3、重症肝炎，特别是暴发性肝衰竭导致的肝性脑病、高胆红素血症。4、脓毒症或系统性炎症综合征。5、银屑病或其它自身免疫性疾病。6、其它疾病，如精神分裂症、甲状腺危象、肿瘤化疗等。,血液入口,血浆滤过器,血液透析滤过器,血液出口,吸附剂,透析液,透析液,出口,入口,血浆滤过吸附（CPFA）示意图,全血经血浆过滤器后滤出血浆，经吸附柱后与血细胞混合，再经血液滤过器经血液透析后返回体
25、内。,CPFA,CPFA,清除细胞因子和炎症介质清除 全部 IL-1ra、IL-1、IL-8 40%80%TNF清除内毒素减少低血压发生率降低死亡率,Peritoneal Dialysis(PD),Principles of PD,Dialysis fluid is introduced to the peritoneal cavity through a catheter placed in the lower part of the abdomen.A thin membrane,called the peritoneum,lines the walls of the peritoneal
26、 cavity and covers all the organs contained in it.In PD the peritoneum serves as the dialysis membrane.The peritoneal cavity can often hold more then 3 litres,but in clinical practice only 1.5 2.5L of fluid are used.This is an intra-corporeal blood purification as no blood ever leaves the body of th
27、e patient.,Principles of PD,The abdominal cavity,hold the large organs of the digestive system,is lined by the peritoneum.In PD,special fluid is instilled through a permanent catheter in the lower abdomen.,The Peritoneum,The abdominal cavity and all the organs contained in it are lined by a thin smo
28、oth membrane,the peritoneum.It is a loose connective tissue containing blood vessels and nerves.If put under the microscope,three layers can be identified between the peritoneal cavity and the blood stream.The capillary wall/the interstitium/the mesotheliumEach of these is a barrier to the transport
29、 of fluid and solutes.,Principles of PD,An osmotic pressure gradient is applied by the addition to the dialysis fluid of an osmotic agent which will“suck”fluid from the blood.The concentration of this osmotic agent is chosen to give just the fluid removal needed.In most cases glucose is used to crea
30、te the osmotic pressure.Fluid is removed by ultrafiltration driven by an osmotic pressure gradient.(Eg.Yellow/Green/Red Bags),Principles of PD,Solutes are transported across the membrane by diffusion.The driving force is the concentration gradient between the PD fluid and the blood.Waste products pr
31、esent in the blood per fusing the peritoneum will diffuse from the blood vessels into the“cleaner”dialysis fluid.,Principles of PD,The dialysis fluid should be instilled for 4 to 6 hours.When the dialysis fluid is drained from the abdominal cavity,it contains waste products and excess fluid extracte
32、d from the blood.PD is most often applied and effective as a continuous therapy.In this way it is a more physiological treatment then Haemodialysis(HD),Fluid Removal,To understand how fluid removal is achieved,we need to understand how osmosis works.Osmosis is the process in which water moves throug
