超纯血液透析对炎症及胰岛素抵抗的作用

目的探讨超纯透析液对尿毒症维持性血液透析患者微炎症与胰岛素抵抗的影响。方法测定在本院透析中心维持性血液透析的60例患者血浆高敏C反应蛋白及胰岛素抵抗指数,分析高敏C反应蛋白与胰岛素抵抗的关系。将C反应蛋白水平较高者分为治疗组和对照组,治疗组予超纯透析液血液透析,对照组继续常规透析,均使用低通量透析器,分别观察两组3个月和6个月后高敏C反应蛋白、白细胞介素一l口、白细胞介素-6、血清白蛋白水平与胰岛素抵抗指数的变化。结果①尿毒症血液透析患者高敏C反应蛋白水平与胰岛素抵抗指数呈正相关（P〈0．05）;②3个月、6个月后治疗组与对照组比较血浆高敏C反应蛋白、白细胞介素一1届与白细胞介素-6水平差异无统计学意义（P〉0．05）。③3个月、6个月后治疗组与对照组胰岛素抵抗指数比较差异无统计学意义（P〉0．05）,6个月后血清白蛋白有升高趋势,但差异无统计学意义。结论尿毒症血液透析患者微炎症状态与胰岛素抵抗相关,使用低通量透析器时超纯透析液可能无明显改善微炎症状态与胰岛素抵抗的作用,对提高血清白蛋白可能有一定作用。     

A study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products

♦ Objective: Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard PD fluid (PDF). Short-term studies of new biocompatible PDFs low in glucose degradation products (GDPs) reveal divergent results with respect to peritoneal integrity.♦ Methods: We studied 125 patients on maintenance PD who were assigned, by simple randomization, to receive either conventional or low-GDP PDF at PD initiation. Parameters of dialysis adequacy and peritoneal transport of small solutes were determined at initiation and after a period of maintenance PD at the time when serum and overnight effluent dialysate were simultaneously collected and assayed for various cytokines, chemokines, adipokines, and cardiac biomarkers. All patients were further followed prospectively for an average of 15 months from the day of serum and effluent collection to determine patient survival and cardiovascular events.♦ Results: Patients treated with conventional or low-GDP PDF were matched for sex, age, duration of dialysis, dialysis adequacy, and incidence of cardiovascular disease or diabetes. After an average of 2.3 years of PD treatment, the weekly total and peritoneal creatinine clearance, and the total and peritoneal Kt/V were comparable in the groups. However, urine output was higher in patients using low-GDP PDF despite there having been no difference between the groups at PD initiation. Patients using low-GDP PDF also experienced a slower rate of decline of residual glomerular filtration and urine output than did patients on conventional PDF. Compared with serum concentrations, effluent concentrations of tumor necrosis factor α, hepatocyte growth factor, macrophage migration inhibitory factor, interleukins 8 and 6, C-reactive protein, and leptin were found to be higher in both groups of patients after long-term PD, suggesting that the peritoneal cavity was the major source of those mediators. Compared with patients on low-GDP PDF, patients on conventional fluid showed elevated leptin and reduced adiponectin levels in serum and effluent. The effluent concentration of interleukin 8 was significantly lower in patients using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between these groups after maintenance PD for an average of 3.6 years.♦ Conclusions: It appears that low-GDP PDF results in an improvement of local peritoneal homeostasis through a reduction of chronic inflammatory status in the peritoneum.     

血液透析单位透析用水及透析液内毒素含量检测

目的了解某地区血液透析单位透析用水、透析液内毒素污染情况,为透析安全用水提供参考。方法采用动态比浊法对12家透析单位送检样本进行了检测。结果所检测的12家单位透析用水内毒素平均含量为0.083 EU/ml,透析液内毒素平均含量为0.392 EU/ml。不同季节检测的透析用水和透析液内毒素含量存在差异,夏秋季检测的内毒素含量高于冬春季。结论辽西地区医疗机构透析单位透析用水和透析液质量较好,但仍存在少量超标,要求应严格按标准操作规程执行,减少透析液的污染,降低内毒素含量。     

黄芪注射液对高糖腹透液作用下人腹膜间皮细胞AQP-1表达的影响

目的:探讨高糖腹透液对人腹膜间皮细胞(HPMC)水通道蛋白1(AQP-1)表达的影响及黄芪注射液的干预作用。方法:采用HPMC体外培养模型,将HPMC分为5组:空白组、模型组、黄芪高、中、低剂量组。分别培养6、24、48h。Western blot法测定AQP-1蛋白的表达;RT-PCR检测24h时间段AQP-1 mRNA的表达。结果:Western Blot结果显示:给药6h后各组AQP-1蛋白表达无明显差异;24h后发现黄芪高、中剂量组能明显上调AQP-1蛋白表达,48h后发现仅黄芪高剂量组能上调AQP-1蛋白表达。RT-PCR结果显示:与模型组相比黄芪高、中、低剂量组AQP-1 mRNA的表达均明显上调(P<0.01),黄芪高剂量组作用更显著。结论:黄芪注射液能上调高糖环境下HPMC AQP-1的表达。     

Calcium free hemodialysis: an effective therapy in hypercalcemic crisis — report of 4 cases

