Low polymorphonuclear cell degranulation during citrate anticoagulation: A comparison between citrate and heparin dialysis
Low polymorphonuclear cell degranulation during citrate anticoagulation: A comparison between citrate and heparin dialysis
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DOI：
10.1093/ndt/12.7.1387
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发表时间：
1997-07-01
影响因子：
6.1
通讯作者：
Nube, MJ
中科院分区：
文献类型：
--
作者：
Bos, JC;Grooteman, MPC;Nube, MJ
导言。血液透析(HD)引起的生物不相容包括细胞因素和体液因素的改变。就多形核(PMN)细胞而言，黏附和脱颗粒均有增加的报道。然而，尽管PMN黏附和聚集的增加与早期短暂的补体激活高度相关，但脱颗粒似乎是一个连续的过程，与补体降解产物的形成无关。在包括PMN脱颗粒在内的细胞激活过程中，二价阳离子(Ca~(2+))似乎起着关键作用。由于局部给药柠檬酸盐在透析器内创造了一个几乎无钙的环境，人们很容易推测，起源于透析器内的生物不相容的钙依赖现象可以通过用传统的肝素替代柠檬酸盐来减弱。因此，对10名病情稳定的患者进行了两种抗凝方式的比较，这些患者仅使用三醋酸纤维素膜(CTA)进行血液透析(HD)治疗。除了细胞内颗粒产物髓过氧化物酶(MPO)和乳铁蛋白(LF)外，还测量了生物不相容的经典参数、外周血中性粒细胞减少和补体激活。对透析器上MPO和LF梯度(传出线浓度-传入线浓度)的分析表明，脱颗粒是一个早期过程，主要发生在体外循环中。柠檬酸几乎完全抑制MPO的释放，而部分抑制LF的释放。中性粒细胞减少和补体激活与脱颗粒的发生无关。结论。HD诱导的PMN脱颗粒似乎在很大程度上独立于补体激活，但主要依赖于钙离子，至少在CTA膜上是这样。
Introduction. Haemodialysis (HD)-induced bio-incompatibility includes alterations in both cellular elements and humoral factors. As far as polymorphonuclear (PMN) cells are concerned, an increase in both adhesion and degranulation has been reported. However, whereas increased PMN adherence and aggregation is highly linked with early transient complement activation, degranulation seems a continuous process, independent from the formation of complement degradation products. In the process of cell activation, including PMN degranulation, divalent cations (Ca2+) appear to play a pivotal role. As regionally administering citrate creates an almost Ca2+-free environment within the dialyser, it is tempting to speculate that Ca2+ dependent phenomena of bioincompatibility, originating within the dialyser, can be attenuated by substituting conventional heparin for citrate.Methods. Therefore, both anticoagulation modalities were compared in 10 stable patients, undergoing haemodialysis (HD) treatment with cellulose-triacetate membranes (CTA) only. Apart from the intracellular granule products myeloperoxidase (MPO) and lactoferrin (LF), the classical parameters of bioincompatibility, peripheral blood neutropenia and complement activation, were measured.Results. Analysis of MPO and LF gradients across the dialyser (concentration in efferent line-concentration in afferent line) suggested that degranulation is an early process, that occurs mainly within the extracorporeal circuit. Citrate abolished the release of MPO almost completely, whereas LF release was partially inhibited. Neither neutropenia, nor complement activation could be correlated with the occurrence of degranulation. Conclusions. HD-induced PMN degranulation seems largely independent from complement activation, but primarily reliant on Ca2+, at least in the case of CTA membranes.