Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membranes
Effect of regional citrate anticoagulation on leukopenia, complement activation, and expression of leukocyte surface molecules during hemodialysis with unmodified cellulose membranes
复制标题
DOI：
10.1159/000045683
复制
发表时间：
2000-08-01
期刊：
影响因子：
2.5
通讯作者：
Lameire, N
中科院分区：
文献类型：
--
作者：
Dhondt, A;Vanholder, R;Lameire, N
背景：补体激活膜透析与白细胞减少有关，这与白细胞表面黏附分子的表达增加有关。柠檬酸盐能螯合钙，并声称能减轻白细胞减少症。方法：采用未改性纤维素膜进行血液透析，观察柠檬酸抗凝对白细胞、粒细胞计数、补体活化及粒细胞表面CD11b、CD11c、CD45表达的影响。标准肝素和柠檬酸盐在三个不同的方案中进行了比较：输入柠檬酸盐以获得7或10 mmoL/L血液的浓度。以8.25mmolCa~(2+)/h(柠檬酸盐10 mmoL/L)或11mmolCa~(2+)/h(柠檬酸盐7和10 mmoL/L)向透析器出口注入CaCl2，以恢复患者血液中的钙水平。结果：高浓度柠檬酸(10 mmoL/L)的使用与CD11b在进血系和出血系的钝性上调有关；对于CD11c，从入血系采集的粒细胞的CD11b表达降低。未观察到柠檬酸盐对白细胞减少、粒细胞减少或补体激活的影响。CD11b、CD11c表达增加与全身游离钙离子浓度降低呈正相关。结论：柠檬酸盐/CaCl2对白细胞黏附分子表达的影响呈剂量依赖关系，但对白细胞减少和补体活化无明显影响。版权所有(C)2000 S.Karger AG，巴塞尔。
Background: Dialysis with complement-activating membranes is associated with leukopenia, which is related to an increased expression of adhesion molecules on leukocytes. Citrate chelates calcium and has been claimed to attenuate leukopenia. Methods: In this study, the effects of citrate anticoagulation on leukocyte and granulocyte counts, complement activation, and the expression of CD11b, CD11c, and CD45 on the surface of granulocytes were evaluated during hemodialysis with unmodified cellulose membranes. Standard heparin was compared to citrate in three different schedules: citrate was infused to obtain a concentration of either 7 or 10 mmol/l blood. CaCl2 was administered into the dialyzer outlet at 8.25 mmol Ca2+/h (citrate 10 mmol/l) or at 11 mmol Ca2+/h (citrate 7 and 10 mmol/l) to restitute the calcium levels in the blood returning to the patient. Results: The use of citrate at a high concentration (10 mmol/l) was associated with a blunted upregulation of CD11b, both at the inlet and at the outlet bloodline; for CD11c a reduced upregulation was observed on granulocytes harvested from the inlet bloodline. No effects of citrate were observed on leukopenia, granulocytopenia, or complement activation. A positive correlation between the decrease in systemic ionized Ca2+ concentration and the increase in CD11b and CD11c expression was found. Conclusion: Citrate/CaCl2 administration affects leukocyte adhesion molecule expression in a dose-dependent way; however, no significant effect could be demonstrated on leukopenia and complement activation. Copyright (C) 2000 S. Karger AG, Basel.