Wang T, Cheng H H, Heimbürger O, Chen C, Waniewski J, Bergström J, Lindholm B
Division of Baxter Novum, Huddinge University Hospital, Karolinska Institute, Sweden.
Perit Dial Int. 1999;19 Suppl 2:S106-11.
It has been shown that hyaluronan (HA) can decrease peritoneal fluid absorption. It is not known, however, how various molecular weights and various concentrations of hyaluronan affect peritoneal fluid absorption rate.
A study of 4-hour dwells, with frequent dialysate and blood sampling, was performed in male Sprague-Dawley rats (6-7 rats in each group) with 131I albumin as an intraperitoneal volume marker. Each rat was infused intraperitoneally with 25 mL of 1.5% glucose solution alone or 1.5% glucose solution containing hyaluronan at various molecular weights (MW-85 kD, 280 kD, 500 kD, and 4 MD) or containing hyaluronan of MW 500 kD at various concentrations (0.01%, 0.05%, 0.1%, 0.5%). Two additional groups were infused with 40 mL of 1.36% glucose dialysate alone or 1.36% glucose dialysate with 0.01% hyaluronan (MW 500 kD) to test the effect of hyaluronan when high dialysate fill volume was used.
Addition of 0.01% hyaluronan significantly decreased peritoneal fluid absorption rate (K(E)) (by 22%, p < 0.01). The decrease was more marked with hyaluronan at high MW or high concentration, or with high dialysate fill volume. The net ultrafiltration tended to be higher in all hyaluronan groups compared to their control groups except in the 4 MD group; this difference was mainly due to a lower K(E) in all the hyaluronan groups. The direct lymphatic flow was significantly decreased in the 0.5% HA group. The transcapillary ultrafiltration rate (Qu) was significantly lower in the 4 MD group as compared to the control group. No difference in Qu was found between the other groups as compared to their control groups.
(1) Intraperitoneal addition of hyaluronan may increase net peritoneal fluid removal, mainly because hyaluronan decreases peritoneal fluid absorption rate. The decrease was more marked when high dialysate fill volume was used, indicating that intraperitoneal addition of hyaluronan can prevent the decreased net ultrafiltration caused by an increase in dialysate fill volume. (2) The decrease in peritoneal fluid absorption rate may be both MW-dependent and concentration-dependent: that is, a higher MW as well as a higher concentration of hyaluronan result in a more marked decrease in peritoneal fluid absorption rate. (3) Low concentrations of high MW hyaluronan may also decrease Qu. However, Qu did not decrease when high concentrations of hyaluronan were used despite a significant decrease in peritoneal fluid absorption rate.
已表明透明质酸（HA）可降低腹膜液吸收。然而，尚不清楚不同分子量和不同浓度的透明质酸如何影响腹膜液吸收速率。
对雄性Sprague-Dawley大鼠（每组6 - 7只大鼠）进行了一项为期4小时驻留的研究，频繁采集透析液和血液样本，以131I白蛋白作为腹腔容积标记物。每只大鼠腹腔内单独注入25 mL 1.5%葡萄糖溶液，或注入含有不同分子量（MW - 85 kD、280 kD、500 kD和4 MD）透明质酸的1.5%葡萄糖溶液，或含有不同浓度（0.01%、0.05%、0.1%、0.5%）500 kD透明质酸的1.5%葡萄糖溶液。另外两组分别单独注入40 mL 1.36%葡萄糖透析液或含有0.01%透明质酸（MW 500 kD）的1.36%葡萄糖透析液，以测试使用高透析液填充量时透明质酸的效果。
添加0.01%透明质酸显著降低了腹膜液吸收速率（K(E)）（降低22%，p < 0.01）。分子量高或浓度高的透明质酸，或透析液填充量高时，这种降低更为明显。除4 MD组外，所有透明质酸组的净超滤量相较于其对照组往往更高；这种差异主要是由于所有透明质酸组的K(E)较低。0.5% HA组的直接淋巴流量显著降低。4 MD组的跨毛细血管超滤率（Qu）相较于对照组显著更低。与各自对照组相比，其他组的Qu未发现差异。
（1）腹腔内添加透明质酸可能会增加腹膜液净清除量，主要是因为透明质酸降低了腹膜液吸收速率。使用高透析液填充量时，这种降低更为明显，表明腹腔内添加透明质酸可防止因透析液填充量增加导致的净超滤量降低。（2）腹膜液吸收速率的降低可能既依赖于分子量又依赖于浓度：即，较高的分子量以及较高浓度的透明质酸会导致腹膜液吸收速率更显著降低。（3）低浓度的高分子量透明质酸也可能降低Qu。然而，尽管腹膜液吸收速率显著降低，但使用高浓度透明质酸时Qu并未降低。
