Wiegmann T B, MacDougall M L, Diederich D A
Kidney and Urology Research Center, University of Kansas, Kansas City.
Am J Kidney Dis. 1988 May;11(5):418-24. doi: 10.1016/s0272-6386(88)80055-6.
The goal of these prospective studies was to determine the effect of different dialyzer membranes and dialysate composition on leukopenia and hypoxemia during hemodialysis with citrate anticoagulation. Significant early leukopenia was found with a cuprophane membrane, while a cellulose acetate membrane was associated with mild early leukopenia. Bath composition had no effect. Bicarbonate dialysate, compared with acetate, eliminated hypoxemia in cellulose acetate membranes and reduced its degree and duration with cuprophane. Membrane composition had no effect on hypoxemia during acetate dialysis. The findings indicate that leukopenia is directly and exclusively related to membrane composition while hypoxemia only relates in part to membrane effects. Serial determinations of complement components C3a and C5a showed significant increases in parallel with leukopenia during heparin anticoagulation, but the anaphylatoxin concentration changes were dissociated during dialysis with citrate anticoagulation. The concentrations of anaphylatoxins C3a and C5a appear not to be directly related to dialysis-induced leukopenia. The dissociation between anaphylatoxin concentrations and leukopenia may be related to changes in generation or unmasked changes in leukocyte response. Citrate anticoagulation may provide a useful probe for further studies on membrane-leukocyte interactions in vivo.
这些前瞻性研究的目的是确定在使用柠檬酸盐抗凝进行血液透析期间，不同透析器膜和透析液成分对白细胞减少和低氧血症的影响。使用铜仿膜时发现明显的早期白细胞减少，而醋酸纤维素膜与轻度早期白细胞减少有关。透析液成分没有影响。与醋酸盐相比，碳酸氢盐透析液消除了醋酸纤维素膜中的低氧血症，并降低了铜仿膜中低氧血症的程度和持续时间。在醋酸盐透析期间，膜成分对低氧血症没有影响。研究结果表明，白细胞减少直接且仅与膜成分有关，而低氧血症仅部分与膜效应有关。连续测定补体成分C3a和C5a显示，在肝素抗凝期间，其水平与白细胞减少同时显著升高，但在使用柠檬酸盐抗凝进行透析期间，过敏毒素浓度变化出现分离。过敏毒素C3a和C5a的浓度似乎与透析引起的白细胞减少没有直接关系。过敏毒素浓度与白细胞减少之间的分离可能与生成变化或白细胞反应中未被掩盖的变化有关。柠檬酸盐抗凝可能为进一步研究体内膜 - 白细胞相互作用提供有用的探针。
