腹膜透析患者癌症相关抗原125水平及腹膜转运功能的纵向观察

腹膜功能的丧失是长期腹膜透析 (简称腹透 )患者面临的严重问题。腹膜间皮细胞是腹膜的重要细胞 ,担负着分泌、吸收、再生、防御功能 ,腹膜功能好坏与间皮细胞密切相关。癌症相关抗原 12 5 (ＣＡ 12 5 )是一种相对分子量为 2 2 0×10 6的糖蛋白 ,能被间皮细胞分泌 ,是反映间皮细胞数量的标记物[1] 。本研究的目的在于纵向观察腹透患者ｄ ＣＡ 12 5水平和腹膜转运功能及其变化与间皮细胞受损有无相关性。一、对象与方法1.对象 :本院腹膜透析患者 30例 ,男性 14例 ,女性 16例 ,平均年龄 (6 0± 16 )岁 ,平均腹透时间 (36± 18)个月。使用商品…     

腹透液中人腹膜间皮细胞的原代培养

人腹膜间皮细胞 (ＨＰＭＣ)是腹膜表层主要的细胞群体 ,间皮细胞在腹膜透析 (ＰＤ)时对腹膜具有重要的保护功能。长期ＰＤ的患者 ,其腹膜间皮层微绒毛减少、脱落乃至间皮层消失[1] ,最终促进了腹膜纤维化的进展及腹膜失超滤的发生。建立间皮细胞的体外培养体系 ,对于开展ＰＤ领域的基础及临床研究 ,具有非常重要的意义。基于以上的认识 ,本研究建立ＰＤ流出液中原代培养ＨＰＭＣ的培养方法 ,并设法应用扫描电镜动态观察来自不同透龄培养的间皮细胞其形态学上的差异 ,以利用这种无创性的体外培养方法间接地判断ＰＤ患者体内腹膜间皮层的实际…     

高浓度葡萄糖诱导人腹膜间皮细胞凋亡

实验小鼠腹膜透析 (ＰＤ)时 ,非生理性透析液 ,尤其是高浓度葡萄糖可损伤腹膜表层的间皮细胞 ,并引起小鼠死亡增多[1] ,但对于高浓度葡萄糖引起腹膜间皮细胞损伤的机制目前尚不十分清楚。虽然有学者经体外研究发现 ,高浓度葡萄糖可诱导体外培养的血管内皮细胞凋亡[2 ] ,但目前对高糖是否能诱导腹膜间皮细胞凋亡尚无定论[3 ,4] 。本研究以体外培养的人腹膜间皮细胞 (ＨＰＭＣ)为研究对象 ,探讨高浓度葡萄糖引起ＨＰＭＣ死亡的方式 ,揭示高浓度葡萄糖损伤ＨＰＭＣ的机制。1　材料和方法1.1　细胞台盼蓝 (ｔｒｙｐａｎｂｌｕｅ)染色检测间皮细…     

碳酸氢盐腹膜透析液的研究近况

长期以来,腹膜透析液（腹透液）的配制,都是以能排除患者尿毒症毒素,维持水和电解质酸碱平衡为目的［１］。许多研究表明,腹透液应符合人体生理,具有非常好的生物相容性,才能使腹膜长期较好地保持其半透膜的特性。现行市场上的腹透液中,缓冲碱乳酸盐是对腹膜产生不...     

