腹部震荡对腹膜溶质转运的影响

目前常用的提高腹膜透析小分子溶质转运的主要方法有：增加透析液溶质的浓度、增加透析交换次数和透析液量、腹透液内加血管扩张剂如硝普钠和丹参用以增加腹膜有效面积等。而我们则通过破坏腹腔内不流动液体层增加腹膜透析时小分子溶质交换这一途径来观察腹膜透析时小分子...     

川芎嗪注射液对腹膜透析溶质转运的影响

近年来，随着腹膜透析（ＰＤ）装置的不断改进，ＰＤ并发感染的发生率已明显下降，而腹膜溶质转运障碍等原因所致透析不充分的问题日益突出，因此如何增加 ＰＤ时腹膜对溶质清除，减少蛋白质的丢失，成为目前急待研究与解决的问题。我们通过观察中药川芎嗪对腹膜溶质转运的影响，以期为其预防及改善腹膜转运障碍提供理论依据。 一、材料与方法 （一）实验动物：１８只新西兰大白兔体重 ２． ０～２． ５ ｋｇ，由本院动物实验中心提供。 （二）实验方法： １．分组：每只大白兔按随机分组的原则分为３组，Ａ组单纯用１．５％ Ｂａｘｔｅｒ腹…     

重新评价腹膜平衡试验以确定腹膜透析患者的溶质转运类型

目的 确定由Twardowski提出的腹膜平衡试验（PET）的转运类型评判值是否适合本中心患者。方法 选取我院自1995年来首次进行PET测试的患者158例。首先依据Twardowski的评判标准（值）判断患者的转运类型,再根据本组患者实际4hD/Pcr的χ±s来确定患者的溶质转运类型,然后将患者重新分组:按两种数值均符合高转运为H1组,均符合平均转运为A组,均符合低转运为L1组,部分高转运患者经重新评价后符合平均转运为H2组,部分平均转运患者经重新评价后符合低转运为L2组。通过与临床情况（溶质和水的清除）进行对照,以进一步评价更适合本中心患者的评判标准。结果 按照Twardowski的标准,高转运、高平均转运、低平均转运及低转运患者的比例分别为21.5％、44.9％。27.8％及5.7％。本研究患者群中4hD/Pcr的均值和标准差为0.70和0.14,据此重新评判后,各组的比例分别为14.6％、33.5％、33.5％及18.4％。经与临床结果相对比,L2组对水份的清除能力明显高于A组（P<0.005）,与L1组差别无显著性意义。结论4hD/Pcr在不同的地区和人群中表现出不同的均数和标准差值,因而产生了不同的腹膜转运类型。根据本中心患者人群确定的值更适合本中心患者的临床情况。     

静脉滴注PGEl对腹膜透析溶质转运的影响

目的 探讨前列腺素El(PGE1)对腹膜透析患者腹膜溶质转的影响。方法 对正在进行CAPD的尿毒症患者,静脉滴注PGEl治疗;通过腹膜平衡试验观察肌酐D／P值,腹透液中葡萄糖、蛋白质的变化,并测定尿素清除指数(KT／V值)。结果 PGEl治疗后,患者肌酐D／P值明显提高,透析液的葡萄糖浓度明显降低而蛋白质丢失无明显差异;同时,患者透析KT／V和残余肾KT／V也明显改善。结论 静脉滴注PGE1有助于改善腹膜透析患者腹膜溶质转运功能,同时对残余肾功能增加有一定的作用。     

腹膜炎不同时相腹膜溶质转运变化

腹膜炎不同时相腹膜溶质转运变化刘伏友彭佑铭李军成梅初根据临床ＣＡＰＤ并发腹膜炎时透出液内白细胞、蛋白质、肌酐及葡萄糖等转运增加，水超滤减少的特征，我们采用腹膜炎动物模型，探讨腹膜炎不同时相溶质转运变化。材料与方法３６只新西兰雄性大白兔随机分为６组，每...     

