Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
BMC Nephrol. 2014 Jan 17;15:19. doi: 10.1186/1471-2369-15-19.
During continuous venovenous haemofiltration (CVVH), regional anticoagulation with citrate may be superior to heparin in terms of biocompatibility, since heparin as opposed to citrate may activate complement (reflected by circulating C5a) and induce neutrophil degranulation in the filter and myeloperoxidase (MPO) release from endothelium.
No anticoagulation (n = 13), unfractionated heparin (n = 8) and trisodium citrate (n = 17) regimens during CVVH were compared. Blood samples were collected pre- and postfilter; C5a, elastase and MPO were determined by ELISA. Additionally, C5a was also measured in the ultrafiltrate.
In the heparin group, there was C5a production across the filter which most decreased over time as compared to other groups (P = 0.007). There was also net production of elastase and MPO across the filter during heparin anticoagulation (P = 0.049 or lower), while production was minimal and absent in the no anticoagulation and citrate group, respectively. During heparin anticoagulation, plasma concentrations of MPO at the inlet increased in the first 10 minutes of CVVH (P = 0.024).
Citrate confers less filter-induced, potentially harmful complement activation and neutrophil degranulation and less endothelial activation than heparin when used for anticoagulation during continuous venovenous haemofiltration in critically ill patients.
在连续静脉-静脉血液滤过（CVVH）过程中，局部枸橼酸抗凝可能比肝素更具生物相容性，因为与枸橼酸相反，肝素可能会激活补体（反映为循环中的 C5a）并在滤器中诱导中性粒细胞脱颗粒和内皮细胞释放髓过氧化物酶（MPO）。
比较了 CVVH 期间无抗凝（n=13）、未分级肝素（n=8）和三钠枸橼酸（n=17）方案。采集预滤器和后滤器的血样；通过 ELISA 测定 C5a、弹性蛋白酶和 MPO。此外，还在超滤物中测量了 C5a。
肝素组有 C5a 跨滤器生成，与其他组相比，随时间推移 C5a 生成量减少（P=0.007）。肝素抗凝时，弹性蛋白酶和 MPO 也有净跨滤器生成（P=0.049 或更低），而无抗凝和枸橼酸组的生成量则最小或不存在。肝素抗凝期间，CVVH 开始后 10 分钟内入口处的 MPO 血浆浓度增加（P=0.024）。
与肝素相比，在危重病患者的 CVVH 过程中使用枸橼酸进行抗凝时，滤器诱导的潜在有害补体激活和中性粒细胞脱颗粒以及内皮细胞激活程度较低。
