Department of Medicine, Pathology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA.
Perit Dial Int. 2010 May-Jun;30(3):284-93. doi: 10.3747/pdi.2009.00100. Epub 2010 Feb 11.
We hypothesized that both sterile solutions and foreign body reaction to the peritoneal dialysis catheter are associated with inflammatory changes in rats exposed to hypertonic solution.
Four hypertonic solutions (30 - 40 mL) were injected daily via needle and syringe over 20 weeks in 4 groups of rats: 4.25% standard clinical solution (LAC), LAC plus pyridoxamine (PYR), LAC plus ethyl pyruvate (EP), and a biocompatible 4% dextrose solution (BIC). Two groups received catheters: a non-injected 4-week catheter group (C4) and a group injected for 20 weeks with the BIC solution (CI). Control animals (CON) were not injected. In the C4 group, adherent cells were separated from the catheter and examined by culture and electron microscopy to ensure that animals were bacteria free prior to exposure to solution. Animals underwent transport experiments to determine mass transfer coefficients of mannitol (MTC(M)) and albumin (MTC(A)), osmotic filtration flux (J(osm)), and hydrostatic pressure-driven flux (J(p)). After euthanasia, tissues were examined for submesothelial thickness, vascular density, and immunohistochemistry for various cytokines.
The catheter cell layer was free of bacteria and consisted of macrophages, lymphocytes, mesothelial cells, and fibroblastic cells. Marked differences in angiogenesis and submesothelial thickening were noted for the catheter groups. Transport differences were mixed: MTC(M) was significantly less for the CI group and MTC(A) was variable among the groups. There were no differences among groups for J(osm) or J(p). Inflammatory markers in the catheter-adherent cells correlated with inflammatory changes in the tissue. These data demonstrate significant changes in submesothelial thickness, angiogenesis, transport function, and inflammatory markers between animals injected with sterile solutions over 20 weeks with and without catheters.
An indwelling catheter amplifies peritoneal inflammation from dialysis solutions through a foreign body reaction. Our data also suggest that additives to existing solutions may have limited the effect on inflammatory response to non-biocompatible solutions.
我们假设，在接受高渗溶液的大鼠中，无菌溶液和对腹膜透析导管的异物反应均与炎症变化有关。
在 4 组大鼠中，通过针和注射器每天注射 4.25%标准临床溶液（LAC）、LAC 加吡哆胺（PYR）、LAC 加乙基丙酮酸（EP）和生物相容的 4%葡萄糖溶液（BIC）40 毫升，共 20 周：4 组大鼠分别为：标准临床溶液（LAC）、LAC+吡哆胺（PYR）、LAC+乙基丙酮酸（EP）和生物相容的 4%葡萄糖溶液（BIC）。两组接受导管：非注射 4 周导管组（C4）和注射 20 周 BIC 溶液组（CI）。对照组（CON）未注射。在 C4 组中，从导管上分离出黏附细胞，通过培养和电子显微镜检查，以确保动物在暴露于溶液之前无细菌。动物进行转运实验，以确定甘露醇（MTC（M））和白蛋白（MTC（A））的质量转移系数、渗透过滤通量（J（osm））和静水压力驱动通量（J（p））。安乐死后，检查组织的亚膜下厚度、血管密度和各种细胞因子的免疫组织化学。
导管细胞层无细菌，由巨噬细胞、淋巴细胞、间皮细胞和成纤维细胞组成。导管组的血管生成和亚膜下增厚有明显差异。转运差异混杂：CI 组 MTC（M）显著降低，而 MTC（A）在各组之间变化。各组间 J（osm）或 J（p）无差异。导管黏附细胞中的炎症标志物与组织中的炎症变化相关。这些数据表明，在接受 20 周无菌溶液注射且伴有或不伴有导管的大鼠中，亚膜下厚度、血管生成、转运功能和炎症标志物均有显著变化。
留置导管通过异物反应放大透析液引起的腹膜炎症。我们的数据还表明，现有溶液的添加剂可能限制了对非生物相容溶液炎症反应的影响。
