Glorieux Griet, Lameire Norbert, Van Biesen Wim, Dequidt Clement, Vanholder Raymond
Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium.
Nephrol Dial Transplant. 2003 Aug;18(8):1648-53. doi: 10.1093/ndt/gfg202.
Icodextrin dialysate used for peritoneal dialysis contains an iso-molar glucose polymer solution, which provides sustained ultrafiltration over long dwell times and is considered a valuable approach to reduce intraperitoneal glucose exposure. However, several side effects have been described, including abdominal pain and allergic and hypersensitivity reactions. Also, reactions compatible with chemical peritonitis have been reported. Over the period of a few months (January 2002-May 2002), a remarkable increase in the number of continuous ambulatory peritoneal dialysis (CAPD) patients using icodextrin dialysate diagnosed with sterile peritonitis was observed in our unit.
Five of the CAPD patients using icodextrin dialysate in our unit and diagnosed with sterile peritonitis were screened for leucocyte count and leucocyte differentiation during a follow-up period of 77 +/- 23 days. In addition, expression of CD14, a receptor for lipopolysaccharide (LPS), on the peripheral and peritoneal monocyte population was analysed. These results were compared to CAPD patients suffering from bacterial peritonitis.
The peritoneal leucocyte count of CAPD patients using icodextrin dialysate and diagnosed with sterile peritonitis did not decrease significantly before treatment with icodextrin dialysate was interrupted, whereas it currently disappeared within 2-4 days in proven bacterial peritonitis. The sterile, cloudy icodextrin effluent contained an excess of macrophages on the day of diagnosis, whereas in bacterial peritonitis essentially an increase in the granulocyte population was observed. No elevation in the eosinophil population was observed. In contrast to bacterial peritonitis, we observed no increase in CD14 expression on the peripheral and peritoneal macrophages on the day of presentation and during the follow-up period.
Specific batches of the icodextrin CAPD fluids contain a macrophage chemotactic agent, which causes a sustained inflammatory state in the peritoneal cavity. Because no increase in the expression of the LPS receptor CD14 could be observed, the increased peritoneal leucocyte count is probably not caused by LPS or LPS-like (possibly peptidoglycan-like) contamination.
用于腹膜透析的艾考糊精透析液含有等摩尔葡萄糖聚合物溶液，能在长时间留置时提供持续超滤，被认为是减少腹腔内葡萄糖暴露的一种有效方法。然而，已描述了几种副作用，包括腹痛、过敏和超敏反应。此外，还报告了与化学性腹膜炎相符的反应。在几个月的时间里（2002年1月至2002年5月），我们科室观察到使用艾考糊精透析液的持续性非卧床腹膜透析（CAPD）患者中，被诊断为无菌性腹膜炎的人数显著增加。
对我们科室5例使用艾考糊精透析液并被诊断为无菌性腹膜炎的CAPD患者，在77±23天的随访期内进行白细胞计数和白细胞分化筛查。此外，分析外周血和腹腔单核细胞群体中脂多糖（LPS）受体CD14的表达。将这些结果与患有细菌性腹膜炎的CAPD患者进行比较。
使用艾考糊精透析液并被诊断为无菌性腹膜炎的CAPD患者腹腔白细胞计数在中断艾考糊精透析液治疗前没有显著下降，而在确诊的细菌性腹膜炎中，目前在2至4天内白细胞计数就会消失。诊断当天，无菌、浑浊的艾考糊精流出液中含有过量巨噬细胞，而在细菌性腹膜炎中主要观察到粒细胞群体增加。未观察到嗜酸性粒细胞群体升高。与细菌性腹膜炎不同，在就诊当天和随访期间，我们未观察到外周血和腹腔巨噬细胞上CD14表达增加。
特定批次的艾考糊精CAPD液含有巨噬细胞趋化剂，可导致腹腔内持续炎症状态。由于未观察到LPS受体CD14表达增加，腹腔白细胞计数增加可能不是由LPS或LPS样（可能是肽聚糖样）污染引起的。
