不同透析膜对终末期肾病患者IL-18水平的影响

The effect of different dialyzer membranes on IL-18 level in patients with end stage renal diseases

目的探讨终末期肾病(end stage renal disease,ESRD)患者血浆白细胞介素18(IL-18)水平以及不同透析膜对其的影响,并判断其能否作为评价透析膜生物相容性的指标。方法30例ESRD患者分为未透析组和维持性血液透析(maintenance hemodialysis,MHD)组,MHD组随机分为纤维素生物膜组(650)和聚砜膜组(F6)各10例,同时健康者10例为对照组。应用酶联免疫吸附(ELISA)法测定各组血浆中IL-18水平,以及外周血单个核细胞(pe-ripherial blood mononuclear cells,PBMC)经及未经脂多糖(lipopolysaccharide,LPS)干预的培养上清中IL-18的水平,同时以半定量逆转录多聚酶链反应(RT-PCR)法检测PBMC中IL-18 mRNA的表达。结果ESRD未透析组及MHD组透析前、后血浆IL-18水平较正常对照组明显升高(P<0.05),MHD组透析前、后血浆IL-18水平无明显变化(P>0.05)。ESRD未透析患者的PBMC经LPS刺激后IL-18培养上清水平无明显变化(P>0.05),mRNA表达量则显著降低(P<0.05);650组透析后PBMC经LPS刺激后IL-18培养上清水平及mRNA表达量均降低(P<0.05),F6组透析后PBMC经LPS刺激后IL-18培养上清水平及mRNA表达量均明显升高(P<0.05)。结论(1)ESRD患者体内处于微炎症状态;(2)从血浆IL-18水平变化看,血液透析不能改善ESRD患者体内炎症状态;(3)聚砜膜较纤维素生物膜能改善患者的单核细胞对抗原的反应能力;(4)IL-18可作为评价透析膜生物相容性的指标之一。

Objective To investigate the plasma level of imerleukin 18 （ IL-18 ） and the effect of differem dialyzer membranes on its expression in patients with end stage renal disease（ESRD）, then evaluate whether IL- 18 can be a biocompatibility index of dialyzer. Methods Thirty patients with ESRD were divided into maintenance hemodialysis （MHD） group and non-hemodialysis group. The plasma level of IL-18 and the level of IL-18 in supernatants of peripheral blood mononuclear cells（PBMC）cultured with or without lipopolysaccharide （LPS） were measured by enzyme-linked immunosorbent assay （ ELISA ）. The expressions of IL-18 rnRNA in PBMC were evaluated by reverse transcriptase polymerase chain reaction （RT-PCR）. Patients in MHD group were dialyzed with regenerated cellulose membrane （650 group） or pelysulform membrane （F6 group） respectively. Ten healthy persons were as controls （ODN group）. Results The plasma levels of IL-18 in non-dialysis ESRD patients and MHD patients were higher significantly than those of healthy controls（ P 〈 0.05）. The plasma levels of IL- 18 in MHD were not obviously changed before and after dialysis（ P 〉 0.05）. In non-dialysis ESRD patients, the level of IL-18 in supernatants of PBMC cultured with LPS had no significant difference（ P 〉0.05）, but expression of IL-18 rnRNA in PBMC decreased significantly after LPS stimulation（ P 〈 0.05 ）. After hemodialysis , the level of IL-18 in supernatants of PBMC cultured with LPS and expression of IL-18 mRNA in PBMC significantly decreased in 650 group （ P 〈 0.05）, but increased significantly in F6 group （ P 〈 0.05 ）. Conclusion The microinflammatory state is present in ESRD patients. The levels of IL-18 are not obviously changed through dialysis, so maintanance hemodialysis could not improve the microinflalmnatory state in uraemic patients. Patient＇s monocyte function can be improved by using pelysulform membrane. The IL-18 can be a parameter in evaluating the biocompatibility of dialyzer.