透析器过敏反应18例临床分析及文献复习

Hypersensitivity reactions to dialyzer:analysis of 18 cases and review of the literature

目的评估血液透析患者透析过敏反应的发生率和临床特征。方法回顾性分析辽宁省4所医院2016年12月~2019年12月需要更换透析器的过敏反应的临床资料,包括临床症状、发作时间、责任透析器、接触责任透析器时间、替代透析器等。结果853名患者中透析器过敏反应共18例,发生率为2.11%,最常见症状为呼吸困难(50%)、皮肤瘙痒(33.33%)。12例过敏症状在透析后的前30min内出现,9例反应发生在血液透析的第1周。所涉及的膜为聚砜/聚乙烯吡咯烷酮(polysulfone/polyvinylpyrrolidone,PS/PVP)膜(9例)、聚芳醚砜/聚乙烯吡咯烷酮/聚酰胺(polyethersulfone/polyvinylpyrrolidone/polyamide,PAES/PVP/PA)膜(7例)、聚芳醚砜/聚乙烯吡咯烷酮(polyethersulfone/polyvinylpyrrolidone,PAES/PVP)膜(2例)。血液透析13例(72.22%),血液透析滤过5例(27.78%),灭菌方式均为蒸汽灭菌。3例更换为不同类型的PS或PAES膜后仍有交叉过敏反应,18例替换为三醋酸纤维素膜后均未再次发生过敏反应。结论合成膜透析器过敏反应发生率与20年前相比波动不大,三醋酸纤维素膜可能是聚砜膜及其衍生膜过敏较好的替代膜,具体原因还需未来研究进一步探索。

Aims To assess the incidence and characteristics of hypersensitive reactions to dialyzer in hemodialysis patients.Methods We retrospectively analyzed the patients necessary to change dialyzers due to hypersensitivity to the dialyzers in the four hospitals in Liaoning province during December 2016 to December 2019.Their clinical data including symptoms,onset time,offending dialyzer,duration of exposure to the dialyzer,and the alternative dialyzer were collected.Results Eighteen patients out of 853 patients(2.11%)had hypersensitive reactions.The most frequent symptoms were dyspnea(50%of reactions)and skin itch(33.33%).Hypersensitive reactions occurred within the first 30 minutes of hemodialysis in 12 cases,and during the first week of dialysis in 9 cases.The membranes involved were polysulfone(n=9),polyamix(n=8)and polyethersulfone(n=2).Thirteen cases were treated with hemodialysis,and 5 cases with hemodiafiltration.The dialyzers were sterilized by steam.Three cases still had hypersensitive reactions when the dialysis membranes were replaced by different types of PS/PAES membranes.All of the cases became asymptomatic when cellulose triacetate membranes were used.Conclusion The incidence of hypersensitive reactions associated with synthetic membranes is less changed compared with that 20 years ago.Cellulose triacetate membrane appears to be a better alternative,of which the reason needs to be further studied.