阿托伐他汀对腹膜透析大鼠腹膜纤维化的影响及机制探讨

目的观察阿托伐他汀对腹膜透析腹膜纤维化的影响,并探讨机制。方法 30只雄性Wistar大鼠随机分成A、B、C组,每组10只。A组不作处理;B组腹腔内注入4.25%百特透析液20 mL/d,并于实验第7、14、21、28天加入红霉素6.25万U;C组在B组基础上同时予阿托伐他汀20 mg/（kg·d）灌胃,连用30 d。取各组大鼠腹膜组织进行HE染色及Masson染色,计算壁层腹膜厚度;取腹透液,计数细胞总数和巨噬细胞数;免疫组化方法测定腹膜组织中的结缔组织生长因子（CTGF）和血管内皮生长因子（VEGF）。结果 A组腹膜厚度为（6.52±0.82）μm,B组为（52.85±2.20）μm,C组为（26.86±1.75）μm,组间比较P均〈0.05。与B组比较,C组腹透液细胞总数和巨噬细胞减少（P均〈0.05）,CTGF和VEGF表达下调（P均〈0.05）。结论阿托伐他汀可明显减轻腹膜透析时腹膜纤维化,可能与其抑制腹膜组织CTGF和VEGF表达有关。     

糖尿病与腹透液蛋白丢失量对腹膜透析患者心脏结构的影响

目的探讨糖尿病对腹膜透析(PD)患者腹透液蛋白丢失量及心脏结构与功能的影响。方法选择青岛市市立医院肾内科随访的腹膜透析治疗12个月的患者共68例,糖尿病患者32例,非糖尿病患者36例。测定2组患者腹膜透析前后生化指标,24 h腹透液蛋白量,以超声多普勒测定患者腹透前后左心房前后径(LAD)、左心室前后径(LVD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室射血分数(LVEF)等,并进行比较。结果腹膜透析治疗前,糖尿病组与非糖尿病组患者各指标无差异。腹膜透析治疗1年后,两组患者在血清白蛋白、腹透液蛋白丢失量、室间隔厚度(IVST)、左室后壁厚度(LVPWT)及左心室射血分数(LVEF)等指标有统计学差异(P0.05)。腹透液蛋白丢失量:腹透液蛋白丢失量与血浆白蛋白及LVEF呈负相关关系(r=-0.476,P0.01;r=-0.269,P0.05);与IVST、LVPWT呈正相关关系(r=0.461,P0.01;r=0.346,P0.01)。结论糖尿病腹膜透析患者的腹透液蛋白丢失量更大,并会进一步影响患者的心脏结构和功能。     

腹膜透析管类型对腹透效果的影响

腹膜透析管类型对腹透效果的影响俞雨生关键词腹膜透析，透析管，透析效果在腹膜透析过程中，建立一个安全、有效的长期腹腔通路是进行透析治疗的基本条件。其中透析管的设计是否合理以及规格是否合适，对腹透效果具有重要影响。１腹透管的功能腹透管的主要功能是保证透析...     

腹膜透析导管植入术33例护理体会

腹膜透析是利用腹膜作为半透膜，向腹腔内注入透液，借助两侧的毛细血管内血浆及腹膜腔内的透析液中溶质浓度梯度和渗透梯度，通过弥散和渗透原理以清除体代谢废物和潴留过多的水分。腹透导管植入术是膜透析开始的首要条件，导管植入术成功与否及术后护直接关系到能否进行腹膜透析。我科从2005年1-12作腹膜透析植管术33例。腹透导管植入术均采用标准Tenckhoff直管。现将33例导管植入术护理体会报如下。     

广西地区腹膜透析技术开展及透析液配送现状调查

目的了解广西各市县二级以上医院腹膜透析开展工作和透析液配送情况,为指导广西全区的腹膜透析技术工作和透析液配送工作提供客观依据。方法通过电话访谈、实地走访、问卷调查等方法调查广西14个地级市、7个县级市、56个县、12个自治县的162家二级以上医院腹膜透析技术开展及腹透液配送情况。结果 162家医院有30家开展腹膜透析技术,能为维持性腹膜透析患者提供腹透液配送及随访服务;有33个市、县未能开展腹膜透析液配送服务。结论广西地区间腹膜透析治疗技术推广水平不均衡,地区间腹透液配送上门服务有待完善。政府应在腹膜透析技术开展方面给予一定扶持;联合政府、企业、医院共同解决基层腹膜透析液供应及配送,完善配送管理策略,可在一定程度上缓解腹膜透析患者看病难问题。     

