肝素对腹膜透析大鼠腹膜电荷屏障及蛋白质丢失的影响

目的:观察尿毒症及腹膜透析(PD)两种状态对对大鼠腹膜电荷屏障的影响,研究电荷屏障与PD液白蛋白丢失的相关性,探讨肝素对PD大鼠腹膜电荷屏障与PD液白蛋白丢失的作用. 方法:选取SD大鼠40只,随机分为对照组(假手术组,n=10)、尿毒症组(5/6肾切除,n=10)、PD组(n=10)和肝素组(n=10);所有大鼠PD 4周后收集血清及PD液,采用清除法测定胰淀粉酶清除率(Cpam)及唾液淀粉酶的清除率(Csam)的比值(Cpam/Csam)用以评价腹膜电荷屏障,同时测定PD液白蛋白的丢失量. 结果:(1)对照组、尿毒症组、PD组及肝素组的腹膜Cpam/Csam结果分别为1.91 ±0.89,2.32 ±0.74、3.11 ±0.76和2.24±0.59.尿毒症组、PD组与对照组比较均有显著差异(P均＜0.01),但尿毒症组和PD组间无显著差异;肝素组与PD组比较也有显著差异(P =0.008).(2)尿毒症组、PD组及肝素组PD液白蛋白量显著高于对照组(41.3 ±8.34 mg,49.2 ±3.61 mg、39.9±3.73 mg vs 27.1±5.66 mg,P均＜0.01);同时,PD组还显著高于尿毒症组(P=0.04),肝素组与PD组相比,亦有显著差异(P=0.001).(3)所有大鼠Cpam/Csam与PD液白蛋白丢失量显著相关(r=-0.469,P=0.002).结论:尿毒症会损害腹膜的电荷特性,PD会进一步损害电荷屏障,增加PD液白蛋白的丢失.PD液中增加肝素可改善电荷屏障,减少白蛋白丢失.     

低钙透析液对腹膜透析患者颈动脉粥样硬化的影响

目的:观察低钙透析液配合口服碳酸钙及活性维生素D3对持续性不卧床腹膜透析(CAPD)患者颈动脉粥样硬化的影响.方法:30例伴有颈动脉粥样硬化行CAPD的患者,改用低钙透析液(钙1.25 mmoL/L),同时调整碳酸钙及1,25-(OH)2维生素D3(罗盖全胶丸)的剂量.在改用低钙透析液3、6、9、12月时,采用多普勒超声观察颈动脉内-中膜厚度(IMT)、颈动脉血流阻力指数(RI)、颈动脉粥样斑块数量和超声分型的变化;同时检测血清钙、磷、血清甲状旁腺素(iPTH,放免法),计算钙磷乘积.结果:随访过程中,1例患者死亡,2例患者自行退出.低钙透析液CAPD后,患者颈动脉IMT逐渐变薄,12个月时降至最低[(1.58±0.36)mm,P＜0.01].伴随着颈动脉RI降低,8例患者颈动脉内的扁平斑及软斑数量减少(P＜0.05),颈动脉粥样硬化斑块总数量也由47块降至34块.与此同时,血钙、磷及钙磷乘积明显下降(P＜0.01),血iPTH明显增加(P＜0.01).至12月时钙、磷、钙磷乘积、iPTH达标比例分别为83.33％、70％、96.67％、70％.碳酸钙的剂量也由(2.27±0.41)g/d增至(3.35±0.22)g/d(P＜0.05),罗盖全剂量由(0.21±0.09)μg/d增至(0.33±0.14)μg/d(P＜0.05).患者均未发生低钙抽搐、低血压等.结论:低钙透析有助于尿毒症腹膜透析患者颈动脉粥样硬化的疾病转归,其机制可能与显著改善患者的钙磷代谢紊乱,减轻其对血管的损伤作用有关.     

