Krieter D H, Fink E, Bönner G, You H M, Eisenhauer T
Department of Nephrology, University of Göttingen, Germany.
Nephrol Dial Transplant. 1995;10(4):509-13. doi: 10.1093/ndt/10.4.509.
Anaphylactoid reactions have been observed in patients treated with AN69 dialysers and ACE inhibitors. Recently, it has been shown in vitro that AN69 membranes induce the release of high amounts of bradykinin in plasma. To verify the possible role of bradykinin in these shock-like reactions, six sheep were dialysed in a random fashion using AN69 or the new SPAN membrane with and without pretreatment with captopril. All animals were dialysed for 60 min via double-lumen Shaldon catheters. Blood samples were drawn at 0, 5, 10, 15, 30, and 60 min from the venous line. A total of 24 haemodialysis procedures was carried out: group A (n = 6), AN69 without captopril; group B (n = 6), SPAN without captopril; group C (n = 6), AN69 with captopril; group D (n = 6), SPAN with captopril. A significant bradykinin release was observed only in groups A and C, reaching peak values already after 5 min. Animals in group C showed the highest bradykinin values. In four of six animals in group C anaphylactoid reactions with severe hypotension were noted. From this animal model we conclude that dialysis with the AN69 membrane is associated with bradykinin release. Pretreatment with ACE inhibitors results in further increasing bradykinin levels, which lead to anaphylactoid reactions. In contrast, the new SPAN membrane was well tolerated without detectable changes in bradykinin concentrations.
使用AN69透析器和血管紧张素转换酶（ACE）抑制剂治疗的患者中曾观察到类过敏反应。最近的体外研究表明，AN69膜可诱导血浆中大量缓激肽的释放。为了验证缓激肽在这些休克样反应中可能发挥的作用，对6只绵羊进行了随机分组透析，分别使用AN69或新型SPAN膜，并在透析前后给予卡托普利预处理。所有动物均通过双腔Shaldon导管进行60分钟的透析。在透析0、5、10、15、30和60分钟时，从静脉管路采集血样。共进行了24次血液透析操作：A组（n = 6），使用AN69膜且未用卡托普利预处理；B组（n = 6），使用SPAN膜且未用卡托普利预处理；C组（n = 6），使用AN69膜且用卡托普利预处理；D组（n = 6），使用SPAN膜且用卡托普利预处理。仅在A组和C组中观察到显著的缓激肽释放，5分钟后即达到峰值。C组动物的缓激肽值最高。C组6只动物中有4只出现了伴有严重低血压的类过敏反应。从这个动物模型我们得出结论，使用AN69膜进行透析与缓激肽释放有关。用ACE抑制剂预处理会导致缓激肽水平进一步升高，从而引发类过敏反应。相比之下，新型SPAN膜耐受性良好，缓激肽浓度未出现可检测到的变化。
