Department of Internal Medicine-Nephrology, University Hospital, Patras, Greece.
Perit Dial Int. 2003 Dec;23 Suppl 2:S26-30.
Long-term exposure of peritoneal membrane to bioincompatible dialysis solutions leads to structural changes and loss of ultrafiltration capability.
We studied the possible relationship between histologic change and the transport characteristics of peritoneal membrane and adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients.
The study included 18 CAPD patients (11 men, 7 women) who underwent a peritoneal biopsy either at initiation of treatment (group A, n = 9) or after a mean of 4 years on CAPD (group B, n = 9). The morphologic changes in the mesothelial cells and the vascular compartment and the thickness of the submesothelial collagenous zone were estimated and compared with observations from 6 patients with normal renal function who underwent biopsy of the parietal peritoneum during abdominal surgery. The relationship of the observed changes in CAPD patients to results from a peritoneal equilibration test (PET) and to adequacy of dialysis [total weekly creatinine clearance (CCr) and Kt/V urea] were also investigated.
The main histologic changes in both groups of patients were loss of mesothelial cells and decrease in the normal mesothelial surface, thickening of the submesothelial collagenous zone, and presence of vascular hyalinosis. The thickness of the submesothelial collagenous zone in both groups of patients was significantly greater than that found in controls (410 mum and 580 mum vs 50 mum, p < 0.05). Although no significant difference was found between morphologic change in the peritoneal membrane of uremic patients starting on CAPD and those who had been on peritoneal dialysis (PD) for a mean period of 4 years, a trend was observed toward more severe lesions in the latter patients. The PET, CCr, and Kt/V urea were not significantly different in the two groups of patients. Those parameters also showed no significant changes when examined at initiation of CAPD and after a mean of 4 years of PD in the same patients (group B). No significant correlations were observed between the histologic changes and the PET, CCr, or Kt/V in both groups of patients.
Significant structural changes are observed in the peritoneal membrane of uremic patients, and those changes become worse with CAPD treatment. Structural changes are not followed by functional changes during the first 4 years on CAPD.
长期暴露于生物不相容性透析液中的腹膜会导致结构改变和超滤能力丧失。
我们研究了组织学变化与腹膜转运特性和腹膜透析（CAPD）患者透析充分性之间的可能关系。
本研究纳入了 18 名 CAPD 患者（男 11 例，女 7 例），他们在开始治疗时（A 组，n=9）或在 CAPD 治疗 4 年后（B 组，n=9）进行了腹膜活检。评估并比较了间皮细胞和血管腔的形态变化以及亚腹膜胶原带的厚度，并与 6 名在腹部手术期间接受壁层腹膜活检的肾功能正常患者的观察结果进行比较。还研究了 CAPD 患者观察到的变化与腹膜平衡试验（PET）和透析充分性[总每周肌酐清除率（CCr）和尿素 Kt/V]之间的关系。
两组患者的主要组织学变化均为间皮细胞丢失和正常间皮表面减少、亚腹膜胶原带增厚和血管玻璃样变。两组患者的亚腹膜胶原带厚度均明显大于对照组（410μm和 580μm 比 50μm，p<0.05）。尽管开始 CAPD 的尿毒症患者与已接受平均 4 年 PD 治疗的患者腹膜间皮的形态变化无显著差异，但后者患者的病变呈加重趋势。两组患者的 PET、CCr 和尿素 Kt/V 均无显著差异。在同一患者中，当在开始 CAPD 时和在开始 CAPD 后平均 4 年时检查这些参数时，这些参数也没有显著变化（B 组）。两组患者的组织学变化与 PET、CCr 或 Kt/V 之间均无显著相关性。
尿毒症患者的腹膜会出现明显的结构变化，随着 CAPD 治疗，这些变化会加重。在开始 CAPD 的前 4 年内，结构变化不会导致功能变化。
