Moriishi Misaki, Kawanishi Hideki, Watanabe Hiroshi, Tsuchiya Shinichiro
Department of Artificial Organs, Akane-Foundation Tsuchiya Hospital, Hiroshima, Japan.
Adv Perit Dial. 2005;21:21-4.
Using changes in cell counts and levels of cancer antigen 125 (CA125), fibrinogen degradation product (FDP), and interleukin-6 (IL-6) in effluent before and after the use of icodextrin-based peritoneal dialysis solution (icodextrin), we evaluated the effects of icodextrin on peritoneal membrane. The subjects were 8 anuric patients (4 men, 4 women) who had been using a 2.5% glucose-based dialysis solution (glucose solution) for the overnight dwell. The mean age of the patients was 57.9 +/- 6.1 years, and their mean duration of continuous ambulatory peritoneal dialysis was 61.6 +/- 44.3 months. In all patients, chronic glomerulonephritis was the cause of end-stage renal disease. We changed the 2.5% glucose solution used for the 8-hour dwell to an icodextrin, and we compared cell counts in effluent and levels of IL-6, FDP, and CA125 in the overnight effluent before, and 12 and 36 weeks after, the switch to the icodextrin. When 2.5% glucose solution was used for the overnight 8-hour dwell, the mean cell count in the effluent was 5.5 +/- 3 cells/mm3. However, 12 and 36 weeks after the start of icodextrin, mean cell counts in effluent were significantly increased to 15.3 +/- 7.7 cells/mm3 (p < 0.01) and 16.5 +/- 11.2 cells/mm3 (p < 0.01) respectively. Values of effluent CA125, FDP, and IL-6 obtained during the use of a glucose solution were compared to values obtained 12 and 36 weeks after the start of icodextrin. Effluent levels of CA125 and IL-6 did not vary before and after the use of the icodextrin, but levels of FDP in the icodextrin effluent were higher than the levels found in the effluent of a 2.5% glucose solution (7278.8 +/- 2915 ng/mL before the start of icodextrin; 29,875 +/- 13,227 ng/mL 12 weeks after icodextrin introduction, p < 0.01; and 12,062.9 +/- 5684.6 ng/mL 36 weeks after icodextrin introduction). Icodextrin induced a subclinical inflammatory response in the peritoneum. Therefore, biocompatibility of an icodextrin solution is not always superior to that of a glucose solution, and further research is needed to clarify the influence of long-term icodextrin use on the peritoneum.
通过比较使用艾考糊精-based腹膜透析液（艾考糊精）前后流出液中细胞计数、癌抗原125（CA125）、纤维蛋白原降解产物（FDP）和白细胞介素-6（IL-6）水平的变化，我们评估了艾考糊精对腹膜的影响。研究对象为8例无尿患者（4例男性，4例女性），他们一直使用2.5%葡萄糖-based透析液（葡萄糖溶液）进行夜间留腹。患者的平均年龄为57.9±6.1岁，平均持续非卧床腹膜透析时间为61.6±44.3个月。所有患者中，慢性肾小球肾炎是终末期肾病的病因。我们将用于8小时留腹的2.5%葡萄糖溶液换成艾考糊精，并比较了换用艾考糊精前、换用后12周和36周夜间流出液中的细胞计数以及IL-6、FDP和CA125水平。当使用2.5%葡萄糖溶液进行夜间8小时留腹时，流出液中的平均细胞计数为5.5±3个细胞/mm³。然而，开始使用艾考糊精后12周和36周，流出液中的平均细胞计数分别显著增加至15.3±7.7个细胞/mm³（p<0.01）和16.5±11.2个细胞/mm³（p<0.01）。将使用葡萄糖溶液期间获得的流出液CA-125、FDP和IL-6值与开始使用艾考糊精后12周和36周获得的值进行比较。使用艾考糊精前后流出液中CA125和IL-6水平没有变化，但艾考糊精流出液中的FDP水平高于2.5%葡萄糖溶液流出液中的水平（艾考糊精开始前为7278.8±2915 ng/mL；引入艾考糊精后12周为29875±13227 ng/mL，p<0.01；引入艾考糊精后36周为12062.9±5684.6 ng/mL）。艾考糊精在腹膜中引发了亚临床炎症反应。因此，艾考糊精溶液的生物相容性并不总是优于葡萄糖溶液，需要进一步研究以阐明长期使用艾考糊精对腹膜的影响。