腹膜溶质转运特性与蛋白质和氨基酸经透析液丢失

目的　探讨腹膜透析（ＰＤ）时腹膜溶质转运特性与蛋白质和氨基酸经ＰＤ液丢失的关系。方法　比较了２５ 名腹膜溶质转运特性为高转运或低转运的ＰＤ 患者每日经ＰＤ 液丢失总蛋白质、白蛋白和２１ 种氨基酸量的差别。结果　高转运组患者每日经透析液丢失的总蛋白、白蛋白和总氨基酸量均明显高于低转运组［分别为（６－９±２－４０） 比（４－９６±１－５０）ｇ／２４ｈ、（４－９±２－０） 比（３－２±１－４）ｇ／２４ ｈ 和（１５－２４±３－７０）比（９－８９±３－７０）ｍｍｏｌ／２４ ｈ,Ｐ值均＜０－０５］;高转运组患者血浆白蛋白水平明显低于低转运组（３４－９±１－０）比（３８－８±１－９）ｇ／Ｌ,两组有显著性差异（ Ｐ＜０－０５）。根据腹膜平衡试验确定的Ｄ／Ｐ４Ｃｒ 值与透析液中白蛋白和总氨基酸的丢失量呈显著正相关,与血浆白蛋白水平呈显著负相关。结论　高转运ＰＤ患者较低转运者丢失更大量的蛋白质和氨基酸,导致血浆白蛋白水平下降,营养不良。应高度重视慢性ＰＤ的高转运患者的营养管理问题。     

ESRD患者中医辨证分型的分布、变化与腹膜溶质转运类型之间相关性的研究

目的：探讨终末期肾脏病（ESRD）患者腹膜溶质转运类型分布、变化与中医辨证分型之间的相关性,指导判断腹膜透析管置入术后的腹膜溶质转运类型。方法：98例初次行腹膜透析管置入术及腹膜透析治疗的ESRD患者在术前对患者进行中医辨证分型,开始透析1周后行腹膜平衡试验（PET）,分析腹膜溶质转运类型与中医辨证分型之间的相关性。结果：ESRD患者行腹膜透析管置入术前中医辨证分型的本证和透析1周时腹膜溶质转运类型之间有一定相关性：术前辨证为阴阳两虚的患者,术后腹膜转运功能为低转运的较多,腹膜透析治疗效果差。结论：ESRD患者中医辨证分型的本证与腹膜溶质转运类型之间有一定相关性,术前对患者行中医辨证,对判断腹膜转运功能具有一定的指导意义。     

腹膜快速溶质转运及其临床干预

随着腹膜透析（腹透）技术的改进及腹透患者管理的规范化，腹膜透析患者长期生存率及技术存活率显著提高。新近有报道持续性腹透患者10年的生存达51．8％，技术存活达48．6％。长期腹膜透析的成功有赖于腹膜结构和功能的完整。根据腹膜平衡试验（PET）对4h透出液／血浆肌酐浓度比值（D／Pcrea）评估结果，腹膜透析患者的腹膜功能可分为四类：高转运、高平均转运、低平均转运及低转运。CAPD最初应用于临床时，     

不同腹膜溶质转运特性腹膜透析患者营养状况的比较

目的 探讨腹膜转运特性对腹膜透析患者营养状态的影响。方法 按照腹膜平衡试验(PET)计算结果,将82例稳定的CAPD患者分为高转运组和低转运组。检测患者血浆和腹透透出液总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR)。比较两组营养状态及分析相关因素。结果两组的残余肾功能、腹透治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、BUN、Scr和Kt／V均无显著性差异。高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量明显高于低转运组;各项营养指标均低于低转运组,且体重及血清白蛋白有显著性差异。血中及经腹透透出液丢失的白蛋白和氨基酸量均与转运类型相关。结论 腹膜透析高转运患者营养状态较低转运者差。单纯提高透析充分性并不能明显改善营养状态。要加强对高转运患者的营养管理和指导。     

