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血液与血液透析膜相互作用涉及的生化机制

Author
Jeffrey S Berns, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD
Translators
邢昌赢, 主任医师，教授

引言

血液与透析膜接触会引发有组织的炎症反应，该反应包括机体对抗“非我”的防御机制激活。在过去，生物相容膜(biocompatible membrane, BCM)的定义为“引起接触该膜的患者发生最低程度炎症反应的膜”[1]。然而，有人提出，某些类型的透析膜“吸附”(即，结合)低分子量蛋白质或肽是透析期间的另一种清除机制，在定义透析膜的生物相容性方面可能也很重要[2]。

本专题将总结血液与生物材料相互作用时激活的通路，以及吸附对改善这种相互作用所致炎症反应的促进作用。将重点讨论已知的血液与新的血液透析膜之间的相互作用，仅有略微关注重复使用的影响。由于血液透析是一项重复性操作，所以每次治疗时膜引发的微小反应最终会导致远期不良临床后遗症。血液-透析膜相互作用的急性和慢性临床后遗症将单独讨论。 (参见“对血液透析膜的反应”和“血液透析膜生物相容性的临床影响”)

广义上来讲，透析治疗的所有方面都会影响生物相容性。包括透析液成分和温度、透析膜的渗透性/多孔性、清除类型(扩散或对流)、初次使用时的消毒剂(如环氧乙烷)，再次使用时的操作和消毒剂(甲醛、次氯酸盐、过氧乙酸/过氧化氢)以及生产过程中的残留物质。然而，膜的生物相容性本身最为重要，这方面的研究最多。

透析膜的成分

透析膜可被分为以下几种[3]：

●纤维素

          

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-08.
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References
Top
  1. Hakim RM. Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 1993; 44:484.
  2. Pascual M, Tolkoff-Rubin N, Schifferli JA. Is adsorption an important characteristic of dialysis membranes? Kidney Int 1996; 49:309.
  3. Bouré T, Vanholder R. Which dialyser membrane to choose? Nephrol Dial Transplant 2004; 19:293.
  4. United States Renal Data System. USRDS 1995 Annual Data Report. US Department of Health and Human Services. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, August 1995.
  5. United States Renal Data System. USRDS 2003 Annual Data Report. US Department of Health and Human Services. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Am J Kidney Dis 2004; 41 (Suppl 2):S187.
  6. Hakim RM. Complement activation by biomaterials. Cardiovasc Pathol 1993; 2:187S.
  7. Chenoweth DE. Complement activation in extracorporeal circuits. Ann N Y Acad Sci 1987; 516:306.
  8. Meri S, Pangburn MK. Discrimination between activators and nonactivators of the alternative pathway of complement: regulation via a sialic acid/polyanion binding site on factor H. Proc Natl Acad Sci U S A 1990; 87:3982.
  9. Kuwahara T, Markert M, Wauters JP. Biocompatibility aspects of dialyzer reprocessing: a comparison of 3 re-use methods and 3 membranes. Clin Nephrol 1989; 32:139.
  10. Pascual M, Steiger G, Estreicher J, et al. Metabolism of complement factor D in renal failure. Kidney Int 1988; 34:529.
  11. Pascual M, Catana E, White T, et al. Inhibition of complement alternative pathway in mice with Fab antibody to recombinant adipsin/factor D. Eur J Immunol 1993; 23:1389.
  12. Pascual M, Schifferli JA. Adsorption of complement factor D by polyacrylonitrile dialysis membranes. Kidney Int 1993; 43:903.
  13. Pascual M, Schifferli JA, Pannatier JG, Wauters JP. Removal of complement factor D by adsorption on polymethylmethacrylate dialysis membranes. Nephrol Dial Transplant 1993; 8:1305.
  14. Deppisch R, Schmitt V, Bommer J, et al. Fluid phase generation of terminal complement complex as a novel index of bioincompatibility. Kidney Int 1990; 37:696.
  15. Deppisch R, Ritz E, Hänsch GM, et al. Bioincompatibility--perspectives in 1993. Kidney Int Suppl 1994; 44:S77.
  16. Thomaneck U, Vienken J, Waldschläger U, et al. Detection of charges and their distribution on dialysis membranes with cationic/anionic dyes using confocal laser scanning microscopy. Int J Artif Organs 1991; 14:686.
  17. Schulman G, Hakim R, Arias R, et al. Bradykinin generation by dialysis membranes: possible role in anaphylactic reaction. J Am Soc Nephrol 1993; 3:1563.
  18. Krieter DH, Grude M, Lemke HD, et al. Anaphylactoid reactions during hemodialysis in sheep are ACE inhibitor dose-dependent and mediated by bradykinin. Kidney Int 1998; 53:1026.
  19. Wu CC, Chen JS, Wu WM, et al. Myeloperoxidase serves as a marker of oxidative stress during single haemodialysis session using two different biocompatible dialysis membranes. Nephrol Dial Transplant 2005; 20:1134.
  20. Arnaout MA, Hakim RM, Todd RF 3rd, et al. Increased expression of an adhesion-promoting surface glycoprotein in the granulocytopenia of hemodialysis. N Engl J Med 1985; 312:457.
  21. Strasser T, Schiffl H. Generation of leukotriene B4 by hemodialyzer membranes: a novel index of biocompatibility. Klin Wochenschr 1991; 69:808.
  22. Dinarello CA. Cytokines: agents provocateurs in hemodialysis? Kidney Int 1992; 41:683.
  23. Cheung AK. Biocompatibility of hemodialysis membranes. J Am Soc Nephrol 1990; 1:150.
  24. Schindler R, Linnenweber S, Schulze M, et al. Gene expression of interleukin-1 beta during hemodialysis. Kidney Int 1993; 43:712.
  25. Canivet E, Lavaud S, Wong T, et al. Cuprophane but not synthetic membrane induces increases in serum tumor necrosis factor-alpha levels during hemodialysis. Am J Kidney Dis 1994; 23:41.
  26. Himmelfarb J, Lazarus JM, Hakim R. Reactive oxygen species production by monocytes and polymorphonuclear leukocytes during dialysis. Am J Kidney Dis 1991; 17:271.
  27. Zaoui P, Green W, Hakim RM. Hemodialysis with cuprophane membrane modulates interleukin-2 receptor expression. Kidney Int 1991; 39:1020.
  28. Zaoui P, Hakim RM. Natural killer-cell function in hemodialysis patients: effect of the dialysis membrane. Kidney Int 1993; 43:1298.
  29. Bariety J, Hinglais N, Bhakdi S, et al. Immunohistochemical study of complement S protein (Vitronectin) in normal and diseased human kidneys: relationship to neoantigens of the C5b-9 terminal complex. Clin Exp Immunol 1989; 75:76.
  30. Zalman LS, Wood LM, Müller-Eberhard HJ. Isolation of a human erythrocyte membrane protein capable of inhibiting expression of homologous complement transmembrane channels. Proc Natl Acad Sci U S A 1986; 83:6975.
  31. Himmelfarb J, Lazarus J, Hakim RM. Increased expression of glycoprotein GP IIb/IIIa detected by flow cytometry on platelets during hemodialysis (abstract). Kidney Int 1987; 31:234.
  32. Hornych A, Rémy P, Luong N, et al. Biocompatibility of haemodialysis membranes: haemodialysis-related leukotriene B4 and C4 generation. France. Nephron 1996; 74:11.
  33. Kiaii M, Djurdjev O, Farah M, et al. Use of electron-beam sterilized hemodialysis membranes and risk of thrombocytopenia. JAMA 2011; 306:1679.