Wang T, Heimbürger O, Cheng H H, Bergström J, Lindholm B
Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
Perit Dial Int. 1999 Jan-Feb;19(1):17-22.
It has recently been reported that a high peritoneal transport rate was associated with increased mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. One possible explanation is that a high peritoneal transport rate might be caused by a state of chronic inflammation, which also per se might result in increased mortality. Therefore, in this study we investigated whether high peritoneal transport rate patients are in a state of chronic inflammation.
The study included 39 clinically stable peritoneal dialysis patients (free of peritonitis) who had been on PD for more than 3 months (16.8+/-11.8 months). Seven patients were treated with continuous cycling peritoneal dialysis (CCPD) and the others were on CAPD. A 4-hour standard peritoneal equilibration test (PET) using 2.27% glucose solution was performed in each patient. Dialysate samples at 4 hours and blood samples at 2 hours were measured for interleukin-1beta (IL-1beta), tumor necrosis factor(alpha)(TNFalpha), C-reactive protein (CRP), and hyaluronan as markers of inflammation.
There was no significant correlation between dialysate/plasma (DIP) creatinine (0.82+/-0.15, range 0.51 - 1.15) and blood concentrations of IL-1beta (11.2 ng/L, range <5 - 65.9 ng/L),TNFalpha (12.1 ng/L, range <5 - 85.4 ng/L), CRP (<10 mg/L, range <10 - 76 mg/L), nor with the blood hyaluronan concentration (165 microg/L, range 55 - 955 microg/L). The dialysate concentrations of IL-1beta and TNFalpha were below the detectable level in most of the samples. Although dialysate hyaluronan concentration (334 microg/L, range 89 - 1100 microg/L) was correlated with D/P creatinine (r= 0.36, p< 0.05), there was no correlation between the total amount of hyaluronan in the effluent and D/P creatinine. However, a significant correlation was found between serum hyaluronan concentration and glomerular filtration rate (GFR) (r = -0.49, p< 0.005); GFR also tended to be correlated with serum TNFalpha (r = -0.31, p = 0.058) but not with serum IL-1beta and serum CRP.
Our results suggest that a high peritoneal transport rate is not necessarily related to a state of chronic inflammation in CAPD patients. The high mortality rate observed in high transporters may relate to other issues, such as fluid balance or abnormal nutrition and metabolism, rather than to chronic inflammation.
最近有报道称，持续性非卧床腹膜透析（CAPD）患者的高腹膜转运率与死亡率增加相关。一种可能的解释是，高腹膜转运率可能由慢性炎症状态引起，而慢性炎症本身也可能导致死亡率增加。因此，在本研究中，我们调查了高腹膜转运率患者是否处于慢性炎症状态。
本研究纳入了39例临床稳定的腹膜透析患者（无腹膜炎），这些患者接受腹膜透析超过3个月（16.8±11.8个月）。7例患者接受持续循环腹膜透析（CCPD）治疗，其余患者接受CAPD治疗。对每位患者进行了使用2.27%葡萄糖溶液的4小时标准腹膜平衡试验（PET）。检测4小时的透析液样本和2小时的血液样本中的白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNFα）、C反应蛋白（CRP）和透明质酸作为炎症标志物。
透析液/血浆（DIP）肌酐（0.82±0.15，范围0.51 - 1.15）与血液中IL-1β（11.2 ng/L，范围<5 - 65.9 ng/L）、TNFα（12.1 ng/L，范围<5 - 85.4 ng/L）、CRP（<10 mg/L，范围<10 - 76 mg/L）的浓度之间无显著相关性，与血液透明质酸浓度（165 μg/L，范围55 - 955 μg/L）也无显著相关性。大多数样本中，透析液中IL-1β和TNFα的浓度低于可检测水平。虽然透析液透明质酸浓度（334 μg/L，范围89 - 1100 μg/L）与D/P肌酐相关（r = 0.36，p<0.05），但流出液中透明质酸总量与D/P肌酐之间无相关性。然而，血清透明质酸浓度与肾小球滤过率（GFR）之间存在显著相关性（r = -0.49，p<0.005）；GFR也倾向于与血清TNFα相关（r = -0.31，p = 0.058），但与血清IL-1β和血清CRP无关。
我们的结果表明，高腹膜转运率不一定与CAPD患者的慢性炎症状态相关。高转运者中观察到的高死亡率可能与其他问题有关，如液体平衡或异常的营养和代谢，而非慢性炎症。
