柠檬酸碳酸氢盐透析液安全性评估及其对淋巴细胞亚群的影响

Safety evaluation and changes of lymphocyte subsets in using hemodialysate containing citrate and bicarbonate

目的研究柠檬酸碳酸氢盐透析液的安全性及其对维持性血液透析(MHD)患者外周血淋巴细胞亚群(CD4+、CD8+)和HLA-DR的影响。方法选择西安交通大学第二医院肾内科30例MHD患者进行前后自身对照,前4周使用常规碳酸氢盐透析液(对照组),后4周使用柠檬酸酸碳酸氢盐透析液(实验组)。观察患者首次透析过程中生命体征。测定实验组首次透析前、透析后、透析后1h及第4周透析后1h血清离子钙(iCa2+)和柠檬酸的水平。两组首次透析前和第4周透析结束时分别测定CD4+、CD8+和HLA-DR表达率。结果两组透析过程中生命体征平稳;实验组血清柠檬酸透析前后基本保持不变,iCa2+在透析后明显增高(P<0.05);两组透析后外周血淋巴细胞亚群(CD4+/CD8+比值)活性均增高,但对照组以CD4+升高为主,实验组以CD8+降低为主;HLA-DR在实验组透析后明显升高(P<0.05),而对照组改变不明显。结论柠檬酸碳酸氢盐透析液有其独特的优点,具有临床推广应用的价值。

Objective To evaluate the safety, the effects on subsets of lymphocytes （CD4^＋ and CD8^＋ cells） and the expression of human leukocyte antigen-DR （HLA-DR） in maintenance hemodialysis patients using citrate and bicarbonate hemodialysate. Methods We used self-control in the study of 30 cases on maintenance hemodialysis. Patients were administrated with acetate and bicarbonate dialysate for 4 weeks as the control group and then with citrate and bicarbonate dialysate for 4 weeks as the treatment group. Blood pressure and heart rate were monitored every hour during hemodialysis. For the observation of serum citrate and ionized calcium changes in the treatment group, blood was taken before dialysis, after dialysis for one hour and at the end of dialysis in the first and the last sessions of dialysis. Changes of circulating CD4^＋ and CD8^＋ cells and HLA-DR on blood cells were measured before and after using the dialysate for 4 weeks. Results Blood pressure and heart rate were stable in both groups. In the treatment group, serum citrate remained unchanged, but serum ionized Ca2＋ increased significantly after the dialysis. The ratio of CD4^＋/CD8^＋ cells in peripheral blood increased in both groups. However, increase of CD4^＋ cells without change of CD8^＋ cells was found in the control group, and decrease of CD8^＋ cells in the absence of CD4^＋ cell changes was detected in the treatment group. The expression of HLA-DR on blood cells was elevated exclusively in the treatment group. Conclusion Hemodialysate containing citrate and bicarbonate is advantageous for the chronic renal failure patients on maintenance hemodialysis.