血液透析治疗中透析器和透析液对急性期蛋白及细胞因子的影响

Effects of dialyser and dialysate on the acute phase proteins and cytokines in patients with hemodialysis

目的:评估血液透析(HD)过程细胞因子白细胞介素6(IL-6)和一些急性期蛋白[C反应蛋白(CRP)和分泌型磷脂酶A_2(sPLA_2)]的水平,分析HD诱导的急性期反应与透析膜类型或透析液的关系。方法:10例患者行标准HD治疗,在透析开始、透析结束及透析后24h留取血液样本,分别检测IL-6,CRP和sPLA_2水平,所有患者分别使用改良型纤维素膜透析器(FB)和聚砜膜透析器(PS),另外5例患者为增强HD治疗,即纤维素膜透析器加上一组透析液滤器(FBf)。结果:FB组和FBf组在透析结束时IL-6水平显著高于透析开始时(P<0.05),在透析后24h IL-6降至基础水平,相反,PS组透析的患者IL-6水平无明显波动。在透析结束时FB组和FBf组IL-6水平显著高于PS组患者(P<0.05);FB和FBf组透析后24h时平均CRP水平显著高于透析后水平(P<0.05)。两组患者在透析后24h sPLA_2水平较透析结束时显著增高(P<0.05)。透析结束时IL-6水平与透析后24h CRP(r=0.67,P<0.01)水平和sPLA_2(r=0.52,P<0.05)水平显著正相关。但是使用PS膜透析患者,CRP以及sPLA_2水平均无显著性变化。结论:与PS膜相比,FB和FBf膜透析治疗结束时血清IL-6水平显著升高,与开始透析后24h后血清CRP和sPLA_2水平的升高显著正相关。因此,诱导HD急性期反应的原因中,透析膜的生物学特性较透析液细菌学标准(正常范围内)意义更大。

Objective：To estimate the levels of cytokine release （interleukin-6, IL-6） and subsequent production of acute phase proteins （C-reactive protein, CRP and secretory phospholipase A_2, sPLA_2） in patients with hemodialysis （HD） and investigate whether the HD-induced acute phase reaction depends on the type of membrane or dialysate. Methodology： The levels of IL-6, CRP and sPLA： levels were assessed in blood samples drawn before, at the end and 24h after the start of HD in ten HD patients. All patients were dialysed on fibrin diacetate （FB） and Polysulphon （PS） dialysers, and 5 patients underwent an additional HD session on FB plus a dialysate filter （FBf）. Results：The IL-6 levels in patients with FB and FBfwere increased significantly at the end of HD （P〈0. 05）. After 24 h of HD, the IL-6 levels had returned to baseline, while it did not occur during HD with PS. At the end of HD, the IL-6 was significantly greater with FB and FBf devices, than that with PS （P〈0. 05）. The levels of CRP in patients with FB and FBfwas increased significant after 24 h of liD, compared with postdialysis values （P〈0. 05）. In addition, the levels of sPLA2 were significantly increased after 24h of HD, compared with that at the end of HD （P〈0. 05）. The IL-6 levels at tls0 were significantly correlated with the levels of CRP （r=0. 67, P〈0. 01） and sPLA2（r=0. 52, P〈0. 05） after 24h of HD. During HD with PS membranes, the CRP or sPLA2values were not significantly changed. Conclusion： In contrast to PS, both FB and FBf elevated serum IL-6 levels at the end of HD, which correlated with increased the levels of CRP and sPLA2 24h later. Therefore, the membrane types, rather than the bacterial quality of the dialysate, were responsible for the induction of the acute phase response during HD.