腹膜透析对人腹膜形态结构的影响

目的 探讨腹膜透析（腹透）对人腹膜，重点在间皮层形态结构的影响及其意义。方法 采用光镜，扫描电镜和透射电镜对10例正常对照者，12例尿毒症非透析患者以及10例腹透患者的腹膜活检标本进行形态学观察。结果 尿毒症非透析患者腹膜的结构与正常对照者相似，而腹透患者的腹膜形态结构随着透析时间而呈进行性改变。主要表现为间质细胞表面微绒毛减少，消失，间皮细胞从基底膜脱落直至完全消失，最后只剩下裸露的纤维结缔组织。结论 腹膜透析可引起腹膜的形态学明显改变，这可能是长期腹膜透析引起腹膜衰竭的原因之一。进一步深入研究腹膜结构与功能间关系能为人们了解长期腹透对腹膜影响的病理生理机制并进而寻找保护腹膜的手段提供理论依据。

Morphological changes of human peritoneum during peritoneal dialysis

Objective To investigate the morphological changes of peritoneum during peritoneal dialysis (PD) and elucidate the possible mechanism of its functional deterioration. Methods Peritoneal biopsies were obtained from normal subjects( n = 10), uremic predialysis patients( n = 12) at catheter insertion and PD patients ( n = 10) at the time of catheter remove or reinsertion or renal transplantation, peritoneal morphology was studied by light microscopy, scanning electron microscopy and transmission electron microscopy. Results Normal peritoneal membrane consisted of a monolayer of mesothelial cells on a basement membrane, and a layer of connective tissue containing cells, blood vessels, lymphatic vessels and so on. Mesothelial cells were polygonal, often elongated, and had numerous microvilli on their luminal surface. Sometimes the microvilli ended with roundish formation or resembled a corona. There were lots of oval or roundish pinocytotic vesicles in the cytoplasm of mesothelial cell. Submesothelial connective tissue contained many collagen and elastic fibers. The peritoneal morphology of uremic predialysis patients was similar to that of normal subjects. But significant abnormalities of peritoneal morphology were observed in PD patients and the changes were progressive. Microvilli were the first site of damage, including microvilli shortening, gradual reduction in number and following total disappearance. Then mesolhelial cell detachment from basement membrane and total disappearances were found. Finally the peritoneal membrane only consisted of submesothelial connective tissue denudation of cells. Conclusions PD can modify peritoneal morphology and structure. The morphological change is progressive and might be one of the important causes of peritoneal failure. Peritoneal biopsy can provide lots of valuable informations about the impact of PD, and thus further study on the relationship between peritoneal structure and its function is very useful for understanding of the physiopathology of peritoneum during PD.