腹膜透析液对小鼠腹膜间皮细胞超微结构影响的比较研究

作者通过模拟ＣＡＰＤ动物实验，应用扫描电镜观察比较了不同的腹透液对正常小鼠腹膜超微结构的影响，实验结果发现，随着注药时间延长，实验小鼠腹膜间皮细胞游离面微绒毛与间皮细胞的损害逐渐加重；三组腹透液对腹膜间皮影响是不相同的，Ｂａｘｔｅｒ腹透液对腹膜间皮损伤较严重，其中又以醋酸盐腹膜液为甚，注药后２１ｄ，乳酸盐和醋酸盐组均可见轻至中度的纤维素性粘连形成，停止注药后１０ｄ，腹膜间皮损伤基本恢复正常。本文结     

乳酸盐腹膜透析液对人腹膜间皮细胞功能的影响

目的研究乳酸盐腹膜透析液(L-PDF)对人腹膜间皮细胞(HPMC)功能的影响.方法分离HPMC作体外培养,以MTT试验测定HPMC增殖程度;采用ELISA法检测细胞培养液中白细胞介素-8(IL-8)和纤维连接蛋白(FN)的蛋白质水平;逆转录多聚酶链反应检测IL-8mRNA的表达;用Lowry方法检测细胞培养液内总蛋白.结果L-PDF抑制HPMC的增殖,且呈时间依赖关系.L-PDF刺激HPMC后,培养液中IL-8和FN蛋白质水平明显增高,并上调IL-8mRNA的表达.在恢复培养期间,若加用脂多糖(10mg/L)、金黄色葡萄球菌肠毒素(10mg/L)和肿瘤坏死因子-α(TNF-α,10×10     

残余肾功能对腹膜透析的影响

３８例腹透患者８０例次的观察研究显示，患者的残余肾肾功能与透析效能，营养状况呈正相关。当ＲＲＦ〉２ｍｌ／ｍｉｎ时，经残余肾清除的尿素氮和肌酐占整个透析排出量的３０％以上，个别患者可达４５％。     

3个月内腹膜透析患者递增式腹膜透析109例疗效观察

目的 观察3个月内腹膜透析患者使用递增式腹膜透析的疗效,为早期控制尿毒症患者症状提供较好的方法.方法 调查对象为2007年1月至12月在北京大学第三医院腹膜透析中心接受持续非卧床腹膜透析3个月以内的终末期肾病患者共109例.对新进入腹膜透析的患者采用递增式腹膜透析治疗,于腹膜透析第3个月末时评估患者的透析充分性、营养状态,并于透析前及第3个月末时观察合并症情况.结果 使用递增式腹膜透析的腹膜透析患者第3个月末时的透析充分性及营养状态良好,第3个月末合并症较透析前明显降低,血压及各生化指标较透析前明显好转.结论 递增式腹膜透析在透析早期疗效显著,能明显改善患者的生活质量.     

水盐限制对腹膜透析患者血压的影响

目的研究水盐限制对腹膜透析患者血压的影响。方法选择我院肾内科门诊随访超过3个月的高血压腹膜透析患者42例,并对其进行限制水盐摄入治疗3个月,比较治疗前后体重、水肿状况、血压、血钠、白蛋白、血红蛋白水平、24小时尿钠定量、肾小球滤过率及降压药用量。结果水盐限制后,无浮肿的患者增加（P〈0．05）,轻中度浮肿患者减少（P〈0．01）,重度浮肿患者减少为0（P〈0．01）。患者体重明显减轻（P〈0．05）,24小时尿钠排出量降低（P〈0．05）,血压显著下降（P〈0．01）。透析液灌入量前后比较无显著性差异,总出量及超滤量减少,尿量增加（P〈0．05）,高渗透析液用量减少（P〈0．05）,白蛋白及血红蛋白明显升高（P〈0．05）,肾小球滤过率前后比较有显著性差异。降压药用量明显减少（P〈0．05）。结论对高血压腹膜透析患者进行严格水盐限制可明显减轻水肿、降低血压,减少高渗透析液及降压药用量。饮食指导增加了患者的依从性,患者营养状况改善。治疗后未观察到残。肾功能减退的现象。     

影响腹膜透析患者发生腹膜炎的相关因素分析

目的 探讨腹膜透析(PD)患者发生腹膜炎的影响因素.方法 回顾分析2018年1月1日至2020年8月31日在郑州大学第一附属医院规律复查的PD患者的临床资料,根据是否发生腹膜透析相关性腹膜炎(PDAP)将其分为腹膜炎组和对照组,比较2组患者的临床资料,分析PD患者发生腹膜炎的影响因素,绘制受试者工作特征曲线,评估中性粒...     

