Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, Oita, Japan,
Division of Engineering, Department of Medical Technologists, Kokura Memorial Hospital, Fukuoka, Japan,
Blood Purif. 2019;48(4):358-367. doi: 10.1159/000501632. Epub 2019 Jul 25.
In intensive care medicine, continuous renal replacement therapy (CRRT) is important for critically ill patients. Various types of dialysis membranes are currently used in clinical settings, each having unique structures and characteristics. This study aimed to perform a detailed analysis of the characteristics of polysulfone (PS), polymethylmethacrylate (PMMA), and polyacrylonitrile (AN69ST) membranes, and to determine differences in the adsorption of proteins and blood cells by membrane material.
Subjects were patients undergoing CRRT in the ICU of the Kokura Memorial Hospital. After use, membranes were collected and analyzed. Semi-quantitative analysis of the membrane surface was performed by scanning electron microscopy. We determined the identity of proteins adsorbed to the surface of membranes by TOF/MS analysis, and measured the amount of adsorbed chemical mediators.
Electron microscopy revealed that, compared to PS and PMMA membranes, AN69ST membranes had a greater amount of adsorbed activated white blood cells (WBCs). A large amount of platelets was adsorbed to PMMA membranes. In terms of the amount of adsorbed protein, significantly more proteins adsorbed to AN69ST membranes compared to PS and PMMA membranes. Moreover, TOF/MS analysis revealed a difference in the types of adsorbed proteins by membrane. Chemokines were particularly prevalent among adsorbed proteins for all 3 membranes.
Compared to PS and PMMA membranes, AN69ST membranes had a higher capacity to remove activated WBCs. Moreover, apparent differences were noted in the types of proteins that adsorbed to each type of membrane. These differences in membrane properties may impact clinical outcomes.
在重症监护医学中，连续肾脏替代疗法（CRRT）对危重症患者非常重要。目前在临床环境中使用各种类型的透析膜，它们具有独特的结构和特性。本研究旨在详细分析聚砜（PS）、聚甲基丙烯酸甲酯（PMMA）和丙烯腈共聚物（AN69ST）膜的特性，并确定膜材料对蛋白质和血细胞吸附的差异。
研究对象为在小仓纪念医院 ICU 接受 CRRT 的患者。使用后收集膜并进行分析。通过扫描电子显微镜对半定量分析膜表面。通过 TOF/MS 分析确定吸附在膜表面的蛋白质的身份，并测量吸附的化学介质量。
电子显微镜显示，与 PS 和 PMMA 膜相比，AN69ST 膜吸附的活化白细胞（WBC）更多。大量血小板吸附在 PMMA 膜上。就吸附蛋白的量而言，与 PS 和 PMMA 膜相比，AN69ST 膜吸附的蛋白明显更多。此外，TOF/MS 分析揭示了膜吸附的蛋白质类型存在差异。趋化因子是所有 3 种膜吸附蛋白中特别常见的。
与 PS 和 PMMA 膜相比，AN69ST 膜去除活化 WBC 的能力更高。此外，每种膜吸附的蛋白质类型存在明显差异。这些膜特性的差异可能会影响临床结果。