活血通腑方含药血清对大鼠腹膜间皮细胞增殖的作用

目的观察活血通腑方含药血清干预体外培养大鼠腹膜间皮细胞增殖的效果,初筛对大鼠腹膜间皮细胞增殖能力有影响的最佳药物剂量和时间。方法采用腹腔注射胰酶消化的方式建立RPMC细胞模型,运用血清药理学方法制备不同剂量的活血通腑方含药血清,细胞培养经鉴定成功后分组(空白组、空白血清组、活血通腑方低剂量组、活血通腑方中剂量组、活血通腑方高剂量组),应用MTT法检测活血通腑方含药血清对大鼠腹膜间皮细胞的作用。结果与空白血清组比较,活血通腑方中剂量组含药血清可显著促进RPMC细胞增殖,作用时间在36 h时最为显著。结论活血通腑方含药血清具有诱导大鼠腹膜间皮细胞增殖的作用。     

Relationship between plasminogen activator inhibitor‐1 gene alterations and fibrosis in peritoneal dialysis patients

Peritoneal fibrosis (PF) is a pathological change that occurs mostly long‐term peritoneal dialysis (PD) patients, as a result of triggering the inflammatory response. Plasminogen activator inhibitor‐1 (PAI‐1) is an important molecule featured in the development of fibrosis. It has been shown in literature that PAI‐1 gene alterations are associated with fibrosis in many tissues and organs. However, PAI‐1 gene alterations in long‐term PD patients have not yet been investigated. In this study, PAI‐1 4G/5G polymorphism was examined by reverse hybridization, and all coding exons of the PAI‐1 gene were examined by sequence analysis to provide treatment modification in patients with predisposition before fibrosis develops. The patients were divided into two groups according to ultrafiltration failure test and duration of PD treatment: those with suspected PF or a high probability of developing PF (36%) and those with a low probability of developing PF (64%). There was no significant difference between the two groups in findings such as peritoneal equilibration test (PET), Kt/V, the content of the PD solution used, peritonitis, and PAI‐1 4G/5G polymorphism (P > .05). A total of eight gene alterations (rs2227660, rs2227668, rs2854233, rs41281004, rs61553169, rs368413856, rs2227684) were detected by sequence analysis, one of which was exonic (rs6092). When the genotype distributions of these variants were examined, no significant difference was found between the two groups. PAI‐1 gene changes were not detected in patients with the probability of developing PF. There is a need for further studies involving other molecules responsible for predisposing to PF with larger patient populations in patients undergoing long‐term PD treatment.     

糖尿病肾病与非糖尿病肾病患者应用葡萄糖透析液进行持续性非卧床腹膜透析的全天血糖谱比较

目的研究持续性非卧床腹膜透析（CAPD）患者全天血糖谱的变化规律。方法选取2009年4月至2011年12月在中山大学附属第一医院腹膜透析中心行腹膜透析的终末期肾病患者28例,其中15例为2型糖尿病肾病患者（DN组）,13例为非糖尿病肾病患者（NDN组）。另设健康对照组12名,为同期来我院门诊体格检查各项指标均正常者。应用动态血糖监测系统（CGMS）对3组进行连续72h的动态血糖监测,分析各组动态血糖参数特点。用多元协方差分析控制组问基线差异,并处理血红蛋白对HbAlc的影响效应。结果与正常对照组相比,NDN组〉11．1mmol／L血糖百分比（胛）明显高于正常对照组,差异有统计学意义[（1％（0～5％）比0,P〈0．05],且〉7．8mmol／L曲线下面积（AUC）、〉11．1AUC、平均血糖水平的标准差（SDBG）、血糖最大值（MAX）、日内最大血糖波动幅度（LAGE）均有升高趋势（P值介于0．056～0．094）。而DN组上述指标则更高。此外DN组平均血糖水平（MBG）、24hAUC、透析相关指标如腹膜透析时血糖、透析后MAX也明显高于NDN组[（9．4±2．5）比（6．4±1．3）mmol／L,（7．0±2．7）比（4．2±1．3）mmol·L-1·d-1,透析时血糖（8．6±2．8）比（6．2±1．4）mmoL／L,透析后MAX（11．5±2．6）比（8．5±2．4）mmol／L]（均P〈0．05）。糖化血红蛋白〈7％的DN组患者的血糖指标如MBG、24hAUC、〉7．8AUC及PT、〉11．1PT,腹膜透析相关指标如透析后MAX也较NDN组显著升高（t值为1．808～3．627,均P〈0．05）。DN组的夜间低血糖检出率明显高于NDN组及正常对照组。在DN患者中,使用2．5％葡萄糖透析液与1．5％透析液的患者相比,各项血糖指标均有升高趋势（均P〉0．05）。结论CAPD时葡萄糖腹膜透析液可影响患者的血糖稳态,对DN患者的影响更为明显。     