腹膜透析患者自我管理的研究进展

尿毒症是一种常见慢性疾病。腹膜透析作为尿毒症的一种有效治疗方法,目前已在国内外广泛开展[1]。透析治疗是一个漫长的过程,而腹膜透析又有其特殊性,即主要由患者在家庭中进行,所以患者必须主动参与其治疗过程,对疾病进行自我管理。同时在漫长病程中,患者必须对自己的营养、液     

日间不卧床腹膜透析与持续不卧床腹膜透析对心血管事件发生率的影响

目的探讨日间不卧床腹膜透析(DAPD)和持续不卧床腹膜透析(CAPD)对心血管事件发生率的影响。方法将2012年6月至2013年6月进行腹膜透析置管术的80例患者按随机数字表分为DAPD组(40例)和CAPD组(40例)。观察两组患者充血性心力衰竭等心血管事件发生率,每6个月行一次心功能的评估,心脏超声和胸部平片检查透析前、透析12个月、24个月左心室内径、右心室内径、左心房内径、左心室壁厚度、室间隔厚度等心血管相关指标变化情况。结果 DAPD组患者12个月和24个月心血管事件发生率为7.50%和15.00%,而CAPD组分别为17.50%和35.00%,时间越长心血管事件发生率越大。两组患者入组时心胸比例无统计学差异,24个月时DAPD组患者心胸比例明显小于CAPD组,DAPD左心室内径小于CAPD组(P0.05)。24个月时DAPD组患者的血压达标率82.50%,明显高于CAPD组55.00%(P0.05)。DAPD组残余肾尿素清除指数(Kt/V)和肌酐清除率(Ccr)明显高于CAPD组(P0.05)。结论采用DAPD模式的透析患者心血管事件发生率低,心胸比例变化小,对心血管事件影响小。     

Peritoneal access and related complications in continuous ambulatory peritoneal dialysis

Over a four-year period, 50 patients underwent continuous ambulatory peritoneal dialysis. After 24 months, 48 percent of the patients continued to receive continuous ambulatory peritoneal dialysis treatment (including those who underwent continuous ambulatory peritoneal dialysis with bottled solutions from 1977 to 1978). Using solutions in plastic bags, 63 percent of patients continued to undergo continuous ambulatory peritoneal dialysis after 24 months. The mortality rate at 24 months was 23 percent overall and 15 percent for those using plastic bags. There was an overall average of 2.4 episodes of peritonitis a year per patient and 1.3 episodes a year per patient from 1979 through 1980, when only the technique with plastic bags was used. The number of days a patient was hospitalized averaged 48 per year, and 37 days per year In 1979 and 1980. Fifty-five percent of catheters remained functional at 24 months. Other complications included 15 hernias, 15 skin and tunnel infections, 12 leaks, and five cuff extrusions. Improved catheters and further reductions in the incidence of peritonitis will most likely result in a decreased number of patients who withdraw from continuous ambulatory peritoneal dialysis therapy.     

Peritoneal scintigraphy for diagnosing periumbilical leakage in a patient on continuous ambulatory peritoneal dialysis

Continuous ambulatory peritoneal dialysis (CAPD) offers several advantages over hemodialysis for patients with end-stage renal disease; however, this technique also includes many documented complications. A case with clinical suspicion of dialysate leakage on CAPD was investigated by peritoneal scintigraphy using technetium-99m macroaggregated human albumin (99mTc-MAA). Peritoneal scintigraphy showed radiotracer accumulation over the periumbilical area at 2 hours 30 minutes after intraperitoneal infusion of 99mTc-MAA. Six hours of imaging revealed more apparent radioactivity at the same site. This study is to illustrate the simple diagnostic helpfulness of peritoneal scintigraphy in a patient with a CAPD-related structural defect.     

