透析用水及透析液中内毒素污染状况的分析

A study on the endotoxin and bacterial contamination in reverse osmosis water and dialysis fluids

目的 研究透析用水、透析液内毒素及细菌污染状况。方法 对北京１８ 家医院透析室反渗水、透析液用改良鲎试验检测内毒素，用血琼脂培养基做细菌培养，用ＥＬＩＳＡ法测定患者血浆白介素（ＩＬ）１、ＩＬ６ 及肿瘤坏死因子（ＴＮＦ）α。结果 反渗水内毒素为（０．１１６±０ ．０６３） ＥＵ／ｍｌ；细菌培养有两家医院阳性，均为１００ ＣＦＵ／ｍｌ。Ｂ浓缩透析液内毒素为（０．４６ ±０．３５） ＥＵ／ｍｌ，而Ａ浓缩透析液内毒素仅（０．０９１±０ ．０８４） ＥＵ／ｍｌ（Ｐ＜０ ．００１） ；Ｂ浓缩透析液细菌培养１１ 家阳性，其中８ 家≥２ ０００ ＣＦＵ／ｍｌ，Ａ浓缩透析液细菌培养阳性仅３ 家，均＜ ２ ０００ ＣＦＵ／ｍｌ。１６ 例患者中有５ 例透析器入口透析液内毒素＞０．５ ＥＵ／ｍｌ，且透后血ＩＬ６ 及ＴＮＦα显著增高。结论 目前透析用水及透析液存在内毒素及细菌的污染，定期检测反渗水、透析液的内毒素水平及进行细菌培养，定期消毒反渗水装置及透析液容器，对减少热源反应至关重要。

Objective To evaluate the endotoxin (ET) and the bacterial contamination in reverse osmosis (RO) water and dialysis fluids for hemodialysis treatment.Methods Specimens of RO water and dialysis fluids were obtained at random from 18 hospitals in Beijing. ET was measured with chromogenic limulus amoeboeyte lysate (LAL) assay. Bacteriologic samples were processed on heterotrophic plate count agar with pour plate technique. The plasma IL 1, IL 6 and TNFα were tested with enzyme linked immunosorbent assay (ELISA). Results The level of ET in RO water was 0.116±0.063 EU/ml, and the culture of bacteria had 2 positive results, both counting 100 CFU/ml. The level of ET was much higher in acid concentrate (Protocol B) than in basic concentrate (Protocol A). The culture of bacteria had 11 positive results in Protocol B concentration with 8 samples equal or higher than 2 000 CFU/ml. The culture of bacteria had only 3 positive results in Protocol A concentration, all being lower than 2 000 CFU/ml. Another investigation showed that the level of ET in dialysis inlet was higher than 0 5 EU/ml in 5 cases of a total of 16. Their plasma IL 1 and TNFα levels were significantly increased. Conclusion Both ET and bacterial contamination exist in RO water and dialysate. It is essential to examine the level of ET and perform bacterial culture, as well as to disinfect RO and dialysate tank at regular intervals in order to reduce pyrogenic reactions.