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超纯透析液

Author
Richard A Ward, PhD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
叶朝阳, 主任医师，教授

引言和概述

血液透析患者有被透析液中化学和微生物学污染物损害的危险。(参见“血液透析用水中的污染物”)为避免来自这些污染物的损害，要求用于生产透析液的水和浓缩液，以及透析液自身都要满足已建立的质量标准[1-3]。遵循这些标准，已大大降低了透析液污染物引起的急性不良事件。

只要用于生产透析液的水和浓缩液满足所要求的质量标准，则透析液中化学污染物引起的长期并发症也很少见。但防止因接触微生物污染物而引起的长期并发症相对来说要更困难些。

当处理饮用水被用于血液透析时，由于去除了饮用水中抑制细菌生长的氯化物，所以几乎不可能完全抑制净化水和透析液中的细菌增殖。因此，即使常规透析液满足所要求的质量标准，但其通常仍含有一些低水平的微生物污染物，包括内毒素碎片、肽聚糖和细菌DNA碎片[4-6]。这些污染物有时被统称为“细胞因子诱导物”，且能通过低通量和高通量的血液透析膜[5,7]，并刺激炎症细胞产生细胞因子[8]。

很多血液透析患者的C反应蛋白(C-reactive protein, CRP)和白细胞介素6(interleukin-6, IL-6)血浆水平会增高，这提示了一种慢性炎症状态[9,10]。这种炎症状态可能是血液透析相关长期并发症的一个重要促成因素[11]。虽然炎症似乎是慢性肾脏疾病本身的后果[12,13]，但血液透析过程的某些方面(包括透析液中低水平的微生物污染物)，也可作为炎症刺激物[11,14]。 (参见“肾功能不全中的炎症”)

因此，已推荐常规血液透析使用比要求的微生物学纯度高得多的透析液[1,15]。这种“超纯”透析液通常被定义为细菌计数小于100CFU/L，并且鲎试剂(limulus amebocyte lysate, LAL)试验测得的内毒素含量小于0.03EU/mL[16]。联机血液透析滤过和血液滤过(透析液用于制备替代溶液)需要使用超纯透析液[17]。 (参见“终末期肾病肾脏替代治疗替代方案”)

          

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-26.
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