Bertoli S V, Buzzi L, Ciurlino D, Maccario M, Traversi L, Martino S, Procaccio M
Nephrology and Dialysis Unit, Policlinico MultiMedica, 20099 Sesto San Giovanni, Milan, Italy.
Int J Artif Organs. 2005 Feb;28(2):112-6. doi: 10.1177/039139880502800206.
Function and structure of peritoneal membrane (PM) are impaired on peritoneal dialysis (PD). Peritoneal sclerosis is a common finding in peritoneal biopsies (PB) of PD patients. The aim of this study was to examine the impact of peritoneal sclerosis on peritoneal function and clinical parameters in PD patients submitted to peritoneal biopsy.
A PB was performed on 31 PD patients during catheter removal due to malfunction or after drop-out from treatment. For each patient PM transport was evaluated by the last peritoneal equilibration test before PB. Each daily glucose load was calculated. Tissue was formalin-embedded and stained for histological and immunohistochemical studies.
Patients with submesothelial sclerosis and those with impairment of submesothelial basement membrane and subendothelial vascular membrane were submitted to a larger daily glucose load. Peritoneal sclerosis > 50 microns was more frequent in high transporters, who were exposed to larger daily glucose load compared to medium-high transporters. Mesothelial loss is correlated to peritoneal sclerosis and vascular injuries.
Peritoneal sclerosis is not constant in PD patients: it is related to the loss of mesothelium integrity, to the daily glucose load of PD treatment and to vascular injuries, but apparently not to the presence of inflammatory infiltrate. It remains a matter of debate how much the peritoneal sclerosis modifies the function of PM and how new more biocompatible PD solutions could reduce PM injury.
腹膜透析（PD）时腹膜（PM）的功能和结构会受损。腹膜硬化是PD患者腹膜活检（PB）中常见的发现。本研究的目的是探讨腹膜硬化对接受腹膜活检的PD患者腹膜功能和临床参数的影响。
对31例因导管故障或退出治疗而拔除导管的PD患者进行腹膜活检。在腹膜活检前，通过最后一次腹膜平衡试验评估每位患者的腹膜转运情况。计算每日葡萄糖负荷量。将组织用福尔马林固定并染色，用于组织学和免疫组织化学研究。
存在间皮下硬化以及间皮下基底膜和内皮下血管膜受损的患者每日葡萄糖负荷量更大。与中高转运者相比，高转运者中腹膜硬化>50微米更为常见，他们每日暴露于更大的葡萄糖负荷量。间皮丢失与腹膜硬化和血管损伤相关。
腹膜硬化在PD患者中并非恒定不变：它与间皮完整性丧失、PD治疗的每日葡萄糖负荷量以及血管损伤有关，但显然与炎症浸润的存在无关。腹膜硬化对腹膜功能的影响程度以及新型生物相容性更好的腹膜透析液能在多大程度上减少腹膜损伤，仍存在争议。
