Nakamoto H, Imai H, Ishida Y, Yamanouchi Y, Inoue T, Okada H, Suzuki H
Department of Nephrology, Saitama Medical School, Iruma-gun, Japan.
Perit Dial Int. 2001;21 Suppl 3:S349-53.
Encapsulating peritoneal sclerosis (EPS), in which all or part of the intestine is enveloped in a fibrous ball resembling a cocoon, is a serious complication of peritoneal dialysis (PD). The aim of the present study was to investigate whether pH-neutral or acidic dialysis solutions induce peritoneal fibrosis.
We divided 18 male Wistar-Kyoto (WKY) rats into three groups and dialyzed them with various solutions as follows: group I, 10 mL acidic dialysis solution (pH 3.8, containing 1.35% glucose), n = 6; group II, 10 mL pH 5.0 dialysis solution, n = 6; and group III, 10 mL neutral dialysis solution (pH 7.0), n = 6. Peritoneal catheters were inserted, and dialysis solution was injected every day for 40 days. At the end of the experiment, a peritoneal equilibration test (PET) was performed. Expression of mRNA of aquaporins 1 and 4 (AQP-1 and AQP-4) in the peritoneum were studied by semiquantitative reverse-transcriptase polymerase chain reaction (RT-PCR).
In rats treated with pH 3.8 dialysis solution, necropsy findings revealed features identical to those of EPS. The typical appearance was of granulation tissue or fibrotic tissue (or both) covering multiple surfaces. Multiple adhesions were present. In microscopic examinations, peritoneal fibrosis and loss of mesothelium were found. In rats treated with pH 7.0 dialysis solution, no signs of EPS were seen. In rats treated with pH 5.0 dialysis solution, milder changes (subserosal thickening and partial adhesion of the peritonea) were observed. The mRNA of AQP-1 and AQP-4 were expressed in the peritonea of the rats. The expression of the AQPs was significantly suppressed in rats treated with pH 3.8 dialysis solution.
In rats, long-term intraperitoneal injection of acidic dialysis solution produced features typical of EPS in humans. Newly developed neutral dialysis solutions protected the against the development of EPS during peritoneal dialysis in rats.
包裹性腹膜硬化（EPS）是腹膜透析（PD）的一种严重并发症，其特征为全部或部分肠道被包裹在类似茧的纤维球中。本研究旨在探讨pH中性或酸性透析液是否会诱导腹膜纤维化。
我们将18只雄性Wistar-Kyoto（WKY）大鼠分为三组，并用不同溶液进行透析，具体如下：第一组，10 mL酸性透析液（pH 3.8，含1.35%葡萄糖），n = 6；第二组，10 mL pH 5.0透析液，n = 6；第三组，10 mL中性透析液（pH 7.0），n = 6。插入腹膜导管，每天注入透析液，持续40天。实验结束时，进行腹膜平衡试验（PET）。通过半定量逆转录聚合酶链反应（RT-PCR）研究腹膜中 aquaporins 1和4（AQP-1和AQP-4）的mRNA表达。
在用pH 3.8透析液治疗的大鼠中，尸检结果显示出与EPS相同的特征。典型表现为肉芽组织或纤维化组织（或两者兼有）覆盖多个表面。存在多处粘连。在显微镜检查中，发现腹膜纤维化和间皮细胞缺失。在用pH 7.0透析液治疗的大鼠中，未见EPS迹象。在用pH 5.0透析液治疗的大鼠中，观察到较轻的变化（浆膜下增厚和腹膜部分粘连）。AQP-1和AQP-4的mRNA在大鼠腹膜中表达。在用pH 3.8透析液治疗的大鼠中，水通道蛋白的表达显著受到抑制。
在大鼠中，长期腹腔注射酸性透析液会产生人类EPS的典型特征。新开发的中性透析液可防止大鼠腹膜透析期间EPS的发生。
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