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腹腔内注射心房利钠肽可增加腹水及溶质清除。

Intraperitoneal atrial natriuretic peptide increases peritoneal fluid and solute removal.

作者信息

Wang T, Cheng H H, Heimbürger O, Chen C, Bergström J, Lindholm B

机构信息

Division of Baxter Novum, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.

出版信息

Kidney Int. 2001 Aug;60(2):513-9. doi: 10.1046/j.1523-1755.2001.060002513.x.

Abstract

BACKGROUND

Atrial natriuretic peptide (ANP) is a hormone with well-known diuretic and vasodilating properties. Recently it was reported that ANP could increase the peritoneal fluid formation and increase peritoneal solute clearance. This study investigated the effect of ANP on peritoneal fluid and solute transport characteristics.

METHODS

Eighteen male Sprague-Dawley rats were divided into three groups. A four-hour dwell study using 25 mL 2.27% glucose dialysis solution with 50 microg/kg ANP (N = 6, H-ANP) or 5 microg/kg ANP (N = 6, L-ANP) or without ANP (N = 8, control) and frequent dialysate and blood sampling was done in each rat. Radiolabeled human albumin (RISA) was added to the solution as an intraperitoneal volume marker.

RESULTS

The intraperitoneal volume was significantly higher in the H-ANP group as compared with the control group and the L-ANP group. The drainage volume was 26.2 +/- 1.1, 25.5 +/- 0.7, and 29.8 +/- 0.8 mL for the control, L-ANP, and H-ANP groups, respectively (P < 0.01). This was related to significant differences in the peritoneal fluid absorption rates (K(E); estimated as the RISA elimination coefficient): 39 +/- 3, 38 +/- 3, and 19 +/- 4 microL/min, and in the direct lymphatic absorption rate (K(EB); estimated as the clearance of RISA from dialysate to blood): 7 +/- 1, 6 +/- 1, and 4 +/- 1 microL/min for the control, L-ANP, and H-ANP groups, respectively (all P < 0.01). No differences were found in the intraperitoneal volume, K(E), and K(EB) between the control group and the L-ANP group. The diffusive mass transport coefficient (K(BD)) for urea, sodium, potassium, and total protein did not differ among the three groups. However, the glucose D/D(0) was significantly higher, and the K(BD) for glucose was significantly lower in the H-ANP group as compared with the other two groups. Solute clearances (+175% for sodium and +26% for potassium) were significantly increased in the H-ANP group, mainly as a result of the increased fluid removal in this group.

CONCLUSIONS

Our results suggest that ANP may decrease peritoneal fluid absorption (by 51%, partially because of decreasing the direct lymphatic absorption), resulting in a significant increase in peritoneal fluid removal and small solute clearances. While the basic diffusive permeability of the peritoneal membrane was not changed, the peritoneal glucose absorption was retarded by adding ANP to peritoneal dialysate, perhaps through interaction of ANP with glucose metabolism.

摘要

背景

心房利钠肽(ANP)是一种具有利尿和血管舒张特性的激素。最近有报道称,ANP可增加腹膜液形成并提高腹膜溶质清除率。本研究调查了ANP对腹膜液和溶质转运特性的影响。

方法

将18只雄性Sprague-Dawley大鼠分为三组。对每只大鼠进行一项4小时的留腹研究,使用25 mL含50μg/kg ANP(N = 6,高剂量ANP组)或5μg/kg ANP(N = 6,低剂量ANP组)或不含ANP(N = 8,对照组)的2.27%葡萄糖透析液,并频繁采集透析液和血液样本。将放射性标记的人白蛋白(RISA)添加到溶液中作为腹腔容量标记物。

结果

高剂量ANP组的腹腔容量显著高于对照组和低剂量ANP组。对照组、低剂量ANP组和高剂量ANP组的引流液量分别为26.2±1.1、25.5±0.7和29.8±0.8 mL(P < 0.01)。这与腹膜液吸收率(K(E);以RISA消除系数估算)存在显著差异有关:对照组、低剂量ANP组和高剂量ANP组分别为39±3、38±3和19±4μL/min,以及直接淋巴吸收率(K(EB);以透析液中RISA向血液中的清除率估算)分别为7±1、6±1和4±1μL/min(均P < 0.01)。对照组和低剂量ANP组之间在腹腔容量、K(E)和K(EB)方面未发现差异。三组之间尿素、钠、钾和总蛋白的扩散质量转运系数(K(BD))无差异。然而,与其他两组相比,高剂量ANP组的葡萄糖D/D(0)显著更高,葡萄糖的K(BD)显著更低。高剂量ANP组的溶质清除率(钠增加175%,钾增加26%)显著提高,主要是由于该组液体清除增加。

结论

我们的结果表明,ANP可能会降低腹膜液吸收(降低51%,部分原因是直接淋巴吸收减少),从而导致腹膜液清除和小分子溶质清除率显著增加。虽然腹膜的基本扩散通透性未改变,但向腹膜透析液中添加ANP可延缓腹膜葡萄糖吸收,这可能是通过ANP与葡萄糖代谢的相互作用实现的。

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