腹膜溶质转运特性对腹膜透析患者营养指标的影响

目的探讨腹膜溶质转运特性对腹膜透析患者营养指标的影响.方法按照腹膜平衡试验(PET)计算结果,将68例稳定的连续性不卧床性腹膜透析(CAPD)患者分为高转运组(37例)和低转运组(31例).检测患者血浆和腹透透出液中的总蛋白、白蛋白及氨基酸量,同步计算蛋白质摄入量(DPI)和蛋白质分解率(nPCR).比较两组营养状态及进行相关因素分析.结果两组的残余肾功能、CAPD治疗时间、每日透析液剂量、超滤量、葡萄糖吸收量、血糖、尿素氮(BUN)、血清肌酐(Scr)和尿素清除指数(Kt/V)比较,差异无显著性意义(均P>0.05).高转运组每日经腹透透出液丢失的总蛋白质和多种氨基酸量显著高于低转运组(均P<0.05);各项营养指标均低于低转运组;两组体重及血清白蛋白比较,差异有显著性意义(均P<0.05).每日经腹透液丢失的Alb量和TAA与D/P4Scr呈正相关关系(均P<0.05).结论腹膜透析高转运患者营养指标较低转运者差,应加强对高转运患者的营养护理和指导;每日透析液量及超滤量能达到TCcr与DPI平衡即可,不宜盲目增加腹透液的剂量、浓度和存留时间,导致过度透析,引起蛋白质和氨基酸经腹透液大量丢失及吸收大量的葡萄糖,加重患者蛋白质缺乏性营养不良.     

Association between arterial stiffness and peritoneal small solute transport rate

Abstract:  While cardiovascular disease accounts for 40–50% of the mortality in dialysis patients, and while a high peritoneal transport in continuous ambulatory peritoneal dialysis (CAPD) is an independent predictor of outcome, it is unclear if there are any links. Aortic stiffness has become established as a cardiovascular risk factor. We thus studied pulse wave velocity (PWV) in CAPD patients to explore the possible link between peritoneal small solute transport and aortic stiffness. CAPD patients ( n  = 76, 27 M/49 F) in our center were included in the present study. Aortic stiffness was assessed by brachial pulse pressure (PP) and carotid–femoral PWV. Patients' peritoneal small solute transport rate was assessed by D / P _cr at 4 h. Extracellular water over total body water ( E / T ratio) was assessed by means of bioimpedance analysis. C-reactive protein was also measured. Carotid–femoral PWV was positively associated with patients' age ( r  = 0.555; P  < 0.01), time on peritoneal dialysis ( r  = 0.332; P  < 0.01), diabetic status ( r  =  0.319; P  < 0.01), D / P _cr ( r  = 0.241; P  < 0.05), PP ( r  = 0.475; P  < 0.01), and E / T ( r  = 0.606; P  < 0.01). In a multivariate regression analysis, carotid–femoral PWV was independently determined by E / T ( P  < 0.01), PP ( P  < 0.01), age ( P  < 0.01), and D / P _cr ( P  < 0.05). D / P _cr, in addition to E / T , age, and PP, was an independent predictor of elevated carotid–femoral PWV in CAPD patients, suggesting that there might be a link between high aortic stiffness and increased peritoneal small solute transport rate.     

Nitric oxide-related experiments on peritoneal solute transport in the rabbit.

BACKGROUND: It is unclear whether nitric oxide (NO) is important in regulating peritoneal transport during non-infected peritoneal dialysis. METHODS: In 13 rabbits, 250 mg/l L-arginine, a substrate for NO synthesis, was added to a 3.86% glucose dialysis solution. N:(G)-monomethyl-L-arginine (L-NMMA) 25 mg/1, an inhibitor of NO synthase, was added to the dialysate in 10 rabbits. Standard peritoneal permeability analyses in rabbits were used to analyse the effects of these interventions on solute transport during 1-h dwells. The addition of 4.5 mg/l nitroprusside to the dialysate in five rabbits was used for validation of this model. RESULTS: Nitroprusside caused an 86% (48-233%) increase in albumin clearance, which is similar to the nitroprusside-induced increase found in humans (70%). Contrary to human studies, no effect was found on the mass transfer area coefficient (MTAC) of urea and creatinine, or on glucose absorption. L-Arginine did not affect either the MTAC of urea and creatinine, or the absorption of glucose. Peritoneal albumin clearance increased 18% (-24 to 609%). This resembles the NO-mediated effects of nitroprusside. Addition of L-NMMA caused no change in the solute transport rate. CONCLUSION: The rabbit dialysis model can be used for analysing the effects of interventions on peritoneal permeability characteristics, although the rabbit peritoneal membrane is probably less sensitive to NO compared with that of humans. L-Arginine-induced effects are similar to those of nitroprusside, which suggests that these effects possibly are mediated by NO. As L-NMMA did not affect peritoneal transport, it is unlikely that NO is involved in the regulation of peritoneal permeability in rabbits.     

