Honda Kazuho, Hamada Chieko, Nakayama Masaaki, Miyazaki Masanobu, Sherif Ali M, Harada Takashi, Hirano Hiroshi
Department of Pathology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Clin J Am Soc Nephrol. 2008 May;3(3):720-8. doi: 10.2215/CJN.03630807. Epub 2008 Feb 13.
Peritoneal interstitial fibrosis and hyalinizing vasculopathy were induced by peritoneal dialysis and other associated conditions (e.g., uremia). A quantitative method for peritoneal biopsy evaluation is required to investigate possible causative factors and severity of the peritoneal dialysis-related peritoneal alterations.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Peritoneal biopsy specimens from 173 uremic (before peritoneal dialysis) and 80 peritoneal dialysis patients with or without impaired ultrafiltration capacity were evaluated by average peritoneal thickness of submesothelial compact zone measured at five randomly selected points of peritoneum and by lumen/vessel diameter ratio at postcapillary venule.
The average peritoneal thickness was increased in uremic patients and progressively thickened as the duration of peritoneal dialysis prolonged. The lumen/vessel diameter ratio was lower in uremia than normal and progressively decreased as the duration of peritoneal dialysis prolonged. In pre-peritoneal dialysis peritoneum, patients with diabetes showed significant decrease in lumen/vessel diameter ratio compared with patients without diabetes. The average peritoneal thickness was significantly higher in patients with impaired ultrafiltration capacity than in patients with maintained ultrafiltration capacity; however, no significant difference was observed in the postcapillary venule thickness and lumen/vessel diameter ratio between the two groups.
The average peritoneal thickness and lumen/vessel diameter ratio were useful morphologic parameters to quantify the severity of the peritoneal alterations in uremic and peritoneal dialysis patients. Uremia and diabetes had an impact on the pathogenesis of peritoneal sclerosis in pre-peritoneal dialysis peritoneum. Peritoneal dialysis treatment itself had a much stronger impact on the progression of peritoneal sclerosis.
腹膜间质纤维化和玻璃样变血管病由腹膜透析及其他相关病症（如尿毒症）引发。需要一种腹膜活检评估的定量方法来研究腹膜透析相关腹膜改变的可能病因及严重程度。
设计、场所、参与者及测量方法：对173例尿毒症患者（腹膜透析前）以及80例有或无超滤功能受损的腹膜透析患者的腹膜活检标本进行评估，通过在腹膜随机选取的五个点测量间皮下单密区的平均腹膜厚度以及测量毛细血管后微静脉的管腔/血管直径比来评估。
尿毒症患者的平均腹膜厚度增加，且随着腹膜透析时间延长逐渐增厚。尿毒症患者的管腔/血管直径比低于正常水平，并随着腹膜透析时间延长而逐渐降低。在腹膜透析前的腹膜中，糖尿病患者的管腔/血管直径比与非糖尿病患者相比显著降低。超滤功能受损患者的平均腹膜厚度显著高于超滤功能正常的患者；然而，两组之间毛细血管后微静脉厚度和管腔/血管直径比未观察到显著差异。
平均腹膜厚度和管腔/血管直径比是量化尿毒症和腹膜透析患者腹膜改变严重程度的有用形态学参数。尿毒症和糖尿病对腹膜透析前腹膜的腹膜硬化发病机制有影响。腹膜透析治疗本身对腹膜硬化的进展影响更大。
