HEMODIALYSIS LEUKOPENIA - PULMONARY VASCULAR LEUKOSTASIS RESULTING FROM COMPLEMENT ACTIVATION BY DIALYZER CELLOPHANE MEMBRANES
HEMODIALYSIS LEUKOPENIA - PULMONARY VASCULAR LEUKOSTASIS RESULTING FROM COMPLEMENT ACTIVATION BY DIALYZER CELLOPHANE MEMBRANES
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DOI：
10.1172/jci108710
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发表时间：
1977-01-01
影响因子：
15.9
通讯作者：
JACOB, HS
中科院分区：
文献类型：
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作者：
CRADDOCK, PR;FEHR, J;JACOB, HS
所有患者在使用玻璃纸膜设备进行血液透析的第1小时内均发生急性白细胞减少。这种短暂性细胞减少特别涉及粒细胞和单核细胞，这些细胞对活化的补体成分具有相同的质膜反应性。目前的研究表明，C在血浆暴露于透析器玻璃纸时被激活，当血浆重新输注到静脉循环中时，肺血管中的粒细胞和单核细胞被诱导。在早期透析中，C3 [C组分3]和因子B的转化可以在血浆离开透析器时被证实。用透析剂玻璃纸简单孵育人血浆可引起C3和因子B的转化，伴随溶血C和C3总量的消耗，但溶血Cl的保留。兔体内再输注含有玻璃纸的自体血浆，可产生选择性粒细胞减少症和单核细胞减少症，与透析患者相同。这类动物的肺显示明显的肺血管充盈，伴有粒细胞。负责白细胞停滞的活化C组分的MW约为7,000-20,000道尔顿。由于它是在缺乏c2的血浆中产生的，并与因子B转换有关，因此建议透析激活C主要是通过替代途径。
Acute leukopenia occurs in all patients during the 1st h of hemodialysis with cellophane-membrane equipment. This transient cytopenia specifically involves granulocytes and monocytes, cells which share plasma membrane reactivity towards activated complement [C] components. The present studies document that C is activated during exposure of plasma to dialyzer cellophane, and that upon reinfusion of this plasma into the venous circulation, granulocyte and monocyte entrapment in the pulmonary vasculature is induced. During early dialysis, conversion of C3 [C component 3] and factor B can be demonstrated in plasma as it leaves the dialyzer. Simple incubation of human plasma with dialyzer cellophane causes conversion of C3 and factor B, accompanied by depletion of total hemolytic C and C3 but sparing of hemolytic Cl. Reinfusion of autologous, cellophane-indubated plasma into rabbits produces selective granulocytopenia and monocytopenia identical to that seen in dialyzed patients. Lungs from such animals reveal striking pulmonary vessel engorgement with granulocytes. The activated C component(s) responsible for leukostasis has an approximate MW of 7,000-20,000 daltons. Since it is generated in C2-deficient plasma and is associated with factor B conversion, it is suggested that activation of C by dialysis is predominantly through the alternative pathway.