Renal Department, Affiliated Beijing Friendship Hospital, Nephrology Faculty, Capital Medical University, Beijing, PR China.
Ren Fail. 2012;34(5):582-9. doi: 10.3109/0886022X.2012.669322.
Peritoneal transport status is important not only for prescription, but also as a prognostic index. Flt-1 and Flk-1, the major vascular endothelial growth factor receptors involved in angiogenesis and hyperpermeability, may play a potent role in determining peritoneal transport characteristics. However, the relationship between them has not been studied to date. We hypothesized that Flt-1 and Flk-1 expression in the peritoneal vasculature of uremic patients could be closely related to baseline peritoneal transport status.
Thirty-six new patients without a previous history of peritonitis were enrolled. Clinical parameters such as age, sex, height, weight, causes of renal failure, and residual renal function were assessed. Parietal peritoneal biopsies were obtained during implantation of peritoneal dialytic catheters. Flt-1 and Flk-1 were semi-quantitatively evaluated by immunohistochemical staining. Peritoneal microvascular density (MVD) was counted. Within 6 weeks after commencing peritoneal dialysis, a standard peritoneal equilibration test was performed, and the dialysate-to-plasma concentration ratio for creatinine at 4 h (D4/P Cr) was determined. The patients were divided into two groups based on the D4/P Cr: more than 0.65 (Group H, n = 22) and less than or equal to 0.65 (Group L, n = 14). The 24-h peritoneal protein excretion (PPE) was assayed. Flt-1 and Flk-1 were correlated with peritoneal MVD, D4/P Cr, and PPE.
Flt-1 and Flk-1 were detected in the peritoneal vasculature of uremic patients. Flt-1 expression was similar between the two groups, but Flk-1 expression in Group H was significantly higher than that in Group L (p = 0.001). Flt-1 expression did not show significant correlations with peritoneal MVD, D4/P Cr, and PPE. However, Flk-1 expression showed significant correlations with the above three parameters (p < 0.001 for all).
For the first time, the expressions of Flt-1 and Flk-1 in peritoneal vasculature of uremic patients were detected. Flk-1 expression in peritoneal vasculature of uremic patients is closely correlated with the number of peritoneal microvessels, peritoneal small solute transport rate, and PPE. Our findings strongly suggest that Flk-1 may be a crucial determinant of baseline peritoneal transport characteristics. Further interventional studies are needed.
腹膜转运状态不仅对处方很重要，而且也是预后指标。Flt-1 和 Flk-1 是血管内皮生长因子受体的主要成员，参与血管生成和高通透性，可能在确定腹膜转运特征方面发挥重要作用。然而，目前尚未研究它们之间的关系。我们假设尿毒症患者腹膜血管中的 Flt-1 和 Flk-1 表达可能与基线腹膜转运状态密切相关。
纳入 36 例无腹膜炎既往史的新患者。评估临床参数，如年龄、性别、身高、体重、肾衰竭原因和残余肾功能。在腹膜透析导管植入过程中获取壁腹膜活检。通过免疫组织化学染色半定量评估 Flt-1 和 Flk-1。计算腹膜微血管密度（MVD）。开始腹膜透析后 6 周内进行标准腹膜平衡试验，测定 4 小时时透析液与血浆肌酐浓度比（D4/P Cr）。根据 D4/P Cr 将患者分为两组：大于 0.65（组 H，n = 22）和等于或小于 0.65（组 L，n = 14）。测定 24 小时腹膜蛋白排泄量（PPE）。Flt-1 和 Flk-1 与腹膜 MVD、D4/P Cr 和 PPE 相关。
在尿毒症患者的腹膜血管中检测到 Flt-1 和 Flk-1。两组之间 Flt-1 表达相似，但组 H 的 Flk-1 表达明显高于组 L（p = 0.001）。Flt-1 表达与腹膜 MVD、D4/P Cr 和 PPE 无显著相关性。然而，Flk-1 表达与上述三个参数均有显著相关性（p < 0.001）。
首次检测到尿毒症患者腹膜血管中 Flt-1 和 Flk-1 的表达。尿毒症患者腹膜血管中 Flk-1 的表达与腹膜微血管数量、腹膜小分子转运率和 PPE 密切相关。我们的研究结果强烈表明 Flk-1 可能是基线腹膜转运特征的重要决定因素。需要进一步的干预研究。