33、h a semi permeable membrane from an area of high water concentration(ie;low solute concentration)to an area of low water concentration(ie;higher solute concentration).,81,SoBoth solute and fluid removal in PD is controlled by 1)glucose concentration 2)dwell time 3)volume 4)peritoneal membrane charac
34、teristics,Peritoneal Dialysis(PD)腹膜透析Intermediate peritoneal dialysis(IPD)间隙性腹膜透析continuous ambulatory peritoneal dialysis(CAPD)连续性非卧床腹膜透析 automated peritoneal dialysis(APD)自动腹膜透析tidal peritoneal dialysis(TPD)潮式腹膜透析Continuous Cycling Peritoneal Dialysis(CCPD)连续性循环式腹膜透析Indication:Renal failure,Poison
35、,Category,83,Treatment Modes CAPD/APD,To increase the efficiency of PD and help the patient with the exchanges,a machine can be used,known as Automated Peritoneal Dialysis of APD.Advantages of APD v CAPD are 1)higher clearance of solutes,as higher volumes can be used 2)better fluid removal,as shorte
36、r dwell time can be used 3)more freedom during the daytime as no exchanges need to be made.Drawbacks of APD are that of a higher cost and portability.,Difference between HD&PD,Complications,Hypotension/hypertensionCrampsFebrile reactionsArrhythmiaHemolysisHypoxemiaBleedingElectrolyte abnormalitiesDy
37、sequilibrium syndrome,Electrolyte abnormalitiesAnemiaHypertension/hypotensionRenal osteodystrophy HypercalcemiaDialysis amyloid syndromeHyperlipidemiaAluminum toxicityCardiac dysfunctionInfection,Acute Chronic,86,肾性贫血治疗的重要性肾性贫血治疗面临的现状规范肾性贫血治疗,目录,87,CKD患者中贫血普遍，且Hb水平随肾功能减退而降低,1.Locatelli F et al.Nephr
38、ol Dial Transplant 2004;19:121-132.2.Li Ya,et al.OR-08.2010 CSN,CKD分期,非透析CKD患者的贫血发病率约为50%1贫血的发生率随肾脏功能的衰退而增加2，CKD 5期患者中84%的患者发生贫血,贫血患者比例（%）,88,贫血与透析患者的死亡率和住院率显著相关,Locatelli et al.Nephrol Dial Transplant.2004;19:121-132,纳入研究时的Hb（g/dL）,RR=相对风险,Hb每升高1g/dL的总体RR=0.96（P=0.02）,Hb每升高1g/dL的总体RR=0.95（P=0.03）,住
39、院的相对风险,死亡的相对风险,RR,89,贫血增加CKD患者心血管风险,透析治疗中，Hb每降低1g/dL1患者发生左心室肥大（LVH）的风险增高42%患者发生充血性心力衰竭(CHF)的风险增高18%患者死亡的风险增高14%,1.Foley et al.Am J Kidney Dis.1996;28:53-61.,Hb每降低1g/dL的不良事件发生风险增高百分比（P0.03）,90,贫血升高了CKD患者脑卒中发生风险-ARIC研究,卒中发生率（1/1000患者年）,Abramson et al.Kidney Int.2003;64:610-615,肌酐清除率,60 mL/min60 mL/min
40、,贫血定义为男性Hb13g/dL，女性Hb12g/dL,91,透析前接受EPO类药物的平均疗程为5.2个月。,Source:TreatmentTrends China,BioTrends(Sep 2010)BioTrends公司是一家一流的国际性市场研究公司。来自该公司的调查数据质量可靠，可供期刊发表,欧盟：17%,透析前CKD患者接受EPO类药物治疗太晚,参与访问肾科医生数：150人，来源于中国北，上，广等10城市,92,Hb起始水平低，希望迅速升高以避免输血,Q.When considering the need for a rapid rise in hemoglobin,why is
41、a rapid rise desirable FOR MOST PATIENTS?(n=150),尽快升高血红蛋白水平非常重要,我选择缓慢升高血红蛋白水平以减少血红蛋白的波动,对于血红蛋白水平低下的重度贫血患者迅速升高Hb水平以避免输血,93,上海市Hb达标率仅为18.6%,上海市Hb水平在目标范围内的患者比例仅为18.6%,Hb（10-12 g/dl）：40.8%,欧盟血液透析患者的Hb水平,2010 Shanghai Dialysis Registry ReportThomas Rath.et al.CURRENT MEDICAL RESEARCH AND OPINION.2009(26)
