Division of Nephrology, Department of Medicine, Academic Medical Centre Meibergdreef 9, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands.
Nat Rev Nephrol. 2013 Jul;9(7):419-29. doi: 10.1038/nrneph.2013.99. Epub 2013 May 14.
Long-term peritoneal dialysis can lead to morphological and functional changes in the peritoneum. Although the range of morphological alterations is known for the peritoneal dialysis population as a whole, these changes will not occur in every patient in the same sequence and to the same extent. Longitudinal studies are therefore required to help identify which patients might develop the changes. Although longitudinal studies using peritoneal biopsies are not possible, analyses of peritoneal effluent biomarkers that represent morphological alterations could provide insight. Longitudinal studies on peritoneal transport have been performed, but follow-up has often been too short and an insufficient number of parameters have been investigated. This Review will firstly describe peritoneal morphology and structure and will then focus on peritoneal effluent biomarkers and their changes over time. Net ultrafiltration will also be discussed together with the transport of small solutes. Data on the peritoneal transport of serum proteins show that serum protein levels do not increase to the same extent as levels of small solutes with long-term peritoneal dialysis. Early alterations in peritoneal transport must be distinguished from alterations that only develop with long-term peritoneal dialysis. Early alterations are related to vasoactive mediators, whereas later alterations are related to neoangiogenesis and fibrosis. Modern peritoneal dialysis should focus on the early detection of long-term membrane alterations by biomarkers--such as cancer antigen 125, interleukin-6 and plasminogen activator inhibitor 1--and the improved assessment of peritoneal transport.
长期腹膜透析可导致腹膜形态和功能发生改变。尽管人们已经了解了整个腹膜透析人群的形态改变范围，但这些改变不会以相同的顺序和相同的程度发生在每个患者身上。因此，需要进行纵向研究来帮助确定哪些患者可能会发生这些改变。尽管使用腹膜活检进行纵向研究是不可能的，但对代表形态改变的腹膜流出物生物标志物的分析可以提供深入的了解。已经对腹膜转运进行了纵向研究，但随访时间往往太短，且研究的参数数量也不足。这篇综述首先将描述腹膜的形态和结构，然后重点介绍腹膜流出物生物标志物及其随时间的变化。还将讨论净超滤和小分子溶质的转运。关于血清蛋白在腹膜中的转运的数据表明，随着长期腹膜透析的进行，血清蛋白水平的增加并不像小分子溶质那样显著。必须区分早期腹膜转运的改变与仅在长期腹膜透析时才出现的改变。早期改变与血管活性介质有关，而晚期改变与新生血管形成和纤维化有关。现代腹膜透析应通过生物标志物（如癌抗原 125、白细胞介素 6 和纤溶酶原激活物抑制剂 1）来早期检测长期膜改变，并改进对腹膜转运的评估。
