腹膜表面层和腹膜通透性的关系

近年来,终末期肾脏病(ESRD)的病人数以每年 10%以上的速度增长.由于受肾源的限制,透析疗法是目前治疗ESRD的主要方法,这包括血液透析(血透)和腹膜透析(腹透)二种.腹透, 特别是持续性不卧床腹膜透析(CAPD),是一种有效治疗ESRD患者的方法.CAPD治疗价廉、操作简便、病人可在家自行透析,适合几乎所有的ESRD病人.在我国香港,80%以上的透析患者选择腹透治疗.

Peritoneal surfac e layer and its relationship with the peritoneal membrane permeability

Increase in peritoneal membrane permeabil ity is not uncommon in long-t erm peritoneal dialysis patients. It has been shown that increased peritoneal me mbrane permeability is associated with increased mortality in this patient popul ation. We have been thus focused on the pathogenesis of the abnormal peritoneal membrane permeability. It was hypothesized that increased membrane permeability might be due to (1)neoangiogenesis; (2)chronic inflammation; (3)increased hydrau lic permeability of the peritoneal membrane. We have, however, found that increa se d membrane hydraulic permeability may be the key mechanism. We found that the pe ritoneal surface layer, the key component that determines the tissue hydraulic p ermeability, was rich in hyaluronan, phospholipids and surfactant proteins. Dama ging the peritoneal surface layer by shaking the peritoneal cavity, washing, add ing pentobarbital or deoxycholic acid or hyaluronidase or phospholipidase, we ha ve sig nificantly increased the membrane permeability. On the contrary, by adding hyalu r onan, phospholipids or steroid to increase the formation of the peritoneal surfa ce layer, we have decreased significantly the peritoneal permeability. Our resea rch work on this issue has been well recognized and appreciated by the interna tional society.