直型与卷曲型鹅颈腹膜透析导管的临床应用

目的：对比观察不同类型鹅颈腹膜透析(PD)导管的性能及可能引起的并发症,探讨不同导管的最佳适应证。方法：回顾性分析2007年3月至2010年2月在南京军区南京总医院全军肾脏病研究所行PD置管手术患者358例,按置入导管种类的不同分为鹅颈直管组及鹅颈卷曲管组。两组患者随访时间均大于3个月。观察两组患者的透析液流量、导管移位、隧道感染、出口感染、PD液渗漏等发生情况。结果：直管组231例,卷曲管组127例,两组患者的年龄、原发病情况无差别,两组患者PD隧道感染率和出口感染率无差别(P＞0.05)。直管组患者出现导管移位7例(3.0％),而卷曲管组多达26例(20.4％),两组相比有显著性差异(P＜0.01);且鹅颈直管自行复位率高,需要重新置管的患者较少。另外发现以耻骨联合上11cm定位的直管移位率低。结论：不同类型鹅颈导管各有优缺点,相比直管,卷曲管导管移位率较高。     

Relationship between effluent levels of beta(2)-microglobulin and peritoneal injury markers in 7.5% icodextrin-based peritoneal dialysis solution

The removal of low molecular weight proteins such as beta(2)-microglobulin (beta(2)MG) is accelerated by using a 7.5% icodextrin-based peritoneal dialysis solution (ICO) dwell. To examine the possibility of peritoneal injury in ICO, we investigated the relationship between beta(2)MG and the injury markers in effluent. Sixteen ICO-treated patients (11 male and five female, mean age 50.1 +/- 10.9 years) with continuous ambulatory peritoneal dialysis (CAPD; mean duration 54.6 +/- 30.8 months) were studied. The patients were treated with ICO 2 L and 2.27% glucose-based solution 2 L for an 8-h dwell and the effluent was collected. We investigated the correlations between beta(2)MG and the injury markers (e.g. hyaluronic acid [HA], interleukin-6 [IL-6], matrix metalloproteinase-2 [MMP-2]) in each effluent sample. The beta(2)MG level in the ICO effluent was 8978 +/- 2431 microg/L, significantly higher than in the 2.27% glucose-based solution effluent (6454 +/- 2956 microg/L; P = 0.0032). The levels of HA and MMP-2 in ICO effluent were significantly higher than those in the 2.27% glucose-based solution effluent (P = 0.00214, P = 0.0113, respectively). There was a trend toward higher IL-6-values in ICO effluent, although no significant differences were seen. There were positive correlations between levels of various injury markers and beta(2)MG. We propose that the subclinical injury of the peritoneum by ICO treatment may accelerate peritoneal permeability to increase beta(2)MG in effluent. ICO's biocompatibility might not be superior to that of glucose-based solution.     

