Guth H J, Gruska S, Kraatz G
Center for Hemodialysis Greifswald, Greifswald, Germany.
Int J Artif Organs. 2000 Oct;23(10):675-9.
The activation of monocytes and other immunocompetent cells during hemodialysis can be attributed to their contact with immunogenic structures such as membranes, blood lines, and endotoxins. The simple measurement of cytokines in blood cannot completely describe the whole dimension of this event. Stimulation of monocytes and other immunocompetent cells in whole blood with lipopolysaccharides (LPS) for IL-6 and phytohemagglutinine (PHA) for TNF at the start and end of dialysis may make it possible to better analyze cellular response during dialysis. Ten healthy volunteers and 10 patients suffering from chronic renal failure were tested with the commercial whole-blood stimulation assays "Dynamix"-IL-6-DIA and -TNF-alpha-DIA (Biosource Diagnostics, Ratingen, Germany). Then 24 patients undergoing hemodialysis with hemophane (n=12) and polyamide (n=12) membranes were examined before and after dialysis treatment. The unpaired Wilcoxon t- test was used for statistical analysis. Healthy volunteers and patients with chronic renal failure showed no statistical differences in concentrations of TNF-alpha and IL-6 before or after whole blood stimulation (WBS). In comparison to patients with chronic renal failure, pre-WBS concentrations of both cytokines (p<0.034) were increased in patients of each membrane group before dialysis. After whole blood stimulation, no differences were observed. At the end of dialysis treatment, the pre- and post-WBS IL-6 values were both significantly higher in the hemophane group (p=0.049 and p=0.0038, respectively) TNF-alpha concentrations were unchanged. No significant differences in the polyamide group were found between the start and end of treatment for either cytokine. A comparison of these membrane groups showed that only the pre-WBS IL-6 concentration in the hemophane group was elevated (p=0.022) after dialysis. In conclusion, the presence of uremia alone could not influence the cytokine production and release capacity. In our patients, dialysis elevated pre-WBS concentrations of TNF-alpha and IL-6, and increased IL-6 release from immunocompetent cells after whole blood stimulation in the hemophane group. The use of polyamide membranes decreased the action of monocytes and other immunocompetent cells, but could not completely prevent this phenomenon. The whole blood stimulation assays for measurement of TNF-alpha and IL-6 may represent a new, dynamic method for evaluating biocompatibility.
血液透析过程中单核细胞和其他免疫活性细胞的激活可归因于它们与免疫原性结构（如膜、血路和内毒素）的接触。简单测量血液中的细胞因子并不能完全描述这一事件的全貌。在透析开始和结束时，用脂多糖（LPS）刺激全血中的单核细胞和其他免疫活性细胞以检测IL-6，用植物血凝素（PHA）刺激以检测TNF，这可能有助于更好地分析透析过程中的细胞反应。10名健康志愿者和10名慢性肾衰竭患者接受了商业全血刺激检测“Dynamix”-IL-6-DIA和-TNF-α-DIA（德国莱茵根市Biosource Diagnostics公司）的检测。然后，对24名分别使用血仿膜（n = 12）和聚酰胺膜（n = 12）进行血液透析的患者在透析治疗前后进行了检查。采用非配对Wilcoxon t检验进行统计分析。健康志愿者和慢性肾衰竭患者在全血刺激（WBS）前后TNF-α和IL-6的浓度无统计学差异。与慢性肾衰竭患者相比，每个膜组患者在透析前两种细胞因子的WBS前浓度均升高（p < 0.034）。全血刺激后，未观察到差异。在透析治疗结束时，血仿膜组WBS前和WBS后的IL-6值均显著升高（分别为p = 0.049和p = 0.0038），TNF-α浓度未改变。聚酰胺膜组在治疗开始和结束时两种细胞因子均未发现显著差异。比较这些膜组发现，透析后仅血仿膜组的WBS前IL-6浓度升高（p = 0.022）。总之，仅尿毒症的存在不会影响细胞因子的产生和释放能力。在我们的患者中，透析提高了TNF-α和IL-6的WBS前浓度，并增加了血仿膜组全血刺激后免疫活性细胞中IL-6的释放。聚酰胺膜的使用降低了单核细胞和其他免疫活性细胞的活性，但不能完全防止这种现象。用于测量TNF-α和IL-6的全血刺激检测可能代表一种评估生物相容性的新的动态方法。
