Izumotani T, Ishimura E, Yamamoto T, Otoshi T, Okuno S, Inaba M, Kim M, Nishizawa Y
Kidney Center, Shirasagi Hospital, Osaka, Japan.
Nephron. 2001 Sep;89(1):43-9. doi: 10.1159/000046042.
Sclerosing encapsulating peritonitis (SEP) is a serious complication seen in patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We have previously reported that mesothelial cells in effluent dialysate significantly increased in size as the duration of CAPD progressed. In this study, we investigated the relationship between mesothelial cytology, histopathology of the peritoneum, and clinical outcomes of 34 CAPD patients.
When peritoneal dialysis catheters were inserted (n = 7) or removed (n = 27), a peritoneal biopsy was performed and results compared with mesothelial cytology in effluent dialysate.
A significant positive correlation was noted between the duration of CAPD and the surface area of peritoneal mesothelial cells (r = 0.721, p < 0.0001). The surface area of mesothelial cells in peritoneal sclerosis (n = 9; 584 +/- 97 microm(2)) was significantly greater than in peritoneal fibrosis (n = 14; 389 +/- 26 microm(2), p < 0.05), pathologic acute peritonitis (n = 3; 223 +/- 10 microm(2), p < 0.005), and normal peritoneum (n = 7; 247 +/- 12 microm(2), p < 0.001). The surface area in sclerosing peritonitis (n = 1; 1,200 microm(2)) was greater than that of all the others. Giant cells were found in the 1 case with sclerosing peritonitis and in 3 of 9 cases with peritoneal sclerosis, although they were found in only 1 of 14 patients with peritoneal fibrosis and in none of those with pathologic acute peritonitis or normal peritoneum. As the surface area of mesothelial cells increased to more than 400 microm(2) and giant cells appeared in the effluent, the frequency of peritoneal sclerosis and/or clinical SEP increased.
An increase in the mesothelial cell surface area and the emergence of giant cells in the effluent indicate advanced peritoneal histopathology, and may be useful indicators to determine appropriate timing of discontinuation of CAPD to prevent the development of SEP.
硬化性包裹性腹膜炎（SEP）是长期持续性非卧床腹膜透析（CAPD）患者中出现的一种严重并发症。我们之前报道过，随着CAPD疗程的进展，腹透流出液中的间皮细胞大小显著增加。在本研究中，我们调查了34例CAPD患者的间皮细胞形态学、腹膜组织病理学与临床结局之间的关系。
在插入腹膜透析导管时（n = 7）或拔除时（n = 27）进行腹膜活检，并将结果与腹透流出液中的间皮细胞形态学结果进行比较。
CAPD疗程与腹膜间皮细胞表面积之间存在显著正相关（r = 0.721，p < 0.0001）。腹膜硬化患者（n = 9；584 +/- 97平方微米）的间皮细胞表面积显著大于腹膜纤维化患者（n = 14；389 +/- 26平方微米，p < 0.05）、病理性急性腹膜炎患者（n = 3；223 +/- 10平方微米，p < 0.005）和正常腹膜患者（n = 7；247 +/- 12平方微米，p < 0.001）。硬化性腹膜炎患者（n = 1；1200平方微米）的表面积大于其他所有患者。在1例硬化性腹膜炎患者以及9例腹膜硬化患者中的3例中发现了巨细胞，而在14例腹膜纤维化患者中仅1例发现巨细胞，病理性急性腹膜炎患者和正常腹膜患者中均未发现。随着间皮细胞表面积增加至超过400平方微米且流出液中出现巨细胞，腹膜硬化和/或临床SEP的发生率增加。
间皮细胞表面积增加以及流出液中出现巨细胞表明腹膜组织病理学进展，可能是确定停止CAPD的合适时机以预防SEP发生的有用指标。