42、4,961970,94,46%血透患者Hb水平波动2g/dl,在Hb水平波动的情况下，组织的氧供可能出现波动，导致反复出现局部相对缺血，可最终造成器官功能障碍或器官损伤2,1.Source:IMS patient survey,IMS analysis 20102.Kalantar-Zadeh K,et al.J Am Soc Nephrol 2009;20:479487.,血液透析患者的Hb水平波动分层1,95,中国患者IV铁剂运用8%,严重低于欧洲,上海患者的铁剂治疗情况1,欧洲DOPPS研究中患者的IV 铁剂治疗情况*2,2010 Shanghai Dialysis Registry R
43、eportFrancesco Locatelli,et al.Nephrol Dial Transplant(2004)19:121132.,*DOPPS为透析预后与临床治疗模式研究,96,96,规范肾性贫血治疗,患者管理贫血治疗时机贫血治疗的长期目标Hb达标稳定维持合理使用促红素,97,治疗时机及时纠正贫血，改善长期预后,早期纠正贫血可以减轻CKD患者的心脏并发症1透析治疗前及时纠正贫血，可以改善CKD患者的内皮细胞功能障碍2,1.American Journal of Kidney Diseases.2001.38(4):s20-s25.2.American Journal of Hype
44、rtension.1996.9（5）：426-431.,共识推荐：对于CKD患者，若间隔2周或以上连续两次Hb检测值均11g/dL，并除外铁缺乏等其他贫血病因，应开始实施EPO治疗,98,Hb11g/dL持续时间越长，死亡风险越高透析患者,Ofsthun et al.Nephrol Dial Transplant.2005;20(Suppl 5):v261(abstract MP204),死亡的相对风险,*,*,*,*,*,n=41 919,*P0.05;*P0.001,Hb11g/dL持续时间超过2年,1.00,1.10,1.12,1.32,1.52,1.82,99,Hb水平在11.0g12
45、.9g/dL范围，心血管疾病风险发生率最低,因心血管疾病死亡的风险比,1,Hb水平（g/dL）,n=58 058开始治疗和已规律治疗的患者,9.09.4,9.59.9,10.010.4,11.011.4,11.511.9,12.012.4,12.512.9,13.013.4,13.513.9,10.510.9,14,9,5,3,2,0.8,Regidor et al.J Am Soc Nephrol.2006;17:1181-1191,未校正病例组合校正病例组合&MICS校正,100,CHOIR研究：以13.5g/dL为Hb目标水平增加了复合事件的发生风险,036912151821242730
46、333639,0.300.250.200.150.100.050.00,发生复合事件的概率,时间（月）,13.5 g/dL为Hb目标水平11.3 g/dL为Hb目标水平,有风险的3-4期CKD 患者第1组 715654587520457355270176101725523第2组 717660594539499397293182107674423,到达主要复合终点的时间,事件发生例数：125 vs.97HR=1.34（1.031.74）Log rank检验 P=0.03,Singh et al.N Engl J Med.2006;355:2085-2098,复合事件：死亡、心肌梗塞、因充血性心力
47、衰竭而住院（除外肾替代治疗）或卒中,101,抗贫血治疗的最佳目标使Hb成功达到治疗指南推荐的目标水平1-4：使Hb水平成功地稳定在目标范围之内,达到并稳定在目标范围内是抗贫血治疗的长期目标Hb目标,1.CSN 1999;2.EPBG 2004;3.CARI 2006;4.KDOQI 2007,中国贫血治疗指南推荐：Hb目标水平：11g12g/dL，不超过13g/dL,102,102,规范肾性贫血治疗,患者管理贫血治疗时机：及早纠正，避免过快达到并稳定在目标范围内是抗贫血治疗的长期目标，指南推荐Hb目标值：11g12g/dL,不超过13g/dL合理使用促红素使用的途径：推荐皮下注射使用频度：皮下
48、注射一周一次有助于患者维持疗效Hb水平的控制：EPO 更好的达标率,CKD-MBD,CKD-MBD,CKD-Mineral and Bone Disorder(CKD-MBD)CKD矿物质和骨代谢异常异位钙化全身性的临床综合征,Kidney Int.2006 Jun;69(11):1945-53,NKF-KDOQI Guidelines 2007Stage 3，4,NKF-KDOQI Guidelines 2007Stage 5,CKD病人的维生素D3如何改变？,南京医科大学第一附属医院176例住院病人VIT D3改变,一、VITD3缺乏的定义(1)维生素D严重缺乏：25(OH)vitD75n
49、molL。二、分组：根据25(OH)vitD水平分三组。各组的一般资料见表1。缺乏为90.3%(159/176)A组：25(OH)vitD50nmolL(17例）.,南京医科大学第一附属医院176例住院病人VIT D3改变,南京医科大学第一附属医院176例住院病人VIT D3改变,表3.CKD患者25(OH)vitD影响因素的多元线性回归分析结果,维生素D3作用机制,维生素D3对CKD病人的其他影响？,CKD时CVD危险因素,小 结,血 脂 分 离 进 展,内 容,基础知识血脂分离的方法血脂分离疗效的比较血脂分离的临床应用介绍一种新的DSA血脂分离系统小结,内 容,基础知识血脂分离的方法血脂分
50、离疗效的比较血脂分离的临床应用介绍一种新的DSA血脂分离系统小结,基本概念,脂质 lipids：胆固醇（cholesterol)、甘油三酯（三酰甘油）(triglyceride)、磷脂(phospholipid)和游离脂肪酸（free fatty acid)脂蛋白lipoprotein：主要是胆固醇、甘油三酯与载脂蛋白的结合体,分为：乳糜微粒（CM)、极低密度脂蛋白(VLDL)、中间密度(IDL)、低密度(LDL)、高密度脂蛋白(HDL),脂蛋白(a)载脂蛋白apolipoprotein:A、B、C、D、E、H、J、(a)脂蛋白受体lipoprotein receptor:LDL-R,Plas
