Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Würzburg, Germany.
eXcorLab GmbH, Obernburg, Germany.
Artif Organs. 2021 Sep;45(9):1104-1113. doi: 10.1111/aor.13944. Epub 2021 May 4.
Activation of the complement system and leukocytes by blood-membrane interactions may further promote arteriosclerosis typically present in patients on lipoprotein apheresis. As clinical data on the hemocompatibility of lipoprotein apheresis are scarce, a controlled clinical study comparing two different types of plasma separation and fractionation membranes used in double-filtration lipoprotein apheresis was urgently needed, as its outcome may influence clinical decision-making. In a prospective, randomized, crossover controlled trial, eight patients on double-filtration lipoprotein apheresis were subjected to one treatment with recent polyethersulfone (PES) plasma separation and fractionation membranes and one control treatment using a set of ethylene-vinyl alcohol copolymer (EVAL) membranes. White blood cell (WBC) and platelet (PC) counts, complement factor C5a and thrombin-antithrombin III (TAT) concentrations were determined in samples drawn at defined times from different sites of the extracorporeal blood and plasma circuit. With a nadir at 25 minutes, WBCs in EVAL decreased to 33.5 ± 10.7% of baseline compared with 63.8 ± 22.0% at 20 minutes in PES (P < .001). The maximum C5a levels in venous blood reentering the patients were measured at 30 minutes, being 30.0 ± 11.2 µg/L with EVAL and 12.3 ± 9.0 µg/L with PES (P < .05). The highest C5a concentrations were found in plasma after the plasma filters (EVAL 56.1 ± 22.0 µg/L at 15 minutes vs PES 23.3 ± 15.2 µg/L at 10 minutes; P < .001). PC did not significantly decrease over time with both membrane types, whereas TAT levels did not rise until the end of the treatment without differences between membranes. Regarding lipoprotein(a) and low-density lipoprotein (LDL) cholesterol removal, both membrane sets performed equally. Compared with EVAL, PES membranes cause less leukocyte and complement system activation, the classical parameters of hemocompatibility of extracorporeal treatment procedures, at identical treatment efficacy. Better hemocompatibility may avoid inflammation-promoting effects through blood-material interactions in patients requiring double-filtration lipoprotein apheresis.
血液-膜相互作用激活补体系统和白细胞可能会进一步促进脂蛋白吸附治疗患者中常见的动脉粥样硬化。由于脂蛋白吸附的血液相容性临床数据很少，因此迫切需要进行一项比较两种不同类型的血浆分离和分级膜在双重过滤脂蛋白吸附中的对照临床试验，因为其结果可能会影响临床决策。在一项前瞻性、随机、交叉对照临床试验中，8 名接受双重过滤脂蛋白吸附治疗的患者分别接受了一次新的聚醚砜（PES）血浆分离和分级膜治疗和一次使用一组乙烯-乙烯醇共聚物（EVAL）膜的对照治疗。在不同的体外血液和血浆回路部位抽取规定时间的样本，测定白细胞（WBC）和血小板（PC）计数、补体因子 C5a 和凝血酶-抗凝血酶 III（TAT）浓度。EVAL 中的 WBC 在 25 分钟时降至基线的 33.5±10.7%，而 PES 中的 WBC 在 20 分钟时降至 63.8±22.0%（P<.001）。在静脉血重新进入患者的血液中测量到的最大 C5a 水平在 30 分钟时达到，EVAL 为 30.0±11.2µg/L，而 PES 为 12.3±9.0µg/L（P<.05）。在血浆过滤器后，C5a 的最高浓度出现在血浆中（EVAL 为 15 分钟时为 56.1±22.0µg/L，而 PES 为 10 分钟时为 23.3±15.2µg/L；P<.001）。两种膜类型的 PC 随时间的推移均未显著减少，而 TAT 水平直到治疗结束才升高，两种膜之间无差异。关于脂蛋白（a）和低密度脂蛋白（LDL）胆固醇的去除，两种膜组的效果相同。与 EVAL 相比，PES 膜在相同的治疗效果下引起的白细胞和补体系统激活较少，这是体外治疗过程血液相容性的经典参数。更好的血液相容性可以通过在需要双重过滤脂蛋白吸附的患者中避免血液-材料相互作用引起的炎症促进作用。