Hypercalcemic crisis respresents a medical emergency. If conservative treatment is ineffective, low calcium bath or zero calcium bath hemodialysis are good alternatives. We report 4 patients treated with calcium free acetate hemodialysis because of hypercalcemic crisis due to breast cancer, hepatocellular carcinoma, cirrhosis of the liver and immobilisation with hydrochlorothiazids' medication. Following 3 h of hemodialysis, serum calcium concentrations fell from a mean value of 3.96 (range 3.53–4.46) mmol/l to 2.71 (2.28–3.12) mmol/l. In 2 patients rapid clinical improvement was achieved and in one oliguric patient diuresis started spontaneously during hemodialysis. One patient died from gram-negative sepsis. In 3 cases the subsequent conservative treatment was sufficient to maintain serum calcium levels within the normal range. Together with the previously reported cases (5 patients treated by hemodialysis with low dialysate calcium and 3 patients by hemodialysis with calcium free dialysate) our experience indicates that hemodialysis is an effective and safe therapy for hypercalcemic crisis.     

Mechanisms of Albumin Loss during Peritoneal Dialysis in Man

Abstract. Albumin loss in the dialysate was evaluated during a total of 5 peritoneal dialyses carried out on 3 uraemic patients. The measurements were made by two different methods, the first based on the evaluation in the dialysate of intravenously injected radioiodinated albumin, the second one based on a radioimmunoassay of the protein in the dialysate. The results obtained showed three main mechanisms of protein loss during peritoneal dialysis: 1) albumin shift from extravascular sites adjacent to the peritoneum, 2) direct passage of albumin from blood stream to peritoneal cavity, and 3) tendency of the inter-dialysis peritoneal fluid to equilibrate with plasma proteins. Furthermore, the observations made on a patient with evident peritonitis proved the importance of the intrinsic biological properties of the peritoneum in determining the amplitude of protein wasting by the dialysate.     

头孢唑啉钠在腹膜透析液中的稳定性

本文观察头孢唑啉钠在25℃与37℃条件下与腹膜透析液配伍的稳定性。6袋500ml腹膜透析液(醋酸盐)各加入250mg头孢唑啉钠,3袋置37℃贮存,另3袋置25℃贮存、分别在0、2、4、8、12、24、48、72h取样,用紫外分光光度法测定含量。同时按中国药典85年版微粒检查项下,观察微粒情况,并测定pH值。结果在37℃贮存24h含量下降5%,25℃放置72h,含量几乎无变化。在整个观察期间,溶液澄明,显微镜下观察均未见沉淀产生。pH值变化很小(5.9±0.4)。     

当归、丹参和川芎嗪注射液对腹膜透析腹腔巨噬细胞功能的干预作用

目的：研究当归、丹参和川芎嗪注射液（简称中药）对腹膜透析（PD）腹腔巨噬细胞（MC）功能的影响。方法：（1）将MC置于含当归、丹参和川芎嗪的腹膜透析液（CDS）的培养液中培养24h，测定3个中药组、CDS组和对照组MC的一氧化氮（NO）含量和对四甲基偶氮唑盐（MTT）还原能力。（2）MC分别置于含2、10、100μg/ml的3个中药的CDS中培养24h，观察不同浓度中药对MC吞噬能力、NO含量和MTT还原能力的影响，对照组为等量培养液代替CDS。结果：CDS组MC的NO含量和MTT还原能力均明显低于对照组（P＜0．01）；与CDS组比较，川芎嗪组的MC NO含量和3个中药组MC MTT还原能力均有明显提高（P＜0．01），并随着培养液中的中药浓度的提高，3个中药组MC吞噬能力和NO含量均有显著增加。结论：在CDS中加中药能改善腹膜腔MC的防御功能，降低腹膜炎的发生率，对提高PD疗效有重要意义。     

低钙透析液对CAPD患者钙磷代谢的影响

目的观察低钙腹膜透析液（1．25mmol／L）（LCD）与标准钙离子浓度（1．75mmol／L）的腹膜透析液（SCD）对CAPD患者钙磷代谢的影响。方法选择血钙高于正常或高钙磷乘积的CAPD患者57例，随机分成两组：SCD组24例；LCD组33例。观察两组患者血钙、磷、镁、全段甲状旁腺激素（iPTH）和皮肤瘙痒情况的变化，及不良反应。观察时间为6个月。结果共53例完成6个月的观察，其中SCD22例，LCD31例。6个月后两组的血钙水平均有所下降，但LCD组血钙水平较前明显下降（P〈0．05），SCD组无统计学意义（P〉0．05）；SCD组患者的血清磷、镁及钙磷乘积无明显变化，而LCD组上述指标明显下降，与SCD组比较具有统计学意义（P〈0．05）；与SCD相比，LCD组的iPTH水平明显升高（P〈0．05）；LCD患者皮肤瘙痒情况有所改善，但无统计学意义（P〉0．05）。观察期间LCD组患者无低血压、低钙抽搐等情况发生。结论低钙腹膜透析液能够较好控制血钙水平，降低血磷，减轻对甲状旁腺的抑制，可能在预防和改善动力缺失性骨病的发生和发展过程中发挥重要的作用。