两合一体方案：同时定量小孔径和超小孔径腹膜转运。
Two-in-one protocol: simultaneous small-pore and ultrasmall-pore peritoneal transport quantification.
机构信息
Nephrology Department, Centro Hospitalar do Porto, Hospital de Santo António, and ICBAS/UP, Porto, Portugal.
出版信息
Perit Dial Int. 2012 Sep-Oct;32(5):537-44. doi: 10.3747/pdi.2011.00175. Epub 2012 Mar 1.
BACKGROUND
Reduced free water transport (FWT) through ultrasmall pores contributes to net ultrafiltration failure (UFF) and should be seen as a sign of more severe functional deterioration of the peritoneal membrane. The modified peritoneal equilibration test (PET), measuring the dip in dialysate Na concentration, estimates only FWT. Our aim was to simultaneously quantify small-solute transport, FWT, and small-pore ultrafiltration (SPUF) during a single PET procedure.
METHODS
We performed a 4-hour, 3.86% glucose PET, with additional measurement of ultrafiltration (UF) at 60 minutes, in 70 peritoneal dialysis patients (mean age: 50 ± 16 years; 61% women; PD vintage: 26 ± 23 months). We calculated the dialysate-to-plasma ratios (D/P) of creatinine and Na at 0 and 60 minutes, and the Na dip (Dip(D/PNa60')), the delta dialysate Na 0-60 (ΔDNa(0-60)), FWT, and SPUF.
RESULTS
Sodium sieving (as measured by ΔDNa(0-60)) correlated strongly with the corrected Dip(D/PNa60') (r = 0.85, p < 0.0001) and the corrected FWT (r = 0.41, p = 0.005). Total UF showed better correlation with FWT than with indirect measurements of Na sieving (r = 0.46, p < 0.0001 for FWT; r = 0.360, p < 0.0001 for Dip(D/PNa60')). Corrected FWT fraction was 0.45 ± 0.16. A negative correlation was found between time on PD and both total UF and FWT (r = -0.253, p = 0.035 and r = -0.272, p = 0.023 respectively). The 11 patients (15.7%) diagnosed with UFF had lower FWT (89 mL vs 164 mL, p < 0.05) and higher D/P creatinine (0.75 vs 0.70, p < 0.05) than did the group with normal UF. The SPUF correlated positively with FWT in the normal UF group, but negatively in UFF patients (r = -0.709, p = 0.015). Among UFF patients on PD for a longer period, 44.4% had a FWT percentage below 45%.
CONCLUSIONS
Measurement of FWT and SPUF is feasible by simultaneous quantification during a modified 3.86% glucose PET, and FWT is a decisive parameter for detecting causes of UFF in addition to increased effective capillary surface.
背景
通过超小孔减少游离水转运（FWT）导致净超滤失败（UFF），应被视为腹膜功能恶化更严重的标志。改良腹膜平衡试验（PET）通过测量透析液中 Na 浓度的下降来估计仅 FWT。我们的目的是在单次 PET 过程中同时定量测定小分子转运、FWT 和小孔隙超滤（SPUF）。
方法
我们对 70 例腹膜透析患者（平均年龄：50±16 岁；61%为女性；PD 病程：26±23 个月）进行了 4 小时 3.86%葡萄糖 PET，在 60 分钟时额外测量超滤（UF）。我们计算了 0 分钟和 60 分钟时肌酐和 Na 的透析液与血浆比值（D/P），以及 Na 下降（Dip(D/PNa60')）、透析液中 Na 的 0-60 差值（ΔDNa(0-60)）、FWT 和 SPUF。
结果
钠筛（以 ΔDNa(0-60)测量）与校正后的 Dip(D/PNa60')（r=0.85，p<0.0001）和校正后的 FWT（r=0.41，p=0.005）高度相关。总 UF 与 FWT 的相关性优于与间接测量的 Na 筛（r=0.46，p<0.0001 为 FWT；r=0.360，p<0.0001 为 Dip(D/PNa60'))。校正后的 FWT 分数为 0.45±0.16。PD 时间与总 UF 和 FWT 呈负相关（r=-0.253，p=0.035 和 r=-0.272，p=0.023）。11 例（15.7%）UFF 患者的 FWT（89 mL 比 164 mL，p<0.05）和肌酐 D/P（0.75 比 0.70，p<0.05）均低于 UF 正常组。在 UF 正常组中，SPUF 与 FWT 呈正相关，而在 UFF 患者中呈负相关（r=-0.709，p=0.015）。在 PD 时间较长的 UFF 患者中，44.4%的患者 FWT 百分比低于 45%。
结论
通过改良 3.86%葡萄糖 PET 同时定量测定，可以实现 FWT 和 SPUF 的测定，FWT 是除增加有效毛细血管表面积外，检测 UFF 原因的决定性参数。
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