婴幼儿先天性心脏病术后腹膜透析并发症分析

目的总结心外科婴幼儿先天性心脏病(先心病)术后腹膜透析的并发症以指导临床应用。方法回顾分析2010年6月至2012年6月在高州市人民医院院心外科行心脏手术的婴幼儿临床资料,其中41例患儿术后出现急性肾损伤或心功能不全,进行腹膜透析治疗。对腹膜透析相关并发症进行总结分析。结果大部分患儿肾功能渐恢复,腹膜透析时间(5.92±4.74)d,腹膜透析相关并发症12例,最常见是肺部并发症,腹膜透析相关并发症。经对症处理后均治愈,腹膜透析没有直接引起死亡事件。结论腹膜透析相关并发症少且不严重,在婴幼儿先心病术后发生急性肾损伤或心功能不全时可及早应用。     

自动腹膜透析充分性研究及其影响因素分析

目的探讨腹膜转运功能对自动腹膜透析(APD)充分性的影响。方法选择2009年1月至12月在北京大学人民医院肾内科住院的腹膜透析患者14例,先后行CAPD和APD治疗,并进行PET试验测定腹膜溶质转运功能。分别比较不同腹膜功能患者APD与CAPD充分性差异的异同。并比较不同腹膜功能患者延长存腹时间对APD充分性的影响。结果 APD小分子溶质清除充分性指标——尿素清除指数(KT/V)1.77±0.57,内生肌酐清除率(Ccr/w)(46.6±19.9)L——可达标,超滤量与CAPD无差异。虽APD总Ccr/w(46.6±19.9)KT/V较CAPD(63.8±29.4)KT/V下降,但亚组分析显示,此差异主要来自低转运、低平均转运者。这部分患者APD 14 h KT/V(1.67±0.50)较10 h(1.45±0.48)增加。结论 APD尤其适用于腹膜高转运、高平均转运患者;低转运、低平均转运者小分子溶质清除充分性差,需延长存腹时间或增加透析剂量。     

Shortage of Peritoneal Dialysis Solution and the Food and Drug Administration’s Response

Although the number of new drug shortages has been lower in recent years than in the past, severe shortages have occurred that have affected large numbers of patients. A new law entitled the Food and Drug Administration Safety and Innovation Act was enacted in July of 2012, which requires companies to notify the Food and Drug Administration of anticipated shortages. This notification requirement has allowed the Food and Drug Administration to work closely with manufacturers earlier to mitigate and, often, prevent shortages. However, not all shortages are able to be prevented, and the shortage of peritoneal dialysis solution is one that has had a significant effect on patients. The Food and Drug Administration continues to use all available tools to address this shortage with manufacturers, including temporary availability of imported peritoneal dialysis solution from Ireland. Mitigating shortages is a top priority for the Food and Drug Administration, and communication with all stakeholders is essential.     

长期腹膜透析对尿毒症大鼠腹膜结构的影响

目的探讨长期腹膜透析尿毒症大鼠腹膜结构的变化。方法30只雄性SD大鼠,随机分为对照组（C组）7只,不予干预;尿毒症生理盐水组（NS组,5/6肾切除）11只,每日经导管腹腔给予20 ml生理盐水;尿毒症腹透液组（PD组）12只,每日给予20 ml 4.25%腹透液。各组均维持6周,然后取大鼠壁层、脏层腹膜标本进行检测。结果PD组与其他两组比较,超滤量显著下降（P均〈0.05）;NS组与C组比较,其超滤量明显减少（P〈0.05）。HE染色PD组相对其他两组,腹膜增厚、血管数增多,NS组相对于C组腹膜厚度明显增厚、血管数明显增多（P均〈0.05）。免疫组化显示血管内皮生长因子（VEGF）和转化生长因子（β1）TGF-β1阳性细胞数PD组相对于C组和NS组大量增加,NS组较C组增加（P均〈0.05）。RT-PCR显示NS组和PD组VEGF和TGF-β1mRNA表达较C组显著上调,NS组高于C组（P均〈0.05）。结论尿毒症本身及非生物相容性腹透液均会引起腹膜血管新生及纤维化,导致超滤量减少,最终使患者退出腹透。     

