de Fijter C W, Verbrugh H A, Peters E D, Oe P L, van der Meulen J, Donker A J, Verhoef J
Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands.
Adv Perit Dial. 1991;7:150-3.
Previous in vitro studies have revealed that the currently used peritoneal dialysis fluids (PDFs) inhibit several functions of phagocytic cells. Glucose-mediated hypertonicity was demonstrated to be one of the major detrimental factors. To investigate the clinical relevance of these in vitro findings, we compared the in vivo effect of a PDF with 3.86% glucose (D386) and a PDF containing 1.36% of glucose (D136) on peritoneal macrophage (PMO) function in eight CCPD patients. In a randomized cross-over setting, each patient used exclusively D136 or D386 on day one. The next day the patients who used D136 were switched to D386 and vice versa. PMO were isolated from the effluents and studied for their phagocytic capacity and chemiluminescence response. PMOs obtained from D386 effluents were significantly less phagocytic as compared to PMOs obtained after the in vivo use of D136 (38 +/- 7.1 vs 63 +/- 8.3%, p less than 0.02). In addition PMOs exposed to D386 were less able to mount a respiratory burst (peak response 4 +/- 1.0 vs 15 +/- 1.4% of control cells, p less than 0.05). Thus, the in vivo use of D386 was accompanied by significantly decreased PMO functions. These findings further stress the need to search for alternative solutions that do not rely on glucose-mediated hypertonicity for ultrafiltration.
以往的体外研究表明，目前使用的腹膜透析液（PDF）会抑制吞噬细胞的多种功能。葡萄糖介导的高渗性被证明是主要的有害因素之一。为了研究这些体外研究结果的临床相关性，我们比较了含3.86%葡萄糖的PDF（D386）和含1.36%葡萄糖的PDF（D136）对8例持续循环腹膜透析（CCPD）患者腹膜巨噬细胞（PMO）功能的体内影响。在随机交叉试验中，每位患者在第一天仅使用D136或D386。第二天，使用D136的患者换成D386，反之亦然。从流出液中分离出PMO，并研究其吞噬能力和化学发光反应。与体内使用D136后获得的PMO相比，从D386流出液中获得的PMO吞噬能力明显降低（38±7.1%对63±8.3%，p<0.02）。此外，暴露于D386的PMO产生呼吸爆发的能力也较低（峰值反应为对照细胞的4±1.0%对15±1.4%，p<0.05）。因此，体内使用D386会伴随着PMO功能的显著下降。这些发现进一步强调了寻找不依赖葡萄糖介导的高渗性进行超滤的替代溶液的必要性。
