Pajek Jernej, Kveder Radoslav, Bren Andrej, Gucek Andrej, Ihan Alojz, Osredkar Josko, Lindholm Bengt
Department of Nephrology, University Medical Center Ljubljana, Slovenia.
Perit Dial Int. 2008 Jan-Feb;28(1):44-52.
This study was designed to compare the local peritoneal and systemic inflammatory effects of a conventional lactate-based (Lac) peritoneal dialysis (PD) solution and a new biocompatible bicarbonate/lactate-based (Bic/Lac) solution having low concentration of glucose degradation products.
26 stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the Lac solution and 3 months with the Bic/Lac solution in a randomized order. Flow cytometry was used to measure the expression of inflammatory molecules on peritoneal cells in overnight effluent collected at the end of each study period.
21 patients successfully completed the study. Mean fluorescence intensity of human leukocyte antigen (HLA)-DR and CD14 expression by macrophages were not different between Lac and Bic/Lac. The peritoneal appearance rate of cancer antigen 125 (kU/minute) was 68 +/- 37 with Lac and 133 +/- 66 with Bic/Lac (p < 0.001), and of interleukin (IL)-6 (ng/minute), 0.28 +/- 0.2 with Lac and 0.18 +/- 0.16 with Bic/Lac (p = 0.014). HLA-DR macrophage expression and IL-6 peritoneal appearance rates did not correlate. Serum concentrations with Lac and Bic/Lac were, for IL-6, 3.49 +/- 2.28 and 3.72 +/- 2.46 ng/L (p = 0.17), and for high-sensitivity C-reactive protein, 2.31 +/- 2.98 and 2.71 +/- 3.31 mg/L (p = 0.32) respectively. The concentration of effluent macrophages (x10(6)/L) with Lac was 1.6 +/- 1.6 and with Bic/Lac 2.6 +/- 3.3 (p = 0.07).
We conclude that, although there was a significant reduction in peritoneal IL-6 in patients using Bic/Lac solution, systemic levels of inflammatory markers did not differ between the two solutions and no changes were present in macrophage surface activation markers, suggesting perhaps a less important role of peritoneal macrophages in the intraperitoneal chronic inflammatory process. The number of effluent macrophages tended to be higher in patients using the Bic/Lac solution, possibly contributing to improved intraperitoneal defense.
本研究旨在比较传统的乳酸盐基（Lac）腹膜透析（PD）液与一种新的具有低浓度葡萄糖降解产物的生物相容性碳酸氢盐/乳酸盐基（Bic/Lac）溶液的局部腹膜和全身炎症效应。
26例稳定的、正在进行腹膜透析的患者被纳入这项前瞻性研究。他们按照随机顺序依次接受3个月的Lac溶液治疗和3个月的Bic/Lac溶液治疗。在每个研究期结束时收集过夜流出液，采用流式细胞术检测腹膜细胞上炎症分子的表达。
21例患者成功完成研究。Lac组和Bic/Lac组巨噬细胞表达人类白细胞抗原（HLA）-DR和CD14的平均荧光强度无差异。Lac组癌抗原125的腹膜出现率（kU/分钟）为68±37，Bic/Lac组为133±66（p<0.001）；白细胞介素（IL）-6的腹膜出现率（ng/分钟），Lac组为0.28±0.2，Bic/Lac组为0.18±0.16（p=0.014）。HLA-DR巨噬细胞表达与IL-6腹膜出现率无相关性。Lac组和Bic/Lac组血清中IL-6浓度分别为3.49±2.28和3.72±2.46 ng/L（p=0.17），高敏C反应蛋白浓度分别为2.31±2.98和2.71±3.31 mg/L（p=0.32）。Lac组流出液巨噬细胞浓度（×10⁶/L）为1.6±1.6，Bic/Lac组为2.6±3.3（p=0.07）。
我们得出结论，尽管使用Bic/Lac溶液的患者腹膜IL-6显著降低，但两种溶液的全身炎症标志物水平无差异，巨噬细胞表面激活标志物也无变化，这表明腹膜巨噬细胞在腹膜内慢性炎症过程中的作用可能不那么重要。使用Bic/Lac溶液的患者流出液巨噬细胞数量往往更高，这可能有助于改善腹膜防御。
