Schouten W E, Grooteman M P, van Houte A J, Schoorl M, van Limbeek J, Nubé M J
Departments of Haemodialysis and Immunohematology, Medical Centre Alkmaar and St Maartenskliniek, Nijmegen, The Netherlands.
Nephrol Dial Transplant. 2000 Mar;15(3):379-84. doi: 10.1093/ndt/15.3.379.
In chronic haemodialysis (HD), morbidity may result from repetitive induction of the acute phase response, caused by a bioincompatible dialysis membrane and/or contaminated dialysate. In the present study, cytokine release (interleukin-6, IL-6) and subsequent production of acute phase proteins (C-reactive protein, CRP and secretory phospholipase A(2), sPLA(2)) were assessed to investigate whether the HD-induced acute phase reaction depends mainly on the type of membrane or on the sterility of the dialysate.
In 11 patients, IL-6, CRP and sPLA(2) levels were assessed in blood samples drawn before (t(0)), at the end (t(180)) and 24 h after the start of HD (t(1440)). All patients were dialysed on Cuprammonium (CU) and Polysulphon (PS) dialysers and seven patients underwent an additional HD session on CU plus a dialysate filter (CUf).
IL-6 levels were increased significantly at t(180) compared with t(0) (P<0.02) with both CU and CUf. At t(1440), IL-6 levels had returned to baseline. In contrast, marked fluctuations did not occur during HD with PS. At t(180), IL-6 was significantly greater with CU and CUf devices, than with PS (P<0.02). Following HD with CU and CUf, a significant increase in CRP was observed at t(1440), compared with postdialysis values (P</=0.05). In addition, sPLA(2) values were markedly increased at t(1440), compared with t(180), but only significant in the case of CU (P=0.01). IL-6 levels at t(180) were significantly correlated with CRP (r=0.50, P<0.01) and sPLA(2) (r=0.47, P=0.01) values at t(1440). During HD with PS membranes, neither CRP nor sPLA(2) values were markedly changed.
In contrast to PS, both CU and CUf resulted in elevated IL-6 plasma levels at the end of HD, compared with t(0), which correlated with increased CRP and sPLA(2) values 24 h later. Therefore, the type of membrane, rather than the bacterial quality of the dialysate, seems to be responsible for the induction of the acute phase response during clinical bicarbonate HD.
在慢性血液透析（HD）中，发病可能源于生物不相容的透析膜和/或受污染的透析液反复引发的急性期反应。在本研究中，评估了细胞因子释放（白细胞介素-6，IL-6）以及随后急性期蛋白（C反应蛋白，CRP和分泌型磷脂酶A2，sPLA2）的产生，以研究HD诱导的急性期反应主要是取决于膜的类型还是透析液的无菌状态。
对11例患者在HD开始前（t(0)）、结束时（t(180)）和开始后24小时（t(1440)）采集的血样中的IL-6、CRP和sPLA2水平进行评估。所有患者均使用铜氨（CU）和聚砜（PS）透析器进行透析，7例患者在CU透析器上加用透析液过滤器（CUf）进行了额外的HD治疗。
与t(0)相比，使用CU和CUf透析器时，t(180)时IL-6水平显著升高（P<0.02）。在t(1440)时，IL-6水平已恢复至基线。相比之下，使用PS透析器进行HD治疗期间未出现明显波动。在t(180)时，使用CU和CUf装置时的IL-6水平显著高于使用PS透析器时（P<0.02）。使用CU和CUf进行HD治疗后，与透析后值相比，t(1440)时CRP显著升高（P≤0.05）。此外，与t(180)相比，t(1440)时sPLA2值显著升高，但仅在使用CU透析器时具有统计学意义（P=0.01）。t(180)时的IL-6水平与t(1440)时的CRP（r=0.50，P<0.01）和sPLA2（r=0.47，P=0.01）值显著相关。在使用PS膜进行HD治疗期间，CRP和sPLA2值均未发生明显变化。
与PS相比，CU和CUf在HD结束时导致IL-6血浆水平升高，与t(0)相比，这与24小时后CRP和sPLA2值升高相关。因此，在临床碳酸氢盐HD期间，似乎是膜的类型而非透析液的细菌质量引发了急性期反应。
