血液透析膜对体内炎症反应的影响。

Effect of the hemodialysis membrane on the inflammatory reaction in vivo.

作者信息

Schindler R, Boenisch O, Fischer C, Frei U

机构信息

Department of Nephrology and Internal Intensive Care Medicine, University Clinic Charité, Campus Virchow-Klinikum, Humboldt University, Berlin, Germany.

出版信息

Clin Nephrol. 2000 Jun;53(6):452-9.

PMID:10879665

Abstract

BACKGROUND

Increased levels of C-reactive protein (CRP), a marker of systemic inflammation, are associated with myocardial infarction, stroke and the development of peripheral arterial disease. Hemodialysis patients show signs of an inflammatory reaction indicated by elevated plasma levels of CRP and by increased plasma levels of interleukins.

PATIENTS AND METHODS

To investigate the effect of the dialysis membrane on the inflammatory reaction, we conducted a randomized study in 18 hemodialysis patients. Patients were subsequently treated with dialyzers containing polyamide, polycarbonate or cuprophan for 8 weeks on each dialyzer in a crossover design. During each treatment period, CRP plasma levels were measured 6 times at weekly intervals. The total content and the spontaneous and lipopolysaccharide- (LPS) stimulated production of interleukin-1beta (IL-1beta), IL-6 and IL-1 receptor antagonist (IL-1Ra) were determined in whole blood samples.

RESULTS

CRP plasma levels were significantly higher in hemodialysis patients (all patients, 1.63 +/- 0.23 mg/dl) compared to normals (0.14 +/- 0.02 mg/dl, p < 0.0001). CRP levels were lower when patients were dialyzed with polyamide (1.19 +/- 0.18 mg/dl) compared to the levels when the same patients were dialyzed with cuprophan (1.77 +/- 0.37 mg/dl, p = 0.02) or with polycarbonate (1.34 +/- 0.2 mg/dl, n.s). The whole blood content of IL-1Ra in non-incubated samples was significantly lower in normal subjects (512 +/- 60 pg/ml) compared to hemodialysis patients (980 +/- 80 pg/ml, p < 0.01). The whole blood content of IL-1Ra was higher when patients were dialyzed with cuprophan (1,062 +/- 119 pg/ml) compared to the same patients on polyamide (906 +/- 78 pg/ml, p < 0.05) or on polycarbonate (973 +/- 80 pg/ml, n.s.). Spontaneous and LPS-induced production of IL-1beta and IL-6 was similar for all dialyzers.

CONCLUSION

We conclude that the inflammatory reaction in hemodialysis patients is affected by the choice of the dialyzer.

摘要

背景

C反应蛋白（CRP）作为全身炎症的标志物，其水平升高与心肌梗死、中风及外周动脉疾病的发生相关。血液透析患者表现出炎症反应迹象，表现为血浆CRP水平升高以及血浆白细胞介素水平增加。

患者与方法

为研究透析膜对炎症反应的影响，我们对18例血液透析患者进行了一项随机研究。患者随后采用交叉设计，分别使用含聚酰胺、聚碳酸酯或铜仿膜的透析器进行治疗，每种透析器治疗8周。在每个治疗期间，每周测量6次血浆CRP水平。测定全血样本中白细胞介素-1β（IL-1β）、IL-6和IL-1受体拮抗剂（IL-1Ra）的总含量以及自发和脂多糖（LPS）刺激后的产生量。

结果

与正常人（0.14±0.02mg/dl，p<0.0001）相比，血液透析患者的血浆CRP水平显著更高（所有患者，1.63±0.23mg/dl）。与使用铜仿膜透析时（1.77±0.37mg/dl，p = 0.02）或聚碳酸酯透析时（1.34±0.2mg/dl，无显著差异）相比，患者使用聚酰胺透析时CRP水平较低（1.19±0.18mg/dl）。与血液透析患者（980±80pg/ml，p<0.01）相比，正常受试者非孵育样本中IL-1Ra的全血含量显著更低（512±60pg/ml）。与使用聚酰胺（906±78pg/ml，p<0.05）或聚碳酸酯（973±80pg/ml，无显著差异）透析的同一患者相比，患者使用铜仿膜透析时IL-1Ra的全血含量更高（1,062±119pg/ml）。所有透析器对IL-1β和IL-6的自发及LPS诱导产生量相似。