Abstract
Beta-2-Microglobulin(B2M) 被發現它的透析行為相當特殊引起相當多的爭論，因此，本文即針對此毒性物質，以雙室模式(Two-Pool Model)理論配合透析臨床實驗的方法， 嘗試提供對此爭論的另一角度的看法，同時， 也藉此對目前的透析臨床治療作一量化的評估。 研究結果發現，B2M 在病人體內的產生速率會受到使用不同材質透析器的影響， 而有相當大的不同， 其中， 使用 Cuprophan、 PMMA 材質透析器時之產生速率較 AN69 與 PS 大了許多。另外，無論使用何種材質的透析器，在透析期間的 B2M 產生速率均較非透析期間大了 5-10 倍之多， 由此更可推論出本研究所使用的透析器均對 B2M 產生有刺激的作用。本研究對透析治療的量化評估顯示目前一般醫院所使用的治療方法，均無法有效降低病人體內 B2M 之水準，必須尋求發展其他生體相容更佳、清除率更好的透析器。由於上述之臨床實驗須對病人抽血 11 次， 在病人普遍貧血情況下，上述之臨床實驗因而無法普遍推廣成一般常用例行的診斷方法， 為了解決此問題，本文乃發展出以類神經網路（ Neural Network ）輔助之B2M 診斷系統， 此系統僅需原系統三分之一的病人血樣，即可達到與原系統幾乎相同的診斷、評估效果，因此，本類神經網路輔助之 B2M 診斷系統具有相當雄厚的實用潛力。人體體液大略包括下列二大部分：細胞內液與細胞外液， 此二部分的體積在本文人體模式中乃是一非常重要的參數， 同時，透析時的許多副作用亦有可能與此二部分體液的變化有關，因此，本文乃發展出一套「生物電阻抗分析儀」來分析細胞內、外液在透析時體積的變化。 經過腹膜透析及血液透析實驗的驗證，證實了本分析技術的可行性與實用性。The beta-2-microglobulin(B2M) is regarded as a major middlemolecular weight protein toxin. In this investigation,the formation and removal kinetics of B2M werestudied by compartmental modeling of a patient/dialyzersystem. Statistical and parametric analyses of modelequations, coupled with clinical data from selected patients,enabled us to predict the behavior and influence ofmembrane materials upon the clearance characteristicsof B2M during and between hemodialysis treatments.Because of the requirements of many blood samples, it isunpractical to apply the above-mentioned modeling analysisto clinical diagnosis. In order to solve the applicationproblems, we have developed a Neural Networks system tofacilitate the clinical diagnosis of B2M. Based on thelearning technology, this diagnosis system is not onlyless blood required, but also accurate as the modelinganalysis. Because of the advantages of this B2M diagnosissystem, it possesses great potentialities in clinicalapplications. The transcellular water shifts are veryimportant parameters in kinetic models of hemodialysis,especially in the dialysis of middle molecules. This researchalso focus on the volume changes of extra and intra cellularfluids during hemodialysis. Because of the bioimpedanceanalysis possess the advantages of continuous operation and non-invasive investigation, this paper converged on this superiormethod. Under monitoring the bioimpedance of patientswith four-electrodes, this study directs thehemodialysis and CAPD for the chronic renal failurepatients carefully. After these clinical experiments, itdepicts that the bioimpedance analysis is a potential methodfor the research in the diseases correlated with the regulationof body fluids.