Walker R J, Sutherland W H F, De Jong S A
Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Clin Nephrol. 2004 Mar;61(3):198-206. doi: 10.5414/cnp61198.
In vitro, synthetic dialysis membranes induce less activation of blood components to produce pro-inflammatory cytokines and reactive oxygen species compared with cellulose acetate membranes. However, the long-term effect of switching from a cellulose-based dialysis membrane to a synthetic membrane on protein oxidation and systemic inflammation in hemodialysis patients is not well defined.
Nineteen patients receiving hemodialysis were followed prospectively after changing from a low-flux cellulose acetate membrane to a low-flux polysulphone membrane for 11-17 months (n = 15) and then returning to the cellulose acetate membrane for 1 month (n = 13). Plasma markers of protein oxidation, cell activation and systemic inflammation and concentrations of soluble cell adhesion molecules were measured at baseline and at the end of each intervention period.
Plasma levels of protein thiols (18%), IL-6 (34%), VCAM-1 (33%), ICAM-1 (21%) and beta2-microglobulin (21%) increased significantly and dityrosine fluorescence (-36%), protein lipofuscin-like fluorophores (-18%) and TNF-alpha (-20%) decreased significantly in the patients after they switched to the polysulphone membrane. After reverting to the cellulose acetate membrane for 1 month, plasma levels of protein thiols and IL-6 returned to baseline while levels of other variables were not significantly different from values at the end of the polysulphone dialysis period. There was substantial intra-individual variation between 2 baseline measurements of plasma cytokines.
Switching from a cellulose acetate membrane to a low-flux polysulphone dialysis membrane for a year or more may decrease the level of protein oxidation suggesting a decrease in oxidant stress and greater biocompatibility of the polysulphone membrane. The effect of this change in dialysis membrane on systemic inflammation is uncertain due to increases in some but not other inflammation-sensitive molecules.
在体外，与醋酸纤维素膜相比，合成透析膜诱导血液成分产生促炎细胞因子和活性氧的激活作用较小。然而，从纤维素基透析膜转换为合成膜对血液透析患者蛋白质氧化和全身炎症的长期影响尚不清楚。
19例接受血液透析的患者在从低通量醋酸纤维素膜转换为低通量聚砜膜11 - 17个月（n = 15），然后再换回醋酸纤维素膜1个月（n = 13）后进行前瞻性随访。在基线和每个干预期结束时测量蛋白质氧化、细胞激活和全身炎症的血浆标志物以及可溶性细胞粘附分子的浓度。
患者转换为聚砜膜后，血浆蛋白巯基水平（升高18%）、IL - 6（升高34%）、VCAM - 1（升高33%）、ICAM - 1（升高21%）和β2 - 微球蛋白（升高21%）显著升高，而二酪氨酸荧光（降低36%）、蛋白质脂褐素样荧光团（降低18%）和TNF - α（降低20%）显著降低。换回醋酸纤维素膜1个月后，血浆蛋白巯基和IL - 6水平恢复到基线，而其他变量水平与聚砜膜透析期末的值无显著差异。血浆细胞因子的两次基线测量之间存在较大的个体内差异。
从醋酸纤维素膜转换为低通量聚砜透析膜一年或更长时间可能会降低蛋白质氧化水平，提示氧化应激降低以及聚砜膜具有更高的生物相容性。由于一些但并非其他炎症敏感分子增加，这种透析膜的变化对全身炎症的影响尚不确定。
