Himmelfarb J, Hakim R M
Division of Nephrology, Maine Medical Center, Portland 04102, USA.
Adv Ren Replace Ther. 1997 Apr;4(2 Suppl 1):72-80.
The interactions between blood and the dialysis membrane, aside from solute clearance, can be referred to as biocompatibility. It has increasingly been recognized that significant side effects may occur as a result of interactions of blood with the dialysis membrane itself. The use of unmodified cellulosic hemodialysis membranes results in potent activation of the alternative pathway of complement, and numerous investigators have now carefully defined the membrane characteristics that contribute to complement activation, adsorption, and clearance. Complement-dependent granulocyte activation during hemodialysis causes neutrophil degranulation and protease release, the production of reactive oxygen species, and modulation of granulocyte cell adhesion molecules. Recently, a number of experimental studies in animal models suggest that complement and granulocyte activation during hemodialysis could contribute to the prolongation of acute renal failure. Based on the hypothesis that hemodialysis with complement and granulocyte-activating membranes could contribute to the prolongation of acute renal failure and increased mortality, several recent prospective randomized clinical trials examining the role of membrane biocompatibility in the treatment of acute renal failure have been reported. Although not unanimous in their conclusions, most studies suggest that hemodialysis with more biocompatible membranes in patients with acute renal failure leads to a more rapid return of renal function and a lower morbidity and mortality. Thus, hemodialysis membrane biocompatibility may be an important contributor to the outcome of patients with acute renal failure who require dialysis.
除溶质清除外，血液与透析膜之间的相互作用可称为生物相容性。人们越来越认识到，血液与透析膜本身的相互作用可能会产生严重的副作用。使用未改性的纤维素血液透析膜会导致补体替代途径的有效激活，现在许多研究人员已经仔细确定了导致补体激活、吸附和清除的膜特性。血液透析过程中补体依赖性粒细胞激活会导致中性粒细胞脱颗粒和蛋白酶释放、活性氧的产生以及粒细胞细胞粘附分子的调节。最近，一些在动物模型中的实验研究表明，血液透析过程中的补体和粒细胞激活可能导致急性肾衰竭的延长。基于血液透析使用补体和粒细胞激活膜可能导致急性肾衰竭延长和死亡率增加的假设，最近有几项前瞻性随机临床试验报告了膜生物相容性在急性肾衰竭治疗中的作用。尽管结论并不一致，但大多数研究表明，急性肾衰竭患者使用生物相容性更高的膜进行血液透析可使肾功能更快恢复，发病率和死亡率更低。因此，血液透析膜生物相容性可能是需要透析的急性肾衰竭患者预后的一个重要因素。
