Schaefer R M, Rauterberg E W, Deppisch R, Vienken J
Department of Nephrology, University of Würzburg, FRG.
Miner Electrolyte Metab. 1990;16(1):73-6.
Activation of the complement system during the course of hemodialysis was recognized more than 20 years ago and since then the generation of C3a and C5a desarg has been used as parameters of blood-membrane interaction. More recently, determination of terminal C5b-9 complement complexes has become feasible. In the present study we determined plasma concentrations of C5b-9 complexes during hemodialysis using Cuprophan or Hemophan membranes. As early as 10 min into dialysis, Cuprophan membranes led to higher arterial plasma concentrations of C5b-9 complexes in comparison to Hemophan-containing devices. With Cuprophan, systemic arterial peak values of 237 +/- 27 U/ml were reached 45 min after the onset of dialysis, while corresponding peak values using Hemophan were only 58 +/- 16 U/ml. Venous concentrations of C5b-9 complexes, measured at the outlet of the dialyzer, were 489 +/- 102 U/ml with Cuprophan and 77 +/- 19 U/ml with Hemophan dialyzers. As an index of red cell lysis, plasma levels of free hemoglobin were evaluated. There was hemolysis with both membranes. Free hemoglobin levels increased threefold with Cuprophan and only twofold with Hemophan membranes. Taken together, plasma concentrations of C5b-9 complexes clearly discern between dialysis membranes of high or low compatibility. The fact that there is simultaneous lysis of red cells might indicate that deposition of C5b-9 complexes on innocent cells occurs which would lead subsequently to an array of diverse pathophysiological reactions.
血液透析过程中补体系统的激活在20多年前就已被认识到，从那时起，C3a和C5a去精氨酸产物的生成就被用作血膜相互作用的参数。最近，终末C5b-9补体复合物的测定已变得可行。在本研究中，我们使用铜仿膜或血仿膜测定了血液透析过程中血浆C5b-9复合物的浓度。早在透析开始10分钟时，与含血仿膜的装置相比，铜仿膜导致动脉血浆中C5b-9复合物的浓度更高。使用铜仿膜时，透析开始45分钟后全身动脉峰值达到237±27 U/ml，而使用血仿膜时相应的峰值仅为58±16 U/ml。在透析器出口处测得的静脉血C5b-9复合物浓度，使用铜仿膜时为489±102 U/ml，使用血仿膜透析器时为77±19 U/ml。作为红细胞溶解的指标，评估了血浆游离血红蛋白水平。两种膜都有溶血现象。游离血红蛋白水平在使用铜仿膜时增加了三倍，而在使用血仿膜时仅增加了两倍。综上所述，血浆C5b-9复合物浓度能清楚地区分高兼容性或低兼容性的透析膜。红细胞同时发生溶解这一事实可能表明C5b-9复合物沉积在无辜细胞上，这随后会导致一系列不同的病理生理反应。