戊巴比妥腹腔内注射对腹膜转运功能的影响

目的探讨戊巴比妥腹腔内注射对腹膜转运功能的影响及其可能的机制。方法将19只大鼠随机分成对照组(n=8)、实验组(n=8)和冲洗组(n=3)；对照组和实验组均一次性子50mg／kg体重的戊巴比妥，对照组肌肉注射，实验组腹腔内注射，2小时后两组均每小时补充10mg／l‘g体重的戊巴比妥，皮下注射；麻醉平稳后，对照组和实验组均行腹膜功能试验(PET)；实验完毕，留透析液行白细胞计数，取腹膜组织行常规病理检查(HE染色)和冰冻切片(phosphin E染色)。结果与对照组相比，实验组的腹腔内液体重吸收率增加，淋巴重吸收率增高，超滤功能下降，小分子溶质转运增高；实验组腹膜表面层变薄。甚至消失；对照组和实验组的腹膜组织内均未见明显白细胞浸润，透出液白细胞计数均不高。结论戊巴比妥腹腔内注射引起腹腔通透性增高。其机制可能跟戊巴比妥破坏腹膜表面层有关。这些结果提示，动物实验中慎用戊巴比妥腹腔内注射．尤其是那些跟腹膜有直接关系的实验。     

Longitudinal changes of solute transport in peritonitis-free peritoneal dialysis patients

BACKGROUND: The aim of this study was to evaluate the longitudinal changes in peritoneal transport in patients on long-term, peritonitis-free, continuous ambulatory peritoneal dialysis (CAPD) therapy. METHODS: Results were longitudinally recorded for the standard peritoneal equilibration test (PET) in 76 consecutive, nondiabetic, adult patients from the beginning of CAPD therapy until their first episodes of peritonitis, abdominal surgery, or any cause of drop out. The PET results were evaluated once annually using the dialysate-to-plasma ratio of creati-nine (D/PCr) and the dialysate-to-instilled dextrose ratio (D4/D0) at 4 hours after beginning dialysis. RESULTS: A total of 168 PET results were obtained. A statistically significant tendency toward decreased D/PCr and increased D4/D0 values over time for up to 3 years was found. CONCLUSIONS: This study shows a tendency toward progressive decline in small molecular transport over time in nondiabetic patients with uneventful CAPD therapy. Sequential PET follow-up cannot be overlooked in peritonitis-free CAPD patients.     

Evaluation of an experimental rat model for peritoneal dialysis: fluid and solute transport characteristics

The aim of this study was to develop a reference model of fluidand solute transport during experimental peritoneal dialysisin rats, which would simulate the conditions of clinical dialysisin CAPD patients as much as possible. For this purpose a 4-hdialysis study was performed in 13 normal Sprague-Dawley ratswith conventional glucose solutions (Dianeal 1.36% solution,n=6 and Dianeal 3.86% solution, n=7) and a protocol and methodslike those used in clinical dwell studies. The dilution of amarker, radioactive human serum albumin (RISA), was used todetermine the intraperitoneal dialysate volume with correctionsfor the elimination of RISA from the peritoneal cavity and samplevolumes. The isovolumetric method was employed to calculatethe diffusive mass transport coefficients. To compare our datawith reference values in CAPD patients, the data were scaledby a factor calculated as a ratio of the dialysate volume inCAPD to the dialysate volume in the rats. In a separate seriesof experiments the intraperitoneal hydrostatic pressure wasmonitored with increasing infusion volumes. The fluid transport characteristics, described as the percentagechanges of the initial intraperitoneal volume, were essentiallycomparable to those in CAPD patients. However, the intraperitonealvolume curves were shifted more to the left than were the reportedvalues in CAPD patients. The scaled diffusive mass transportcoefficient for urea was similar to that in CAPD patients. However,the transport of other solutes, in particular glucose, was fasterin the rats than in CAPD patients. The intraperitoneal hydrostaticpressure increased exponentially with increasing infusion volumerelative to body weight and was 0.3–0.9 mmHg with thestandard infusion volume of 30 ml in the present study. Theintraperitoneal hydrostatic pressure in the rats receiving 30mi of fluid intraperitoneally was lower than the reported intraperiCorrespondencetoneal pressure in CAPD patients using 2 1 of dialysis fluid. We conclude that the present experimental model of peritonealdialysis in the rat with a protocol and methods similar to thoseused in clinical studies, after appropriate scaling, seems tohave fluid and solute transport characteristics that resembledthose in clinical peritoneal dialysis, but considerable differenceswere also found.     