Comparison between the pathology of encapsulating sclerosis and simple sclerosis of the peritoneal membrane in chronic peritoneal dialysis

Reports analyzing the histopathological differences between encapsulating peritoneal sclerosis (EPS) and simple peritoneal sclerosis (non-EPS) and those comparing the pathology of early and late EPS are limited. We present pathological comparisons between EPS and non-EPS, also between the early and late EPS stages. We compared peritoneal membrane (PM) samples (Group B) of 12 EPS patients (Group A) and 23 non-EPS cases regarding; mesothelial loss, submesothelial compact zone degenerated layer and compact zone thicknesses, densities of total and diseased vessels, fibrin stain, new membrane formation and degenerative changes. Group A was subdivided into 7 early (group A1) and 8 late (group A2) EPS cases; we compared both subgroups in the same manner and finally compared groups A1, A2, and B. No differences were found between groups A and B in the incidences of mesothelial detachment, new membrane formation and compact zone degenerative changes between the two groups. Furthermore, there were no differences in compact zone thickness, and vascular densities in the compact zone of respective vascular grade. Whereas, fibrin deposition and thickness of the submesothelial degenerated layer were significantly higher in group A than group B (P = 0.01 and 0.05, respectively), and the thickness of the compact zone was less in group A1 than in group A2 (P = 0.03). Positive fibrin stains and thick degenerative compact zone layers are important pathological findings in EPS. Angiogenesis, vasculopathy, new membrane formation, fibrosis and degenerative changes of the compact zone are not unique characteristics for EPS. Larger size studies are recommended to verify this issue.     

Overview of regular dialysis treatment in Japan (as of 31 December 2005)

A statistical survey conducted at the end of 2005 covered 3985 medical facilities across Japan, and 3940 facilities (98.87%) responded. The dialysis population in Japan at the end of 2005 was 257,765, which showed an increase of 9599 patients (3.87%) from the end of the previous year. The number of patients per million was 2017.6. The crude death rate for one year (from the end of 2004 to the end of 2005) was 9.5%. The mean age of the patients who began dialysis (in 2005) was 66.2 years, and the mean age of the entire dialysis population was 63.9 years. The primary diseases of the patients who began dialysis were diabetic renal disease (42.0%) and chronic glomerulonephritis (27.3%). The mean (+/-SD) serum ferritin concentration of all the dialysis patients was 191 (+/-329) ng/mL. The percentages of antihypertensive agents administered to the hemodialysis patients were as follows: calcium-channel blocker, 50.3%; angiotensin-converting enzyme inhibitor, 11.5%; and angiotensin II-receptor blocker, 33.9%. Of the peritoneal dialysis patients, 33.4% used automated peritoneal dialysis devices. Moreover, 7.3% of the peritoneal dialysis patients received dialysis treatment only in the daytime, and 15% received the treatment only at night. Icodextrin solution was used by 37.2% of the peritoneal dialysis patients. The average amount of dialysis solution used by the peritoneal dialysis patients was 7.43 (+/-2.52) L/day and the average amount of removal fluid was 0.81 (+/-0.60) L/day. A peritoneal equilibration test was conducted on 67% of the patients, and the mean dialysate to plasma creatinine ratio was 0.65 (+/-0.13). The annual incidence of peritonitis in the peritoneal dialysis patients was 19.7%. Of the 126 040 patients who responded to the inquiry of the therapeutic situation of peritoneal dialysis, 676 (0.7%) had a history of encapsulated peritoneal sclerosis and 66 (0.1%) were treated for encapsulated peritoneal sclerosis. The mean life expectancy of the dialysis population in 2003 was calculated according to sex and age. Results showed that the mean life expectancy of the dialysis population was approximately 40-60% of that of the general population of the same sex and age.