肾素-血管紧张素系统抑制剂对CAPD患者VEGF水平的影响  

Effects of rennin-angiotensin system inhibitors on VEGF level in serum and dialysis fluid in CAPD patients

作　　者：黄雅清 俞国庆[1] 陈鑫 傅云泉 林强 庄永泽[1] HUANG Ya-qing1, YU Guo-qing1, Chen Xin1, FU Yun-quan1, Lin Qiang1, ZHUANG Yong-ze1(1Department of Urology, Nanjing General Hospital of Fuzhou Military, Fuzhou 350001, Chin)

机构地区：[1]福州总医院肾内科,福州350025

出　　处：《中国血液净化》2018年第3期165-169,共5页Chinese Journal of Blood Purification

基　　金：福建省自然基金面上项目(No.2014J01426)

摘　　要：目的本文通过研究肾素-血管紧张素抑制剂(rennin-angiotensin system inhibitors,RASI)对持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响,探讨RASI对腹膜功能的相关保护作用。方法选取在福州总医院规律随访的CAPD患者(n=34),根据是否应用RASI分成治疗组(n=20),对照组(n=14)观察时间为6个月,对患者的一般资料、血液、尿液、腹膜透析液的生化指标进行检测和记录,并行腹膜平衡实验等进行腹膜转运功能及透析充分性评估,并收集血清及腹膜透析液,分别进行VEGF浓度测定,进行统计分析。结果 (1)纳入研究前2组患者一般资料间的差异无统计学意义。(2)在0个月和6个月时2组的各项临床指标无显著差异。(3)在0个月时治疗组与对照组的血清及腹膜透析液的VEGF水平无差异;6个月后治疗组血清VEGF水平较对照组显著降低[(171.515±84.831)pg/ml比(276.598±129.866)pg/ml,t=-2.859,P=0.007],而腹透液VEGF水平较对照组不显著降低[(46.017±19.104)pg/ml比(54.673±19.691)pg/ml,t=-1.284,P=0.208]。(4)在0个月2组间的腹透蛋白丢失量无差异;6个月后,治疗组的腹透蛋白丢失量较对照组显著下降[(3.379±2.329)g/24h比(6.397±3.049),Z=-2.800,P=0.005]。结论 RASI可以减轻或使CAPD患者腹膜VEGF的表达处于稳定状态,减轻腹膜血管新生及渗透性,减少腹透蛋白丢失,从而起到保护腹膜的作用。Objective This study discusses the effects of rennin-angiotensin system inhibitor （RASI） on vascular endothelial growth factor （VEGF） levels in serum and dialysis fluid in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods A total of 34 patients received CAPD and in stable conditions were enrolled in this study. Twenty cases were treated with RASI （treatment group）, and 14 cases did not use any ACEI/ARB （control group）. They were observed for 6 months. Estimation of peritoneal function, such as Kt/V and cCr of the peritoneum and protein in dialysis fluid, was performed. Serum and dialysate were collected for the assay of VEGF. Results ① There were no significant differences in basal data between treatment group and control group. ②There were no differences in clinical indicators including 4h D/P Cr, Kt/V, MTAC Cr, etc, between the two groups at the beginning and after the treatment for 6 months. ③There were no significant differences in serum and dialysate VEGF at the beginning between the two groups （P〉0.05）. After 6 months of the treatment, however, serum VEGF was significantly lower in treatment group than in control group （171.515±84.831 vs. 276.598±129.866pg/ml, t=-2.859, P=0.007）, but dialysate VEGF had no difference between the two groups （46.017±19.104 vs. 54.673±19.691pg/ml, t=-1.284, P=0.208）. ④There was no significant difference in protein loss from dialysate at the beginning between the two groups. After 6 months of the treatment, however, protein loss from dialysate was significantly lower in treatment group than in control group （3.379±2.329 vs. 6.397±3.049g/day, Z=-2.800, P=0.005）. Conclusion RASI can reduce and stabilize VEGF expression level on peritoneum and thus protect peritoneal function in CAPD patients.

关 键 词：腹膜透析 血管内皮生长因子 腹膜功能 ACEI/ARB 

分 类 号：R459.5[医药卫生—治疗学]