透析前腹膜微血管密度与腹膜基线溶质转运关系的研究  

Association between pre-dialysis peritoneal microvascular density and baseline peritoneal solute transport status

作　　者：张爱华[1] 丰玲 王刚[1] 张东亮[1] 张启东[1] 刘莎[1] 廖云[1] 尹乐[1] 刘文虎[1] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科,北京100050 [2]涿州市东方地球物理勘探有限公司第二职工医院,河北涿州072750

出　　处：《中国血液净化》2010年第10期554-557,共4页Chinese Journal of Blood Purification

摘　　要：目的借助免疫组化技术,分析透析前腹膜微血管密度(腹膜透析置管术时)与腹膜基线溶质转运间的关系,以探究基线转运的可能形态学基础。方法入选首都医科大学附属北京友谊医院腹膜透析中心的新入非糖尿病持续不卧床腹膜透析患者。腹膜透析置管术时留取壁层腹膜标本,以CD34为血管内皮标志行免疫组化染色,显微镜下计数微血管密度(microvessel density,MVD)。开始透析4～6周后行标准腹膜平衡试验(peritoneal equilibration test.PET),计算存腹4h的肌酐腹腔引流液/血浆比值(D/Pcr),;前1日收集24h腹膜透析液,测定蛋白质总量(peritoneal protein excretion,PPE)。结果共纳入32例患者,以D/Pcr=0.65为界,分为高/高平均转运组(19例)和低/低平均转运组(13例)。研究期内无急性腹膜炎发作。在对体表面积、残余肾功能、平均动脉压、降压药使用情况、2.5%葡萄糖透析液使用频率、PET当天的血红蛋白、血浆C反应蛋白、白蛋白水平校正之后,前者腹膜MVD值显著高于后者(F=10.470,P=0.004);腹膜MVD值与D/Pcr呈显著正相关(r=0.432,P=0.035),但与PPE无显著相关性(r=0.079,P=0.683)。结论非糖尿病腹膜透析患者透析前腹膜MVD与其小分子溶质基线转运率正相关,与24h腹腔蛋白丢失量无关,可能蛋白质的漏出更多受制于微血管的内在通透性。Objective To evaluate the relationship between pre-dialysis peritoneal microvascular density and baseline peritoneal solute transport status by immunohistochemical staining, and to investigate the morphological bases for the evaluation of baseline solute transport status. Methods Non-diabetic patients newly treated with continuous ambulatory peritoneal dialysis （CAPD） in the Peritoneal Dialysis Unit of Renal Department, Beijing Friendship Hospital were enrolled in this study. Parietal peritoneal biopsies were obtained during implanting peritoneal dialytic catheters. Peritoneal microvascular density （MVD） was evaluated by anti-CD34 antibody staining. After commencing CAPD for 4-6 weeks, a standard peritoneal equilibration test （PET） was performed, and the dialysate-to-plasma concentration ratio for creatinine at 4 hours （D/Pcr） was determined. The 24-hour peritoneal protein excretion （PPE） was assayed. Result Thirty-two CAPD patients without the history of peritonitis were included, and were divided into two groups based on D/Pcr： group H with the D/Pcr〉 0.65 （n=19）, and group L with the D/Pcr ≤ 0.65 （n=13）. After corrections for body surface area, residual renal function, mean arterial pressure, administration of antihypertensive agents, prescription of 2.5% glucose-base peritoneal dialysate, hemoglobin, CRP and serum albumin, MVD was significantly higher in group H than in group L （P=0.001）. MVD showed significant correlation with D/Pcr （p=0.035）, but not with PPE （P=0.683）. Conclusion In non-diabetic CAPD patients, pre-dialysis peritoneal microvascular density is positively correlated with baseline peritoneal small solute transport rate, but not with 24-hour peritoneal protein excretion. The later is possibly restricted by peritoneal inherent permeability.

关 键 词：腹膜透析 腹膜微血管密度 腹膜基线转运 腹膜小分子溶质转运率 腹膜蛋白质排泄 

分 类 号：R459.5[医药卫生—治疗学]