中国血液净化

›› 2003, Vol. 2 ›› Issue (3): 121-124.

• 论著 •    下一篇

不对称双层聚乙醚硫胺膜透析器对透析液中细胞因子诱导物质的屏障作用

李保春 崔若兰 许 静 郭志勇 于 光 翟振燕 袁伟杰 高大勇   

  1. 200433 上海，第二军医大学第一附属医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2003-03-19 发布日期:2003-03-19
  • 通讯作者: 李保春

  • Received:1900-01-01 Revised:1900-01-01 Online:2003-03-19 Published:2003-03-19

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摘要： 【摘要】目的 研究新型透析膜Syntra 160对细胞因子诱导物质（Cytokine-inducing substance，CIS）的通透情况。方法 选用高流量聚乙醚硫胺透析器,在碳酸氢盐透析液中加入铜绿杆菌（Pseudomonas. aeruginosa，P.A） 培养滤过液模拟污染透析液（contaminated dialysate，CD）情况，以周围血单核细胞（peripheral blood mononuclear cells，PBMC）表达细胞因子的量（pg/2.5×106 PBMC）评价透析膜对CIS的通透性，研究CIS在不同条件下（透析液中混入稀释度分别为1∶102, 1∶103,1∶104的P.A培养滤过液，以下简写为：10-2CD, 10-3CD，10-4CD）是否能通过透析膜进入血液侧。结果 分别在开始透析前（B0），在全血与无污染的碳酸氢盐透析液（UCD）一同循环15 min后（B15），以及在与10-2CD, 10-3CD，10-4 CD一同循环60min后（B60）各时间点留取血液测血标本。提取各点血标本行PBMC培养，结果示标本中均未检测TNF-α。将PBMC分别与10-2CD, 10-3CD，10-4CD一同培养(CD0)，测得TNF-α的量分别是477.0±260.7, 318.9±49.3, 102.6±77.0；在10-2CD组中，IL-1Ra在B0,B15,B60,CD0的量分别为156.8±81.6，188.9±108.8，271.2±127.4，2971.8 ±1123.0。在10-3CD组中，IL-1Ra在B0, B15, B60, CD0的量分别为201.2±154.0,143.9±72.7,208.7±99.7,2274.0±925.9。在10-4CD组中，IL-1Ra在B0, B15,B60,BS60,CD0的量分别为116.3±40.5,127.8±60.8,111.7±18.5,1175.5±603.0。结论 在透析液污染和反超滤情况下，Syntra160能有效阻止高污染透析液中的CIS通过透析膜进入血液侧。

关键词: 透析器, 肿瘤坏死因子, 细胞因子诱导物质, 血液透析, 反超

Abstract:

【Abstract】Objective To test the cytokine-inducing substance (CIS) permeability of a new kind of dialyzer-Syntra 160 in vitro dialysis with whole human donor blood. Methods The dialyzers used in these tests were high-flux polyethersulfone dialyzers. Bicarbonate dialysate (D) was contaminated by Pseudomonas. aeruginosa (P.A) culture filtrate, and cytokine production in the peripheral blood mononuclear cells (PBMC) expressed as pg/2.5×106 was used as the indicator of transmembrane passage of CIS. Whether the CIS can pass through the dialysis membrane to the blood side was investigated under several conditions, including D contaminated with different dilution of bacterial culture filtrate (10-2, 10-3, 10-4)。 Results The total production of all TNF-α was not detectable in the PBMC sample harvested from blood before exposure to dialyzer (B0), after 15 min circulating the whole blood with uncontaminated bicarbonate D (B15), 60 min after circulating the CD with 10-2, 10-3,10-4 diluted bacterial culture filtrate (B60) and 60 min after the both blood and contaminated D keeping in still condition (B60S). While the TNF production in the 10-2,10-3,10-4 diluted bacterial culture filtrate CD (CD0), the TNF-α production were 477.0±260.7, 318.9±49.3, 102.6±77.0. The IL-1Ra production in the group of Dcontaminated by 10-2 diluted bacterial culture filtrate was 156.8±81.6 in B0, 188.9±108.8 in B15, 271.2±127.4 in B60, 2971.8±1123.0 in D0. In the group of D contaminated by 10-3 diluted bacterial culture filtrate, the IL-1Ra in B0, B15, B60, D0 was 201.2±154., 143.9±72.7, 208.7±99.7, 2274.0±925.9. In the group of D contaminated with 10-4 diluted bacterial culture filtrate, the IL-1Ra value in B0, B15, B60, D0 value was 116.3±40.5, 127.8±60.8, 111.7±18.5, 1175.5±603.0. There was no significant difference among the blood sample among B15, B60 and B0, but the cytokine production in D0 was much higher than any other group, the difference was significant. Conclusion The Syntra 160 can effectively prevent the passage of cytokine-inducing substance from highly contaminated D under very critical condition. 

Key words: TNF, Dialyzer, Hemodialysis, Backfiltration