Peritoneal membrane failure in peritoneal dialysis patients

A review is given of the conditions associated with peritoneal membrane failure, and the possible causes. Ultrafiltration failure is the most important manifestation. It is mostly associated with high transport rates of low molecular weight solutes suggesting the presence of a large vascular surface area. Enlargement of the peritoneal surface area can be functional (effective surface area: more perfused microvessels) or anatomic (more microvessels). The former is likely to be present in some patients in the beginning of peritoneal dialysis, and also during peritonitis. The latter can develop in long-term peritoneal dialysis.     

Haemoperitoneum post colonoscopy in a continuous ambulatory peritoneal dialysis patient

We present the case of a patient on peritoneal dialysis (PD) who had an uneventful oesophagogastroduodenoscopy and colonoscopy. His peritoneal dialysis after colonoscopy had bright red peritoneal dialysate. The patient was completely asymptomatic and a CT scan was performed which did not reveal any retroperitoneal haematoma and showed no signs of perforation or splenic tear. His PD dialysate cleared up with time. We do not find any such case in the literature in which a patient has had haemoperitoneum after a colonoscopy without any obvious cause to account for it. Our patient was unique due to his CAPD in combination with his immunosuppression for his kidney transplant which may have predisposed him to the intraperitoneal bleed after colonoscopy or it may just have been a normal phenomenon after colonoscopy. More studies need to be done as the realisation of its pathology can prevent unnecessary testing and avoid patient and healthcare worker’s anxiety.     

Subdural hematoma in a patient on continuous ambulatory peritoneal dialysis

A patient on continuous ambulatory peritoneal dialysis developed a subdural hematoma. This problem is common among hemodialysis patients but is rare in patients on peritoneal dialysis, possibly because peritoneal dialysis offers protective advantages, including the lack of anticoagulation, better control of hypertension and milder fluid shifts leading to diminished changes in brain volume. Recently described changes in vascular structures in polycystic kidney disease may contribute to the risk of subdural hematoma in these patients.     

Diaphragmatic function in patients on continuous ambulatory peritoneal dialysis

We investigated 8 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for diaphragmatic strength and the neuromechanical efficiency of the diaphragm while the abdomen was filled with dialysate and while it was empty. Maximum transdiaphragmatic pressure (Pdi_max) served as parameter for diaphragmatic strength; diaphragmatic efficiency was assessed by simultaneously monitoring transdiaphragmatic pressure (Pdi) and diaphragmatic electromyogram (EMGdi) during room-air breathing and hyperoxic CO₂-rebreathing. After instilling dialysate, Pdi_max increased from 76.7 ± 12.1 cmH₂O to 92.2 ± 16.3 cmH₂O (P < 0.05). While the slopes of the regression lines relating minute ventilation (VE) to arterial CO₂ tension, and the change in VE for a given change in Pdi during hypercapnic rebreathing were similar in both states, the slope of EMGdi vs Pdi was significantly steeper when the abdomen was filled (P < 0.05). The increase in Pdi_max observed in the filled state may suggest an adaptive rightward shift in the diaphragm's force-length relationship in CAPD patients, although this mechanism is insufficient to prevent a reduction of neuromechanical efficiency of the diaphragm. Offprint requests to: T. Wanke     

Neutrophil function in patients on continuous ambulatory peritoneal dialysis

Frequent and recurrent episodes of peritonitis are a major cause of morbidity in patients on continuous ambulatory peritoneal dialysis (CAPD). One factor contributing to this problem may be an abnormality of neutrophil function in these patients. We have therefore quantified phagocytosis and killing by circulating and peritoneal neutrophils from patients on CAPD with and without peritonitis. Circulating neutrophils from uninfected patients showed reduced phagocytosis of both Staphylococcus epidermidis and Candida guilliermondii because of an opsonic defect in CAPD serum and because of a defect of the neutrophils themselves. In contrast, phagocytosis by circulating and peritoneal neutrophils from patients with peritonitis was normal. Intracellular killing of C. guilliermondii was normal in all groups of neutrophils but killing of S. epidermidis, the organism most commonly isolated in CAPD peritonitis, was reduced. The possible mechanisms for the enhanced neutrophil activity seen in peritonitis, and for the decreased killing of S. epidermidis in contrast to normal killing of C. guilliermondii are discussed. A defect in killing of S. epidermidis may explain why peritonitis caused by this organism can be difficult to erradicate.