Impacts of baseline peritoneal transport characteristics and their changes during follow up on the survival of peritoneal dialysis patients

Objective To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of maintaining peritoneal dialysis (PD) patients. Methods Five hundred and eight-six PD patients who started PD from September 11, 2006 to October 30, 2014 in a single center were included and followed up until March 30, 2016. According to their baseline D/Pcr value in peritoneal equilibrium test (PET), the patients were divided into high transport (H) group (D/Pcr 0.82-1.03), high average transport (HA) group (D/Pcr 0.65-0.81), low average transport (LA) group (D/Pcr 0.50-0.64) and low transport (L) group (D/Pcr 0.34-0.49). According to the changes of follow-up D/Pcr comparing with baseline D/Pcr, the patients were also divided into ascending group, descending group and no-change group. The patient and technical survival rates were estimated by Kaplan-Meier analysis. Cox proportional hazards analyses were used to analyze the risk factors for PD patient death and technical failure. Results There were 67 patients in L group, 229 patients in LA group, 252 patients in HA group, and 38 patients in H group. The patient survival rate in H group was significantly lower than those of L group (P=0.036), LA group (P=0.008) and HA group (P=0.041). There was no significant difference on technical survival rate among these 4 groups. According to the tendency of follow-up D/Pcr changes, there were 127 patients in ascending group, 101 patients in descending group and 179 patients in no-change group. There was no significant difference on patient survival among these 3 groups (P=0.064). However in patients with a high transport rate (D/Pcr≥0.65), the patient survival was lower in descending group than those in ascending group (P=0.033) and no-change group (P=0.049). Age over 65 years old (HR=2.499), malnutrition during follow-up (HR=3.144), ultrafiltration less than 400 ml/d during follow-up (HR=1.863) and high sensitive C reactive protein≥10 mg/L (HR=4.526) were the independent risk factors for patient death (all P＜0.05). Gender (HR= 1.609), age over 65 years old (HR=1.929), ultrafiltration less than 400 ml/d during follow-up (HR=1.708), high sensitive C reactive protein≥10 mg/L (HR=1.829), malnutrition (HR=1.876) and change of peritoneal transport function (HR=0.579) affect technical failure (all P＜0.05). Conclusions The survival rate of PD patients with basal high peritoneal transit is relatively low, especially for patients with descending transport rate during follow-up. The concern on the peritoneal transport status is constructive for the prognosis of PD patients.     

Increases in peritoneal small solute transport in the first month of peritoneal dialysis predict technique survival

BACKGROUND: Peritoneal transport of small solutes generally increases during the first month of peritoneal dialysis (PD). The aim of this study was to prospectively evaluate the ability of the peritoneal equilibration test (PET), carried out 1 and 4 weeks after the commencement of PD, to predict subsequent technique survival. METHODS: Fifty consecutive patients commencing PD at the Princess Alexandra Hospital between 1 February 2001 and 31 May 2003 participated in the study. Paired 1 week and 1 month PET data were collated and correlated with subsequent technique survival. RESULTS: A significant increase was observed in the dialysate : plasma creatinine ratio at 4 h (D/P Cr) between 1 and 4 weeks after the onset of PD (0.55 +/- 0.12 vs 0.66 +/- 0.11, P <0.001). Mean death-censored technique survival was superior in patients who experienced > or =20% rise in D/P Cr during the first month of PD compared with those who did not (2.3 +/- 0.2 vs 1.6 +/- 0.2 years, P <0.05). Using a multivariate Cox proportional hazards model analysis, the significant independent predictors of death-censored technique survival were an increase in D/P Cr of greater than 20% during the first month (adjusted hazard ratio [HR] 0.20, 95% CI 0.05-0.75), the absence of diabetes mellitus, the absence of ischaemic heart disease, body mass index and baseline peritoneal creatinine clearance. CONCLUSIONS: A 20% or greater rise in D/P Cr during the first month of commencing PD is independently predictive of PD technique survival. Further investigations of the mechanisms underlying this phenomenon are warranted.