de Fijter C W, Verbrugh H A, Oe P L, Peters E D, van der Meulen J, Donker A J, Verhoef J, Lameire N
Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands.
Adv Perit Dial. 1991;7:154-7.
Though glucose is universally applied as osmotic agent in CAPD, there is great interest in the use of alternative osmotic agents. Glycerol-containing peritoneal dialysis fluids (G-PDF) have been used in an attempt to minimize the metabolic effects of long-term exposure to glucose, especially in patients with diabetes. Since data were lacking, we studied the effect of G-PDF on peritoneal macrophage (PMO) function. In a randomized cross-over setting eight stable diabetic CAPD patients performed the third and fourth exchange of the day with either G-PDF or with glucose-containing PDF (D-PDF) of comparable osmolality. The next day the patients who had used G-PDF were switched to D-PDF and vice versa. PMO were isolated from the effluents and tested for their phagocytic capacity and chemiluminescence response. No differences were encountered in total and differential white cell counts between G-PDF and D-PDF effluents. PMO phagocytic capacity for both S. epidermidis (SE) and E. coli (EC) was significantly depressed after the instillation of G-PDF as compared to D-PDF (SE: 52 +/- 2.7 vs 69 +/- 5.0%, p less than 0.02, and EC: 44 +/- 5.7 vs 63 +/- 6.7%, p less than 0.02). The same held true for peak chemiluminescence response (5.3 +/- 1.36 vs 7.2 +/- 1.43% of control cells, p less than 0.005). Thus, G-PDF may compromise PMO function in vivo more than D-PDF despite its more favourable metabolic profile as compared to D-PDF for diabetic patients.
尽管葡萄糖在持续性非卧床腹膜透析（CAPD）中被普遍用作渗透剂，但人们对使用替代渗透剂仍有着浓厚兴趣。含甘油的腹膜透析液（G-PDF）已被用于尽量减少长期接触葡萄糖所产生的代谢影响，尤其是在糖尿病患者中。由于缺乏相关数据，我们研究了G-PDF对腹膜巨噬细胞（PMO）功能的影响。在一项随机交叉试验中，八名病情稳定的糖尿病CAPD患者使用渗透压相当的G-PDF或含葡萄糖的腹膜透析液（D-PDF）进行当日的第三次和第四次换液。第二天，使用G-PDF的患者改用D-PDF，反之亦然。从流出液中分离出PMO，并检测其吞噬能力和化学发光反应。G-PDF和D-PDF流出液的白细胞总数和分类计数没有差异。与D-PDF相比，灌注G-PDF后，PMO对表皮葡萄球菌（SE）和大肠杆菌（EC）的吞噬能力均显著降低（SE：52±2.7%对69±5.0%，p<0.02；EC：44±5.7%对63±6.7%，p<0.02）。化学发光峰值反应也是如此（为对照细胞的5.3±1.36%对7.2±1.43%，p<0.005）。因此，尽管与D-PDF相比，G-PDF对糖尿病患者的代谢状况更为有利，但它在体内对PMO功能的损害可能比D-PDF更大。
