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。

Influence of long-term peritonea dialysis on morphological alterations of peritoneum in uremic rats

Objective To investigate the change of the morphological alterations of peritoneum in uremic rats undergoing long-term peritoneal dialysis.Methods Thirty male SD rats were randomly divided into control group（7 cases）,NS group（11 cases）,and PD group（12 cases）.A 5/6 nephrectomy was carried out in group NS and PD rats,while rats of control group underwent sham surgery and left untreated.Rats of NS and PD group were treated with daily transcatheter injection of 20 ml 0.9% sodium chloride or 4.25% peritoneal dialysate respectively for 6 weeks.Parietal and visceral peritoneum were obtained for morphological examination.Results The net ultrafiltration was decreased in NS and PD group compared with control group,and decreased in PD group compared with NS group（P0.05）.HE method displayed that the parietal thickness and the number of blood vessels were significantly increased in PD group compared with control group and NS group,and increased in NS group compared with control group（P0.05）.Immunohistochemistry displayed that the positive cells of VEGF and TGF-β1 were higher in PD group than that in control group and NS group（P0.05）.The expressions of VEGF and TGF-β1 mRNA were up-regulated in PD group compared with other two groups,and higher in NS group than that in control group（P0.05）.Conclusion Both uremia and non-biocompatible peritoneal dialysate fluid exposure may lead to peritoneal angiogenesis,fibrosis,ultrafiltration failure of patients,and ultimately drop out from peritoneal dialysis.