Stroncek D F, Keshaviah P, Craddock P R, Hammerschmidt D E
J Lab Clin Med. 1984 Sep;104(3):304-11.
A prospective study of 10 patients undergoing hemodialysis showed that less neutropenia and complement activation occurred with dialyzer reuse. Neutrophil counts fell 95% +/- 5% (SEM) with first use and 66% +/- 8% and 48% +/- 10% with second and third uses, respectively (p less than 0.05). The production of complement component C5a-desarg, as measured by the bioassay granulocyte aggregation, was decreased by 96% +/- 1% and 93% +/- 2% with second and third uses, respectively (p less than 0.05). We investigated the role of the dialyzer disinfectant formaldehyde in decreased neutropenia. In vitro, formaldehyde inhibited granulocyte aggregation and chemotaxis and the dialyzer membrane's ability to generate granulocyte aggregating activity; however, this occurred only at concentrations higher than those likely to obtain in patients. The ability of dialysis membranes to generate granulocyte aggregating activity in plasma was decreased 55% +/- 5% by their prior sequential preincubation in plasma and then formalin (p less than 0.05) and extensive rinsing, which is similar to the circumstances obtaining with dialyzer reuse. Preincubation of membranes in plasma or formalin alone resulted in no change in the membrane's ability to generate granulocyte aggregating activity. We conclude that the exposure of membranes to both plasma and formalin during dialysis and storage is responsible for the decreased C5a-desarg production with reuse, probably because plasma proteins are fixed to the membrane in such a way that interrupts free interaction between the membrane and plasma complement components.
一项针对10例接受血液透析患者的前瞻性研究表明，复用透析器时中性粒细胞减少和补体激活的情况较少。首次使用时中性粒细胞计数下降95%±5%（标准误），第二次和第三次使用时分别下降66%±8%和48%±10%（p<0.05）。通过生物测定粒细胞聚集来测量的补体成分C5a-去精氨酸的产生，在第二次和第三次使用时分别下降了96%±1%和93%±2%（p<0.05）。我们研究了透析器消毒剂甲醛在减少中性粒细胞减少中的作用。在体外，甲醛抑制粒细胞聚集和趋化作用以及透析器膜产生粒细胞聚集活性的能力；然而，这仅在高于患者体内可能达到的浓度时才会发生。透析膜在血浆中先序贯预孵育然后再用福尔马林处理（p<0.05）以及大量冲洗后，其在血浆中产生粒细胞聚集活性的能力下降了55%±5%，这与透析器复用的情况相似。仅在血浆或福尔马林中对膜进行预孵育，膜产生粒细胞聚集活性的能力没有变化。我们得出结论，透析和储存过程中膜暴露于血浆和福尔马林中是复用导致C5a-去精氨酸产生减少的原因，可能是因为血浆蛋白以某种方式固定在膜上，从而中断了膜与血浆补体成分之间的自由相互作用。
