腹膜透析患者透出液Gremlin水平对腹膜功能改变的影响  

The effect of gremlin content in peritoneal dialysate effluent on peritoneal function

作　　者：马东红[1] 刘云[1] 吕玉敏[1] 化秋菊[1] 郭明好[1] 

机构地区：[1]新乡医学院第一附属医院肾病科,新乡453100

出　　处：《中国血液净化》2016年第2期82-85,共4页Chinese Journal of Blood Purification

摘　　要：目的 观察腹膜透析患者透出液Gremlin的水平变化,探讨其对腹膜功能改变的影响.方法 收集2010年1月～2015年1月新乡医学院第一附属医院肾内科规律随访的持续不卧床腹膜透析（continous ambulatory peritoneal dialysis,CAPD）患者78例,采用ELISA方法检测不同时间点透出液中Gremlin和TGF-β1的水平,同时定期评价腹膜转运功能,分析Gremlin对腹膜功能改变的影响.结果 ①随着透析龄延长,腹膜平衡试验结果显示低转运及低平均转运比例逐渐减少,部分患者腹膜功能逐渐转化为高转运或高平均转运;和初始相比,腹膜平衡试验各比率在随访3年、4年、5年时x2值分别为12.219、9.154和10.707,P值分别为0.007、0.027和0.013,均有明显统计学差异,说明腹膜溶质转运功能逐渐增强.②腹膜透析1个月,透出液中Gremlin和转化生长因子β1（transforming growth factor-β1,TGF-β1）水平均较低,分别为（3.54±2.51）pg/mL和（4.04±2.58） pg/mL,随着透析龄的延长,二者水平均逐渐升高,5年时可达到（232.71±55.01）pg/mL和（367.25±182.34） pg/mL,随访6月、1年、2年、3年、4年、5年的数据分别和腹膜透析1个月比较,t值分别为-5.956,-11.303,-22.187,-21.502,-34.255,-38.759,P值均为0.000,有明显统计学差异.③透出液中Gremlin和TGF-β水平与透析龄长短呈明显正相关,相关系数分别为0.744和0.873,P值分别为0.029和0.017.结论 Gremlin可能参与了腹膜透析患者腹膜纤维化的发生,从而导致腹膜溶质转运功能发生改变.干预Gremlin表达有望为抑制或逆转腹膜纤维化提供理论依据.Objective To investigate the gremlin level in peritoneal dialysate effluent and its influence on peritoneal function. Methods A total of 78 cases of continuous ambulatory peritoneal dialysis （CAPD） patients treated in the First Affiliated Hospital of Xinxiang Medical College from Jan. 2010 to Jan. 2015 were enrolled in this study. Gremlin and TGF-β1, in peritoneal dialysate effluent were measured by ELISA, and peritoneal function was assessed by peritoneal equilibrium test. The relationship between gremlin level and peritoneal function was then evaluated. Results ① With the extension of dialysis, peritoneal equilibrium test showed that the proportion of low transport and low average transport were gradually reduced, and some patients transformed into high transport or high average transport. Compared to the baselines, the Z2 values for the peritoneal equilibrium test ratios in the follow-up of 3 years, 4 years, 5 years were 12.219, 9.154 and 10.707, respectively, with the P values of 0.007, 0.027 and 0.013, respectively, indicating that peritoneal solute transport function gradually enhanced. Gin initial stage of peritoneal dialysis （CAPD for one month）, gremlin and TGF-β1 in the peritoneal dialysate effluent were 3.54±2.5 lpg/mL and 4.04±2.58pg/mL, respectively. With the extension of dialysis, gremlin and TGF-13, levels increased gradually and reached 232.71±55.01pg/mL and 367.25 ±182.34pg/mL, respectively, in the follow-up of 5 years. The values at the follow-up period of 6 months, one year, 2 years, 3 years, 4 years and 5 years were statistically different from those at the baseline condition （P=0.000）. ②Gremlin and TGF-β1 levels in peritoneal dialysate effluent were positively correlated with duration of dialysis, with the correlation coefficient of 0.744 and 0.873, respectively. Conclusions Gremlin may be involved in the pathogenesis of peritoneal fibrosis, resulting in the changes of peritoneal sol- ute transport function. Intervention of gremlin expression may be useful for inhibitin

关 键 词：GREMLIN 腹膜纤维化 腹膜透析 腹膜功能 

分 类 号：R459.5[医药卫生—治疗学]