Opatrná S, Topolcan O, Opatrný K
I. interní klinika LF UK a FN, Plzen.
Vnitr Lek. 2000 Nov;46(11):794-800.
Peritoneal dialysis is a method of renal replacement therapy which has been increasingly in use worldwide and, in recent years, also in our country. A factor limiting long-term use of peritoneal dialysis is the maintenance of the function of the peritoneum as a dialysis membrane. Impairment of the anatomical and functional integrity of the peritoneal membrane may be due to severe or recurrent peritonitis but, also, in patients without a history of peritoneal infection, presumably as a result of contact between the peritoneum and a bioincompatible dialysis solution. When investigating the structural and functional changes in the peritoneal membrane, considerable attention was given to cytokines. The main source of cytokines in the peritoneal cavity are macrophages, mesothelial cells, and fibroblasts. In peritoneal dialysis, cytokines play a role both in defense against the development of peritoneal infection and in the course of peritoneal infection. By virtue of their biological effects, cytokines may affect the permeability of the peritoneal membrane and, consequently, the efficacy of peritoneal dialysis. In addition, cytokines are released on contact of the peritoneum with the dialysis solution and may thus be made use of in biocompatibility studies. Changes of cytokine levels can be studied--when performing peritoneal dialysis in clinical practice--in the dialysis solution drained from the peritoneal cavity, in tissue cultures, and in animal experiments. The effects of cytokines are modified by the action of their soluble receptors and antagonists. Future studies are warranted to clarify the role of cytokine antagonists and their soluble receptors.
腹膜透析是一种肾脏替代治疗方法，在全球范围内的使用日益增加，近年来在我国也逐渐得到应用。限制腹膜透析长期使用的一个因素是维持腹膜作为透析膜的功能。腹膜解剖和功能完整性的损害可能归因于严重或复发性腹膜炎，但在没有腹膜感染病史的患者中，推测是由于腹膜与生物不相容的透析液接触所致。在研究腹膜结构和功能变化时，细胞因子受到了相当多的关注。腹膜腔中细胞因子的主要来源是巨噬细胞、间皮细胞和成纤维细胞。在腹膜透析中，细胞因子在抵御腹膜感染的发生以及腹膜感染过程中均发挥作用。凭借其生物学效应，细胞因子可能会影响腹膜的通透性，进而影响腹膜透析的疗效。此外，细胞因子在腹膜与透析液接触时释放，因此可用于生物相容性研究。在临床实践中进行腹膜透析时，可以在从腹膜腔引流的透析液、组织培养和动物实验中研究细胞因子水平的变化。细胞因子的作用会被其可溶性受体和拮抗剂的作用所改变。有必要开展进一步研究以阐明细胞因子拮抗剂及其可溶性受体的作用。
