Yamagami S, Adachi T, Sugimura T, Wada S, Kishimoto T, Maekawa M, Yoshimura R, Niwa M, Terano Y, Shaldon S
Osaka City University Medical School, Japan.
Int J Artif Organs. 1990 Apr;13(4):205-10.
Endotoxins are often seen in dialysate. They are derived from Gram-negative bacteria especially Pseudomonas, E. coli and Serratia. Endotoxins are large-molecular-weight substances with an average molecular weight of 10(8). These large units can be divided into subunits down to a molecular weight of 10,000 which are thought to pass through dialyzer membranes. To investigate this, endotoxin antibody levels were measured in two groups of patients on chronic regular hemodialysis, a low-flux group using cellulosic membrane dialyzers (cuprophan and cuproammonium rayon (CAR) and a high-flux group using synthetic polymer membrane dialyzers (PMMA, EVAL). Using an ELISA based on standard endotoxin antibodies the percentages of patients in the low flux group with endotoxin antibodies were 26.9% with Cuprophan and 25% with CAR, not significantly different from a normal control group. In the PMMA and EVAL groups, it was 53.6% and 68.4% respectively. Back filtration of dialysate into blood is understood as the main reason for the entry of endotoxin in patients treated with high-flux dialyzers.
内毒素在透析液中很常见。它们来源于革兰氏阴性菌，尤其是假单胞菌、大肠杆菌和沙雷氏菌。内毒素是大分子物质，平均分子量为10⁸。这些大的单位可以被分成分子量低至10000的亚单位，据认为这些亚单位可以通过透析器膜。为了对此进行研究，对两组慢性规律血液透析患者的内毒素抗体水平进行了测量，一组是使用纤维素膜透析器（铜仿膜和铜氨人造丝（CAR））的低通量组，另一组是使用合成聚合物膜透析器（聚甲基丙烯酸甲酯（PMMA）、乙烯-醋酸乙烯共聚物（EVAL））的高通量组。使用基于标准内毒素抗体的酶联免疫吸附测定法（ELISA），低通量组中使用铜仿膜的患者内毒素抗体阳性率为26.9%，使用CAR的为25%，与正常对照组无显著差异。在PMMA组和EVAL组中，该阳性率分别为53.6%和68.4%。透析液回渗到血液中被认为是高通量透析器治疗患者内毒素进入的主要原因。
