Dhondt A, Vanholder R, Waterloos M A, Glorieux G, De Smet R, Lameire N
Department of Internal Medicine, University Hospital, Gent, Belgium.
Nephrol Dial Transplant. 1998 Jul;13(7):1752-8. doi: 10.1093/ndt/13.7.1752.
Citrate, used for the anticoagulation of the extracorporeal dialysis circuit, reduces ionized calcium by chelation and has been claimed to attenuate dialyser membrane bioincompatibility. Dialysis with complement-activating cuprophane membranes is associated with leukopenia which has been related to an increase in adhesion molecule expression on the surface of circulating leukocytes.
The effect of citrate anticoagulation on the expression of CD11b, CD11c and CD45 on the surface of granulocytes and CD14 on monocytes during haemodialysis with cuprophane membranes, was evaluated by flow cytometric analysis. A comparison of standard heparin vs citrate was performed in 14 chronic haemodialysis patients. During citrate anticoagulation a calcium-free dialysate was used and citrate was infused to obtain a concentration of 4.3 mmol/l blood. The unchallenged 'baseline state' expression of the surface molecules and the increase after ex vivo stimulation with phorbol 12-myristate 13-acetate (delta-PMA) or formyl-methionyl-leucyl-phenylalanine (delta-fMLP) was studied.
With heparin, as well as with citrate, a sharp fall in granulocyte and monocyte count was observed after 15 min of dialysis, followed by a recovery at the end of the session. The expression of CD11b, CD11c and CD45 on granulocytes increased markedly during cuprophane dialysis with a peak at 15 min; there were no differences in response between heparin and citrate anticoagulation. Delta-PMA and delta-fMLP for CD45, CD11c and CD14 showed a decrease during cuprophane dialysis vs t0; again there were no differences between heparin and citrate.
We conclude that the use of citrate was not associated with reduced leukocyte activation as measured by the expression of surface molecules during cuprophane dialysis and that no effect on dialysis leukocytopenia could be registered.
用于体外透析回路抗凝的枸橼酸盐，通过螯合作用降低离子钙，并据称可减轻透析器膜的生物不相容性。使用激活补体的铜仿膜进行透析与白细胞减少有关，这与循环白细胞表面黏附分子表达增加有关。
通过流式细胞术分析，评估在使用铜仿膜进行血液透析期间，枸橼酸盐抗凝对粒细胞表面CD11b、CD11c和CD45以及单核细胞表面CD14表达的影响。对14例慢性血液透析患者进行了标准肝素与枸橼酸盐的比较。在枸橼酸盐抗凝期间，使用无钙透析液，并输注枸橼酸盐以达到血液浓度为4.3 mmol/l。研究了表面分子的未受刺激的“基线状态”表达以及用佛波酯12-肉豆蔻酸酯13-乙酸酯（δ-PMA）或甲酰甲硫氨酰亮氨酰苯丙氨酸（δ-fMLP）进行体外刺激后的增加情况。
使用肝素以及枸橼酸盐时，透析15分钟后观察到粒细胞和单核细胞计数急剧下降，随后在透析结束时恢复。在使用铜仿膜透析期间，粒细胞上CD11b、CD11c和CD45的表达明显增加，在15分钟时达到峰值；肝素和枸橼酸盐抗凝之间的反应没有差异。与t0相比，在使用铜仿膜透析期间，CD45、CD11c和CD14的δ-PMA和δ-fMLP显示下降；肝素和枸橼酸盐之间再次没有差异。
我们得出结论，在使用铜仿膜透析期间，通过表面分子表达测量，枸橼酸盐的使用与白细胞激活减少无关，并且未发现对透析白细胞减少有影响。
