Rousseau Y, Carreno M P, Poignet J L, Kazatchkine M D, Haeffner-Cavaillon N
Institut National de la Santé et de la Recherche Médicale, INSERM U430, Hôpital Broussais, Paris, France.
Biomaterials. 1999 Oct;20(20):1959-67. doi: 10.1016/s0142-9612(99)00101-5.
Complement activation, neutrophil stimulation, increased cellular adhesiveness, transient leukocyte margination and pulmonary leukostasis take place during hemodialysis with cellulosic dialysis membranes. Several investigators have hypothesized that complement activation is primarily responsible for the acute neutropenia occurring during the early phase of bio-incompatible hemodialysis. We have investigated the relationship between complement activation, levels of expression of CD11b and CD61 integrins on neutrophils and platelets, neutrophil counts and blood gas measurements in patients dialyzed with three types of membranes, known to activate the complement system to a different extent. Polysulfone, cellulose acetate and cuprophane membranes were used subsequently in six patients in a prospective cross-over trial design to reduce inter-individual variability. Increased levels of CD61 and CD11b, as well as neutropenia, were detected regardless of the type of membrane used. We observed a high inter-individual variation with regard to complement activation suggesting varying susceptibility to dialysis membranes. We also report that the kinetics of anaphylatoxin generation were dissociated from those of the upregulation of adhesion molecules, early neutrophil margination and decrease in PaO2 during the first 30 min of hemodialysis. Similar results were obtained with all three types of dialysis membranes. The data strengthen the hypothesis that factors other than complement are involved in the induction of dialysis-related neutropenia and hypoxemia.
使用纤维素透析膜进行血液透析期间会发生补体激活、中性粒细胞刺激、细胞黏附性增加、短暂性白细胞边缘化和肺白细胞淤滞。几位研究者推测，补体激活是生物不相容性血液透析早期发生急性中性粒细胞减少的主要原因。我们研究了使用三种已知在不同程度上激活补体系统的膜进行透析的患者中，补体激活、中性粒细胞和血小板上CD11b和CD61整合素的表达水平、中性粒细胞计数与血气测量之间的关系。随后，在一项前瞻性交叉试验设计中，对6名患者依次使用了聚砜膜、醋酸纤维素膜和铜仿膜，以减少个体间差异。无论使用何种类型的膜，均检测到CD61和CD11b水平升高以及中性粒细胞减少。我们观察到补体激活存在高度个体间差异，表明对透析膜的易感性不同。我们还报告称，在血液透析的前30分钟内，过敏毒素生成的动力学与黏附分子上调、早期中性粒细胞边缘化和PaO2降低的动力学相互分离。使用所有三种类型的透析膜均获得了类似结果。这些数据强化了以下假说，即补体以外的因素参与了透析相关中性粒细胞减少和低氧血症的诱导。
