Berland Y
Service de néphrologie-hémodialyse, Hôpital Sainte-Marguerite, Marseille.
Nephrologie. 1998;19(6):329-34.
This article summarise the main data in the literature on the role of bacteriological contamination of the dialysate fluid in inflammatory reactions in hemodialysis. Pyrogenic substances of small molecular weight from Gram-negative bacteria grown in dialysate can pass across intact dialyzer membrane to stimulate cytokine production by peripheral blood mononuclear cells. Cellulosic hemodialysis membranes are more permeable to endotoxins than synthetic membranes. Polysulfone membranes and polyamide membranes are able to adsorb bacterial toxins on the dialysate side. The diffusive transfer of bacterial products across dialysis membrane from dialysate fluid was demonstrated. Transmembrane passage of cytokine-inducing bacterial products across reprocessed dialyzers is greater than across new dialyzers. Bacteriological contamination of the dialysate fluid is a problem which must be considered with much more care by nephrologists, especially as LAL test is unable to detect all the bacterial products which can contaminate the dialysate fluid.
本文总结了文献中关于透析液细菌污染在血液透析炎症反应中作用的主要数据。透析液中生长的革兰氏阴性菌产生的小分子致热物质可穿过完整的透析器膜，刺激外周血单核细胞产生细胞因子。纤维素透析膜比合成膜对内毒素更具渗透性。聚砜膜和聚酰胺膜能够在透析液侧吸附细菌毒素。已证实细菌产物可从透析液通过透析膜进行扩散转移。细胞因子诱导性细菌产物跨再处理透析器的跨膜转运大于跨新透析器的转运。透析液的细菌污染是肾病学家必须更加谨慎考虑的问题，尤其是因为鲎试剂检测无法检测出所有可能污染透析液的细菌产物。
