Jörres A, Gahl G M, Topley N, Neubauer A, Ludat K, Müller C, Passlick-Deetjen J
Department of Nephrology, Universitätsklinikum Rudolf Virchow, Berlin-Charlottenburg, Germany.
Nephrol Dial Transplant. 1994;9(7):785-90.
Evidence is accumulating that conventional dialysis fluids for CAPD are incompatible with peritoneal host defence. We therefore investigated the effect of alternative CAPD fluids on mononuclear leukocyte (PBMC) viability and cytokine production in vitro. Fluids tested were bicarbonate-buffered solutions containing 1.5% or 4.25% glucose, 7.5% glucose polymer dialysis fluid (GPDF), and conventional 1.5% glucose fluid (G1.5%). PBMC were stimulated (2 h, 37 degrees C) in the different test fluids with a clinical isolate of Staphylococcus epidermidis or Escherichia coli lipopolysaccharide. The cytokines TNF alpha and IL-6 in PBMC supernatants were measured by specific enzyme immunoassays. Induction of cytokine messenger RNA was evaluated by reverse transcription-polymerase chain reaction. Conventional G1.5% (pH 5.5) inhibited cytokine release from activated PBMC by > 95%, whereas cell responses in low-glucose bicarbonate fluid were not significantly reduced. In contrast, high-glucose bicarbonate fluid exerted > 80% inhibition despite its neutral pH. GPDF was inhibitory at its initial low pH, whereas cytokine release was restored following pH neutralization. Cytokine mRNA expression was suppressed by conventional G1.5% fluid and by high-glucose bicarbonate fluid. These data indicate that pH neutralization leads to a substantial improvement of dialysis fluid biocompatibility; however, hyperosmolality and/or high glucose content inhibit cell responsiveness even at normal pH. Replacement of glucose by glucose polymer might prove beneficial provided that the initial low pH is neutralized.
越来越多的证据表明，用于持续性非卧床腹膜透析（CAPD）的传统透析液与腹膜宿主防御不相容。因此，我们研究了替代的CAPD液对体外单个核白细胞（PBMC）活力和细胞因子产生的影响。所测试的液体为含有1.5%或4.25%葡萄糖的碳酸氢盐缓冲溶液、7.5%葡萄糖聚合物透析液（GPDF）和传统的1.5%葡萄糖液（G1.5%）。用表皮葡萄球菌临床分离株或大肠杆菌脂多糖在不同的测试液中刺激PBMC（2小时，37摄氏度）。通过特异性酶免疫测定法测量PBMC上清液中的细胞因子TNFα和IL-6。通过逆转录-聚合酶链反应评估细胞因子信使RNA的诱导情况。传统的G1.5%（pH 5.5）抑制活化的PBMC释放细胞因子>95%，而低糖碳酸氢盐液中的细胞反应未显著降低。相比之下，高糖碳酸氢盐液尽管pH呈中性，但仍有>80%的抑制作用。GPDF在初始低pH时具有抑制作用，而pH中和后细胞因子释放恢复。细胞因子mRNA表达受到传统G1.5%液和高糖碳酸氢盐液的抑制。这些数据表明，pH中和可显著改善透析液的生物相容性；然而，即使在正常pH下，高渗性和/或高糖含量也会抑制细胞反应性。如果初始低pH被中和，用葡萄糖聚合物替代葡萄糖可能被证明是有益的。
